Is confidence of mammographic assessment a good predictor of accuracy?
OBJECTIVE
Interpretive accuracy varies among radiologists, especially in mammography. This study examines the relationship between radiologists' confidence in their assessments and their accuracy in interpreting mammograms.


METHODS
In this study, 119 community radiologists interpreted 109 expert-defined screening mammography examinations in test sets and rated their confidence in their assessment for each case. They also provided a global assessment of their ability to interpret mammograms. Positive predictive value (PPV) and negative predictive value (NPV) were modeled as functions of self-rated confidence on each examination using log-linear regression estimated with generalized estimating equations. Reference measures were cancer status and expert-defined need for recall. Effect modification by weekly mammography volume was examined.


RESULTS
Radiologists who self-reported higher global interpretive ability tended to interpret more mammograms per week (p = 0.08), were more likely to specialize (p = 0.02) and to have completed a fellowship in breast or women's imaging (p = 0.05), and had a higher PPV for cancer detection (p = 0.01). Examinations for which low-volume radiologists were "very confident" had a PPV of 2.93 times (95% CI, 2.01-4.27) higher than examinations they rated with neutral confidence. Trends of increasing NPVs with increasing confidence were significant for low-volume radiologists relative to noncancers (p = 0.01) and expert nonrecalls (p < 0.001). A trend of significantly increasing NPVs existed for high-volume radiologists relative to expert nonrecall (p = 0.02) but not relative to noncancer status (p = 0.32).


CONCLUSIONS
Confidence in mammography assessments was associated with better accuracy, especially for low-volume readers. Asking for a second opinion when confidence in an assessment is low may increase accuracy.
Department of Family Medicine, University of Vermont, 1 S Prospect St, Burlington, VT 05401-3444, USA. berta.geller@uvm.edu
Berta M
BM
Geller
Andy
A
Bogart
Patricia A
PA
Carney
Joann G
JG
Elmore
Barbara S
BS
Monsees
Diana L
DL
Miglioretti
D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography / Q000592:standards*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011871:Radiology / Q000706:statistics & numerical data*; D012015:Reference Standards; D015203:Reproducibility of Results; D013647:Task Performance and Analysis