title: Performance benchmarks for diagnostic mammography.
abstract: OBJECTIVE
  To evaluate a range of performance parameters pertinent to the comprehensive auditing of diagnostic mammography examinations, and to derive performance benchmarks therefrom, by pooling data collected from large numbers of patients and radiologists that are likely to be representative of mammography practice in the United States.
  
  
  METHODS
  Institutional review board approval was met, informed consent was not required, and this study was Health Insurance Portability and Accountability Act compliant. Six mammography registries contributed data to the Breast Cancer Surveillance Consortium (BCSC), providing patient demographic and clinical information, mammogram interpretation data, and biopsy results from defined population-based catchment areas. The study involved 151 mammography facilities and 646 interpreting radiologists. The study population included women 18 years of age or older who underwent at least one diagnostic mammography examination between 1996 and 2001. Collected data were used to derive mean performance parameter values, including abnormal interpretation rate, positive predictive value (for abnormal interpretation, biopsy recommended, and biopsy performed), cancer diagnosis rate, invasive cancer size, and the percentages of minimal cancers, axillary node-negative invasive cancers, and stage 0 and I cancers. Additional benchmarks were derived for these performance parameters, including 10th, 25th, 50th (median), 75th, and 90th percentile values.
  
  
  RESULTS
  The study involved 332,926 diagnostic mammography examinations. Mean performance parameter values were abnormal interpretation rate, 8.0%; positive predictive value for abnormal interpretation, 31.4%; positive predictive value for biopsy recommended, 31.5%; positive predictive value for biopsy performed, 39.5%; cancer diagnosis rate, 25.3 per 1000 examinations; invasive cancer size, 20.2 mm; percentage of minimal cancers, 42.0%; percentage of axillary node-negative invasive cancers, 73.6%; and percentage of stage 0 and I cancers, 62.4%.
  
  
  CONCLUSIONS
  The presented BCSC outcomes data and performance benchmarks may be used by mammography facilities and individual radiologists to evaluate their own performance for diagnostic mammography as determined by means of periodic comprehensive audits.
authors.affiliation: Department of Radiology, University of California San Francisco School of Medicine, 1600 Divisadero St, Rm H-2801, San Francisco, CA 94115, USA. edward.sickles@ucsfmedctr.org
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.forename: Jessica W T
authors.initials: JW
authors.lastname: Leung
authors.forename: Robert D
authors.initials: RD
authors.lastname: Rosenberg
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith-Bindman
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Yankaskas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D014481:United States