title: Rates and causes of disagreement in interpretation of full-field digital mammography and film-screen mammography in a diagnostic setting.
abstract: OBJECTIVE
  This study was performed to determine the rates and causes of disagreements in interpretation between full-field digital mammography and film-screen mammography in a diagnostic setting.
  
  
  METHODS
  Patients undergoing diagnostic mammography were invited to participate in the digital mammography study. Three views, selected by the radiologist interpreting the film-screen mammography, were obtained in both film-screen mammography and digital mammography. Radiologists independently assigned a Breast Imaging Reporting and Data System (BI-RADS) category to the film-screen mammography and the digital mammography images. The BI-RADS categories were grouped into the general categories of agreement, partial agreement, or disagreement. A third and different radiologist reviewed all cases of disagreement, reached a decision as to management, and determined the primary cause of disagreement.
  
  
  RESULTS
  Six radiologists reviewed digital mammography and film-screen mammography diagnostic images in a total of 1147 breasts in 692 patients. Agreement between digital mammography and final film-screen mammography assessment was present in 937 breasts (82%), partial agreement in 159 (14%), and disagreement in 51 (4%), for a kappa value of 0.29. The primary causes of disagreement were differences in management approach of the radiologists (52%), information derived from sonography or additional film-screen mammograms (34%), and technical differences between the two mammographic techniques (10%).
  
  
  CONCLUSIONS
  Significant disagreement between film-screen mammography and digital mammography affecting follow-up management was present in only 4% of breasts. The most frequent cause of disagreement in interpretation was a difference in management approach between radiologists (interobserver variability). This source of variability was larger than that due to differences in lesion visibility between film-screen mammography and digital mammography.
authors: Radiology Department, Lynn Sage Comprehensive Breast Center, Northwestern University Medical School, Galter Pavilion, 13th Floor, 251 E. Huron St., Chicago, IL 60611-2923, USA.
authors: L A
authors: LA
authors: Venta
authors: R E
authors: RE
authors: Hendrick
authors: Y T
authors: YT
authors: Adler
authors: P
authors: P
authors: DeLeon
authors: P M
authors: PM
authors: Mengoni
authors: A M
authors: AM
authors: Scharl
authors: C E
authors: CE
authors: Comstock
authors: L
authors: L
authors: Hansen
authors: N
authors: N
authors: Kay
authors: A
authors: A
authors: Coveler
authors: G
authors: G
authors: Cutter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D012815:Signal Processing, Computer-Assisted; D014962:X-Ray Film