Differences in lesion interpretation between radiologists in two countries: Lessons from a digital breast tomosynthesis training test set

Li, Tong; Gandomkar, Ziba; Trieu, Phuong Dung; Lewis, Sarah; Brennan, Patrick C.

doi:10.1111/ajco.13686

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…DBT could remove the overlapping of breast tissues on breast abnormalities, 37 and this can potentially equalize sensitivity for breast cancer detection in high and low dense breasts. In regard to lesion types, Shanghai radiologists demonstrated a lower sensitivity compared with Australian radiologists in detecting non-mass lesions (e.g., calcifications, architectural distortion, and asymmetric density), which is to some extent aligned with our previous study 38 . In the previous work, our team examined the performance in a high breast density test set of radiologists in Hong Kong who had a different medical education and radiology reading/interpretation systems from those in mainland China; therefore its result may not be generalized to radiologists from mainland China (such as Shanghai in this study).…”

Section: Discussionsupporting

confidence: 88%

“…In regard to lesion types, Shanghai radiologists demonstrated a lower sensitivity compared with Australian radiologists in detecting non-mass lesions (e.g., calcifications, architectural distortion, and asymmetric density), which is to some extent aligned with our previous study. 38 In the previous work, our team examined the performance in a high breast density test set of radiologists in Hong Kong who had a different medical education and radiology reading/interpretation systems from those in mainland China; therefore its result may not be generalized to radiologists from mainland China (such as Shanghai in this study). Shanghai readers were further found to perform better in detecting large lesions (versus small lesions) compared with Australian readers.…”

Section: Discussionmentioning

confidence: 99%

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Variations of image interpretations of radiologists from different populations in mammography and tomosynthesis with different levels of breast density

Trieu

Xiao

et al. 2023

J. Med. Imag.

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.PurposeThis study aims to investigate the diagnostic performances of Australian and Shanghai-based Chinese radiologists in reading full-field digital mammogram (FFDM) and digital breast tomosynthesis (DBT) with different levels of breast density.ApproachEighty-two Australian radiologists interpreted a 60-case FFDM set, and 29 radiologists also reported a 35-case DBT set. Sixty Shanghai radiologists read the same FFDM set, and 32 radiologists read the DBT set. The diagnostic performances of Australian and Shanghai radiologists were assessed using truth data (cancer cases were biopsy proven) and compared overall in specificity, case sensitivity, lesion sensitivity, receiver operating characteristics (ROC) area under the curve, and jack-knife free-response receiver operating characteristics (JAFROC) figure of merit, and they were stratified by case characteristics using the Mann–Whitney U test. The Spearman rank test was used to explore the association between radiologists’ performances and their work experience in mammogram interpretation.ResultsThere were significantly higher performances of Australian radiologists compared with Shanghai radiologists in low breast density for case sensitivity, lesion sensitivity, ROC, and JAFROC in the FFDM set (P < 0.0001); in high breast density, Shanghai radiologists’ performances in lesion sensitivity and JAFROC were also lower than Australian radiologists (P < 0.0001). In the DBT test set, Australian radiologists performed better than Shanghai radiologists in cancer detection in both low and high breast density. The work experience of Australian radiologists was positively linked to their diagnostic performances, whereas this association was not statistically significant in Shanghai radiologists.ConclusionThere were significant variations in reading performances between Australian and Shanghai radiologists in FFDM and DBT across different levels of breast density, lesion types, and lesion sizes. An effective training initiative tailored to suit local readers is essential to enhancing the diagnostic accuracy of Shanghai radiologists.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Variations of image interpretations of radiologists from different populations in mammography and tomosynthesis with different levels of breast density

Trieu

Xiao

et al. 2023

J. Med. Imag.

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“…Thus, it may not necessarily be the volume of reading mammograms which impacts performance, but rather the type of cancer appearances they have been exposed to. A previous study identified that stellate masses and architectural distortion were the cancer appearances that Chinese radiologists found significantly more difficult to identify compared to Australian radiologists [22].…”

Section: Reading Volume and Experiencementioning

confidence: 94%

A comparative study of diagnostic performance and work experience of radiologists in three countries interpreting digital breast tomosynthesis

Gallagher

Trieu

Gandomkar

et al. 2023

Medical Imaging 2023: Image Perception, Observer Performance, and Technology Assessment

