title: Benefits of the quality assured double and arbitration reading of mammograms in the early diagnosis of breast cancer in symptomatic women.
abstract: OBJECTIVE
  To address the benefits of double and arbitration reading regarding tumour detection rates, percentage of in situ tumours, and number (of patients) needed to send for expert reading (number needed to treat; NNT) for one additional tumour finding.
  
  
  METHODS
  QuaMaDi is a quality assured breast cancer diagnosis programme; with two-view mammography (craniocaudal, mediolateral oblique) and, in case of breast density ACR 3 or 4, routine ultrasound imaging; and with independent double reading of all images. A consecutive sample of symptomatic women, i.e. women at risk for breast cancer, women aged 70 and above, and/or women with preceding BI-RADS III findings, was analysed.
  
  
  RESULTS
  28,558 mammograms were performed (mean age of women: 57.3 [standard deviation: 12.3] years). Discordant findings were present in 3,837 double readings and were sent for arbitration reading. After histopathological assessment, 52 carcinomas were found (thereof 32% in situ). These carcinomas accounted for 1.8 tumours per 1,000 examinations in the total cohort and increased the tumour detection rate up to 16.4/1,000. The NNT in discordant cases was 74.
  
  
  CONCLUSIONS
  Double and arbitration reading appears to be a useful tool to ensure the quality of early detection of breast lesions in symptomatic women during indication-based, standardised mammography.
  
  
  CONCLUSIONS
  • Quality assured breast cancer diagnosis is feasible outside organised screening structures.                                                                              • Double and arbitration reading is beneficial for populations ineligible for screening.                                                                              • Double and arbitration reading increases the tumour detection rate.                                                                              • Double and arbitration reading increases the percentage of in situ cancers.
authors.affiliation: Institute of Clinical Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160 (Haus 50), 23538 Luebeck, Germany. Annika.Waldmann@uksh.de
authors.forename: Annika
authors.initials: A
authors.lastname: Waldmann
authors.forename: Smaragda
authors.initials: S
authors.lastname: Kapsimalakou
authors.forename: Alexander
authors.initials: A
authors.lastname: Katalinic
authors.forename: Isabell
authors.initials: I
authors.lastname: Grande-Nagel
authors.forename: Beate M
authors.initials: BM
authors.lastname: Stoeckelhuber
authors.forename: Dorothea
authors.initials: D
authors.lastname: Fischer
authors.forename: Joerg
authors.initials: J
authors.lastname: Barkhausen
authors.forename: Florian M
authors.initials: FM
authors.lastname: Vogt
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008327:Mammography / Q000592:standards* / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity
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