title: The contribution of work-up or additional views to the accuracy of diagnostic mammography.
abstract: This study examines the influence of work-up on the accuracy of diagnostic mammography in symptomatic women. Subjects were sampled from all women consecutively attending a symptomatic breast clinic and aged 25-55 years (240 women shown to have breast cancer and 240 age-matched women shown not to have cancer). Mammography films were prospectively reported by two radiologists independently of each other and in a blinded manner using two phases of film reading: initially only baseline films were read, then mammography was re-read with work-up films. The accuracy of reporting mammography with and without work-up was compared using sensitivity and specificity, likelihood ratios, and receiver operating characteristic (ROC) curves. Reporting the mammogram with work-up (compared to without any work-up films) improved sensitivity (75.3% vs 69.0%, P=0.059) for one radiologist, with a non-significant gain in specificity (84.5% vs 79.4%, P=0.38). For the other radiologist, it resulted in a non-significant decrease in sensitivity (79.5% vs 83.7%, P=0.14) with a significant increase in specificity (85.6% vs 61.9%, P=0.00001). ROC curves for both radiologists showed that reporting mammography with work-up resulted in significant improvement (4.5% for R1, 6.8% for R2) in overall test accuracy. Our findings support the use of work-up mammography in the diagnostic setting.
authors.affiliation: Screening & Test Evaluation Program, School of Public Health, A27, University of Sydney, NSW 2006, Australia. nehmath@health.usyd.edu.au
authors.forename: N
authors.initials: N
authors.lastname: Houssami
authors.forename: L
authors.initials: L
authors.lastname: Irwig
authors.forename: J M
authors.initials: JM
authors.lastname: Simpson
authors.forename: M
authors.initials: M
authors.lastname: McKessar
authors.forename: S
authors.initials: S
authors.lastname: Blome
authors.forename: J
authors.initials: J
authors.lastname: Noakes
mesh_terms: D000328:Adult; D001315:Australia; D001943:Breast Neoplasms / Q000175:diagnosis*; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011336:Probability; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D012680:Sensitivity and Specificity