Variability in interpretive performance at screening mammography and radiologists' characteristics associated with accuracy.
OBJECTIVE
To identify radiologists' characteristics associated with interpretive performance in screening mammography.


METHODS
The study was approved by institutional review boards of University of Washington (Seattle, Wash) and institutions at seven Breast Cancer Surveillance Consortium sites, informed consent was obtained, and procedures were HIPAA compliant. Radiologists who interpreted mammograms in seven U.S. regions completed a self-administered mailed survey; information on demographics, practice type, and experience in and perceptions of general radiology and breast imaging was collected. Survey data were linked to data on screening mammograms the radiologists interpreted between January 1, 1998, and December 31, 2005, and included patient risk factors, Breast Imaging Reporting and Data System assessment, and follow-up breast cancer data. The survey was returned by 71% (257 of 364) of radiologists; in 56% (205 of 364) of the eligible radiologists, complete data on screening mammograms during the study period were provided; these data were used in the final analysis. An evaluation of whether the radiologists' characteristics were associated with recall rate, false-positive rate, sensitivity, or positive predictive value of recall (PPV(1)) of the screening examinations was performed with logistic regression models that were adjusted for patients' characteristics and radiologist-specific random effects.


RESULTS
Study radiologists interpreted 1 036 155 screening mammograms; 4961 breast cancers were detected. Median percentages and interquartile ranges, respectively, were as follows: recall rate, 9.3% and 6.3%-13.2%; false-positive rate, 8.9% and 5.9%-12.8%; sensitivity, 83.8% and 74.5%-92.3%; and PPV(1), 4.0% and 2.6%-5.9%. Wide variability in sensitivity was noted, even among radiologists with similar false-positive rates. In adjusted regression models, female radiologists or fellowship-trained radiologists had significantly higher recall and false-positive rates (P < .05, all). Fellowship training in breast imaging was the only characteristic significantly associated with improved sensitivity (odds ratio, 2.32; 95% confidence interval: 1.42, 3.80; P < .001) and the overall accuracy parameter (odds ratio, 1.61; 95% confidence interval: 1.05, 2.45; P = .028).


CONCLUSIONS
Fellowship training in breast imaging may lead to improved cancer detection, but it is associated with higher false-positive rates.
Elmore
Joann G
JG
Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98104-2499, USA. jelmore@u.washington.edu
Jackson
Sara L
SL
Abraham
Linn
L
Miglioretti
Diana L
DL
Carney
Patricia A
PA
Geller
Berta M
BM
Yankaskas
Bonnie C
BC
Kerlikowske
Karla
K
Onega
Tracy
T
Rosenberg
Robert D
RD
Sickles
Edward A
EA
Buist
Diana S M
DS
D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005189:False Positive Reactions; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D015588:Observer Variation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011871:Radiology / Q000193:education*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States