Radiologist characteristics associated with interpretive performance of diagnostic mammography.
BACKGROUND
Extensive variability has been noted in the interpretive performance of screening mammography; however, less is known about variability in diagnostic mammography performance.


METHODS
We examined the performance of 123 radiologists who interpreted 35895 diagnostic mammography examinations that were obtained to evaluate a breast problem from January 1, 1996, through December 31, 2003, at 72 facilities that contribute data to the Breast Cancer Surveillance Consortium. We modeled the influence of radiologist characteristics on the sensitivity and false-positive rate of diagnostic mammography, adjusting for patient characteristics by use of a Bayesian hierarchical logistic regression model.


RESULTS
The median sensitivity was 79% (range = 27%-100%) and the median false-positive rate was 4.3% (range = 0%-16%). Radiologists in academic medical centers, compared with other radiologists, had higher sensitivity (88%, 95% confidence interval [CI] = 77% to 94%, versus 76%, 95% CI = 72% to 79%; odds ratio [OR] = 5.41, 95% Bayesian posterior credible interval [BPCI] = 1.55 to 21.51) with a smaller increase in their false-positive rates (7.8%, 95% CI = 4.8% to 12.7%, versus 4.2%, 95% CI = 3.8% to 4.7%; OR = 1.73, 95% BPCI = 1.05 to 2.67) and a borderline statistically significant improvement in accuracy (OR = 3.01, 95% BPCI = 0.97 to 12.15). Radiologists spending 20% or more of their time on breast imaging had statistically significantly higher sensitivity than those spending less time on breast imaging (80%, 95% CI = 76% to 83%, versus 70%, 95% CI = 64% to 75%; OR = 1.60, 95% BPCI = 1.05 to 2.44) with non-statistically significant increased false-positive rates (4.6%, 95% CI = 4.0% to 5.3%, versus 3.9%, 95% CI = 3.3% to 4.6%; OR = 1.17, 95% BPCI = 0.92 to 1.51). More recent training in mammography and more experience performing breast biopsy examinations were associated with a decreased threshold for recalling patients, resulting in similar statistically significant increases in both sensitivity and false-positive rates.


CONCLUSIONS
We found considerable variation in the interpretive performance of diagnostic mammography across radiologists that was not explained by the characteristics of the patients whose mammograms were interpreted. This variability is concerning and likely affects many women with and without breast cancer.
Miglioretti
Diana L
DL
Group Health Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. miglioretti.d@ghc.org
Smith-Bindman
Rebecca
R
Abraham
Linn
L
Brenner
R James
RJ
Carney
Patricia A
PA
Bowles
Erin J Aiello
EJ
Buist
Diana S M
DS
Elmore
Joann G
JG
D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D015588:Observer Variation; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012680:Sensitivity and Specificity