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The final stage in the medical imaging diagnostic system is the radiologist’s interpretation of the images, though research on the factors influencing performance in digital breast tomosynthesis (DBT) is inconclusive. This study seeks to understand the performance of radiologists in reading DBT images and the parameters impacting observer performance in three different countries. The study used a DBT mammogram test to compare the performance of radiologists from Australia, China and Iran in reading thirty-five DBT cases. A range of performance metrics including specificity, sensitivity, lesion sensitivity, ROC AUC and JAFROC FOM were generated for each radiologist upon the conclusion of the test set. The radiologists also provided demographic information relating to their experience in reading digital mammograms and DBT. Each country had a greater percentage of radiologists that have completed a breast imaging fellowship compared to those that have not. Australia had a greater percentage of radiologists that have completed training in DBT reading (Australia=88.2%), while China and Iran had a smaller percentage of radiologists that have not completed training in DBT reading (China=37%, Iran=40%). Significant differences were identified between the three countries in specificity (p=.001), lesion sensitivity (p=.016), ROC (p<.001) and JAFROC (p<.001). Australia had the highest mean value for all performance metrics, while China had the lowest mean value for all performance metrics. Australian radiologists have a moderate positive correlation between lesion sensitivity and the number of years reading DBT images (r=.513, p=.042). Iranian radiologists who read more than 20 DBT cases per week obtained significantly higher performance in lesion sensitivity 73.3% vs. 51.8%; p=.032) than the ones who read less than 20 DBT cases per week.

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“…This difference was not only reported in digital mammogram test sets but also found in DBT test sets. For example, in a recent study, it was found that the false positive and false negative rates of Chinese radiologists reading the DBT test set via the BEAST platform was 52% and 69% compared with 36% and 35% in Australian radiologists ( 77 ). This large difference in cancer detection accuracy might imply that a great number of cancer cases could be missed or incorrectly reported in the clinical practices among MIC and LIC countries, which could have harmful implications for treatment outcomes of patients.…”

Section: Breast Screening Reader Training Programs and Breastmentioning

confidence: 99%

“…In addition, BREAST studies reported findings based on performances of radiologists from different countries in reading mammograms with different level of breast density and the ability to detect various types of cancer appearances. The most challenging type of cancer lesions to detect on mammograms for LIC radiologists were small lesions such as stellate/spiculated masses along with architectural distortions (the missed rate was 55%-75%) ( 77 , 78 ), while discrete masses and asymmetric density (or non-specific density) were more likely to be missed (31%-37%) or rated as equivocal (47%-50%) by HIC radiologists ( 77 , 79 ). This is in line with findings from the PERFORMS program where well-defined masses and asymmetric density accounted for the highest percentage of incorrectly diagnosed cases (25%) among UK radiologists ( 70 ).…”

Section: Breast Screening Reader Training Programs and Breastmentioning

confidence: 99%

Look how far we have come: BREAST cancer detection education on the international stage

et al. 2023

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The development of screening mammography over 30 years has remarkedly reduced breast cancer–associated mortality by 20%-30% through detection of small cancer lesions at early stages. Yet breast screening programmes may function differently in each nation depending on the incidence rate, national legislation, local health infrastructure and training opportunities including feedback on performance. Mammography has been the frontline breast cancer screening tool for several decades; however, it is estimated that there are 15% to 35% of cancers missed on screening which are owing to perceptual and decision-making errors by radiologists and other readers. Furthermore, mammography screening is not available in all countries and the increased speed in the number of new breast cancer cases among less developed countries exceeds that of the developed world in recent decades. Studies conducted through the BreastScreen Reader Assessment Strategy (BREAST) training tools for breast screening readers have documented benchmarking and significant variation in diagnostic performances in screening mammogram test sets in different countries. The performance of the radiologists from less well-established breast screening countries such as China, Mongolia and Vietnam were significant lower in detecting early-stage cancers than radiologists from developed countries such as Australia, USA, Singapore, Italy. Differences in breast features and cancer presentations, discrepancies in the level of experiences in reading screening mammograms, the availability of high-quality national breast screening program and breast image interpretation training courses between developed and less developed countries are likely to have impact on the variation of readers’ performances. Hence dedicated education training programs with the ability to tailor to different reader cohorts and different population presentations are suggested to ameliorate challenges in exposure to a range of cancer cases and improve the interpretation skills of local radiologists. Findings from this review provide a good understanding of the radiologist’ performances and their improvement using the education interventions, primarily the BREAST program, which has been deployed in a large range of developing and developed countries in the last decade. Self-testing and immediate feedback loops have been shown to have important implications for benchmarking and improving the diagnostic accuracy in radiology worldwide for better breast cancer control.

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Differences in lesion interpretation between radiologists in two countries: Lessons from a digital breast tomosynthesis training test set

Cited by 7 publications

References 14 publications

Variations of image interpretations of radiologists from different populations in mammography and tomosynthesis with different levels of breast density

Variations of image interpretations of radiologists from different populations in mammography and tomosynthesis with different levels of breast density

A comparative study of diagnostic performance and work experience of radiologists in three countries interpreting digital breast tomosynthesis

Look how far we have come: BREAST cancer detection education on the international stage

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