title: Radiologist agreement for mammographic recall by case difficulty and finding type.
abstract: OBJECTIVE
  The aim of this study was to assess agreement of mammographic interpretations by community radiologists with consensus interpretations of an expert radiology panel to inform approaches that improve mammographic performance.
  
  
  METHODS
  From 6 mammographic registries, 119 community-based radiologists were recruited to assess 1 of 4 randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type (mass, calcifications, asymmetric density, or architectural distortion) and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the patient, breast, and lesion level. Concordance in finding type between study radiologists and the expert panel was also examined. For each finding type, the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls, was determined.
  
  
  RESULTS
  Recall agreement was 100% for masses and for examinations with obvious findings in both cancer and noncancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle noncancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities.
  
  
  CONCLUSIONS
  Agreement in mammographic interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve the accuracy of mammography and reduce unnecessary recalls.
authors.affiliation: Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03756, USA. tracy.l.onega@dartmouth.edu
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Megan
authors.initials: M
authors.lastname: Smith
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Berta A
authors.initials: BA
authors.lastname: Geller
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Robert D
authors.initials: RD
authors.lastname: Rosenberg
authors.forename: Robert A
authors.initials: RA
authors.lastname: Smith
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.forename: Bonnie
authors.initials: B
authors.lastname: Yankaskas
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D015588:Observer Variation; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology