title: National Performance Benchmarks for Modern Diagnostic Digital Mammography: Update from the Breast Cancer Surveillance Consortium.
abstract: Purpose To establish contemporary performance benchmarks for diagnostic digital mammography with use of recent data from the Breast Cancer Surveillance Consortium (BCSC). Materials and Methods Institutional review board approval was obtained for active or passive consenting processes or to obtain a waiver of consent to enroll participants, link data, and perform analyses. Data were obtained from six BCSC registries (418 radiologists, 92 radiology facilities). Mammogram indication and assessments were prospectively collected for women undergoing diagnostic digital mammography and linked with cancer diagnoses from state cancer registries. The study included 401 548 examinations conducted from 2007 to 2013 in 265 360 women. Results Overall diagnostic performance measures were as follows: cancer detection rate, 34.7 per 1000 (95% confidence interval [CI]: 34.1, 35.2); abnormal interpretation rate, 12.6% (95% CI: 12.5%, 12.7%); positive predictive value (PPV) of a biopsy recommendation (PPV2), 27.5% (95% CI: 27.1%, 27.9%); PPV of biopsies performed (PPV3), 30.4% (95% CI: 29.9%, 30.9%); false-negative rate, 4.8 per 1000 (95% CI: 4.6, 5.0); sensitivity, 87.8% (95% CI: 87.3%, 88.4%); and specificity, 90.5% (95% CI: 90.4%, 90.6%). Among cancers detected, 63.4% were stage 0 or 1 cancers, 45.6% were minimal cancers, the mean size of invasive cancers was 21.2 mm, and 69.6% of invasive cancers were node negative. Performance metrics varied widely across diagnostic indications, with cancer detection rate (64.5 per 1000) and abnormal interpretation rate (18.7%) highest for diagnostic mammograms obtained to evaluate a breast problem with a lump. Compared with performance during the screen-film mammography era, diagnostic digital performance showed increased abnormal interpretation and cancer detection rates and decreasing PPVs, with less than 70% of radiologists within acceptable ranges for PPV2and PPV3. Conclusion These performance measures can serve as national benchmarks that may help transform the marked variation in radiologists' diagnostic performance into targeted quality improvement efforts.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Robert F
authors.initials: RF
authors.lastname: Arao
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Louise M
authors.initials: LM
authors.lastname: Henderson
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Garth H
authors.initials: GH
authors.lastname: Rauscher
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Janie M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
authors.affiliation: From the Departments of Surgery, Radiology, and Biochemistry, University of Vermont Cancer Center, University of Vermont, 1 S Prospect St, UHC Room 4425, Burlington, VT 05401 (B.L.S.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, Calif (D.L.M.); Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC (L.M.H.); The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (T.O., A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, Calif (K.K.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (C.D.L.).
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity