Screening, Diagnostic Mammograms Better By Same Radiologist

Radiologists who perform diagnostic work-ups for recalled screening work-ups may see an improvement in their screening performance, according to a study published in the journal Radiology.

Researchers from Washington, Oregon, California, Maryland, Vermont, North Carolina, and New Hampshire conducted a study to examine radiologists’ screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists.

The study included 651,671 screening mammograms that were read by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries between 2002 and 2006. Of interest were the sensitivity and false-positive rate (FPR) of screening mammography, and the cancer detection rate (CDR).

The researchers assessed associations between the volume of recalled screening mammograms where the same radiologist interpreted both the diagnostic and the screening images (their “own” mammograms), and diagnostic and screening images that may have been read by any radiologist (“any” mammograms). The screening performance and any associations between total annual volume and performance according to the volume of diagnostic work-up were also evaluated.

The results showed that for the radiologist who performed diagnostic work-up after screening:

• 38% performed the work-up for 25 or fewer of their own recalled screening

• 24% performed the work-up for 0 to 50 mammograms

• 39% performed the work-up for more than 50 mammograms

For the mammograms where any radiologist may have done the diagnostic work-up:

• 24% of radiologists performed the work-up for 0 to 50 mammograms

• 32% performed the work-up for 51 to 125 mammograms

• 44% performed the work-up for more than 125 mammograms

“With increasing numbers of radiologist work-ups for their own recalled mammograms, the sensitivity (P = .039), FPR (P = .004), and CDR (P < .001) of screening mammography increased, yielding a stepped increase in women recalled per cancer detected from 17.4 for 25 or fewer mammograms to 24.6 for more than 50 mammograms,” the authors wrote. “Increases in work-ups for any radiologist yielded significant increases in FPR (P = .011) and CDR (P = .001) and a nonsignificant increase in sensitivity (P = .15).”

The researchers also found that the radiologists with a lower annual volume of any work-ups had consistently lower FPR, sensitivity, and CDR at all annual interpretive volumes.

The researchers concluded that for radiologists to improve their mammography screening performance, they should work up a minimum of their own recalled cases.