title: Arbitration of discrepant BI-RADS 0 recalls by a third reader at screening mammography lowers recall rate but not the cancer detection rate and sensitivity at blinded and non-blinded double reading.
abstract: OBJECTIVE
  To evaluate the characteristics of low suspicion lesions (BI-RADS 0) at blinded and non-blinded double reading of screening mammograms and to determine the potential effect of arbitration of discrepant BI-RADS 0 recalls by a third reader on screening outcome.
  
  
  METHODS
  We included a series of 84,927 consecutive digital screening mammograms, double read in a blinded (43,184 screens) or non-blinded (41,743 screens) fashion, between July 2009 and July 2011. Discrepant readings were routinely recalled for further evaluation. During 2 years of follow-up, radiology, surgical and pathology reports were collected of all recalled women. Arbitration of discrepant BI-RADS 0 recalls (only one radiologist assigning a BI-RADS 0 score) was retrospectively performed by a third screening radiologist.
  
  
  RESULTS
  At blinded and non-blinded double reading, 32.0% and 32.5% of recalls were assigned BI-RADS 0 with a positive predictive value (PPV) of 7.2% and 6.8%, respectively. Compared to non-blinded double reading, BI-RADS 0 recalls at blinded double reading showed a higher discrepancy rate (9.0 versus 4.3 per 1000 screens, p < 0.001) and false positive recall rate (10.1 versus 8.4 per 1000 screens, p = 0.012). Arbitration of discrepant BI-RADS 0 recalls would have significantly lowered recall rate (from 3.4% to 2.8% at blinded double reading, p < 0.001, and from 2.8% to 2.5% at non-blinded double reading, p = 0.008), without a decrease in cancer detection rate (from 7.5‰ to 7.3‰, p = 0.751, and from 6.6‰ to 6.5‰, p = 0.832, respectively) and program sensitivity (from 83.2% to 81.2%, p = 0.453, and from 76.0% to 74.6%, p = 0.667, respectively). Arbitration would have significantly increased the PPV at blinded double reading (from 22.3% to 26.3%, p = 0.015).
  
  
  CONCLUSIONS
  We advise arbitration of discrepant BI-RADS 0 recalls, at (non-)blinded double reading of screening mammograms, to reduce recall rates and improve the PPV of recall at blinded double reading.
authors.affiliation: Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. Electronic address: elisabethgenevieve@hotmail.com.
authors.forename: E G
authors.initials: EG
authors.lastname: Klompenhouwer
authors.affiliation: Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors.forename: R J P
authors.initials: RJ
authors.lastname: Weber
authors.affiliation: Department of Research, Comprehensive Cancer Centre the Netherlands (IKNL), PO Box 231, 5600 AE Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ Nijmegen, The Netherlands; Department of Radiology, Biomechanical Engineering and Physics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: den Heeten
authors.affiliation: Department of Surgical Oncology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands.
authors.forename: L J A
authors.initials: LJ
authors.lastname: Strobbe
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: M J M
authors.initials: MJ
authors.lastname: Broeders
authors.affiliation: Department of Medical Oncology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: V C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
authors.affiliation: Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS Nijmegen, The Netherlands.
authors.forename: L E M
authors.initials: LE
authors.lastname: Duijm
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D017008:Negotiating; D015588:Observer Variation; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
keywords: Arbitration; Breast cancer; Breast imaging Reporting and Data System (BI-RADS); Double reading; Mammography; Mass screening