Mammographic Interpretive Volume and Diagnostic Mammogram Interpretation Performance in Community Practice

Haneuse, Sebastien; Buist, Diana S.M.; Miglioretti, Diana L.; Anderson, Melissa L.; Carney, Patricia A.; Onega, Tracy; Geller, Berta M.; Kerlikowske, Karla; Rosenberg, Robert D.; Yankaskas, Bonnie C.; Elmore, Joann G.; Taplin, Stephen H.; Smith, Robert A.; Sickles, Edward A.

doi:10.1148/radiol.11111026

Cited by 26 publications

(35 citation statements)

References 22 publications

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“…Contrary to the hypothesis suggested by the Institute of Medicine report that a higher interpretive volume would improve mammography performance, a study of a sample of U.S. radiologists found that volume did not explain much of the observed interradiologist variability in screening or diagnostic performance (4,5). The FPRs of radiologists with higher annual volumes were clinically and significantly lower than those of their lower-volume colleagues; however, the sensitivities were similar (4,5).…”

Section: Subjectsmentioning

confidence: 70%

“…The FPRs of radiologists with higher annual volumes were clinically and significantly lower than those of their lower-volume colleagues; however, the sensitivities were similar (4,5). Interpretive volume composition (ratio of screening volume relative to total volume) had the strongest influence on screening and diagnostic performance; a higher screening focus (ratio of screening to diagnostic mammograms) was associated with significantly lower screening sensitivity, cancer detection rate (CDR), and FPR (4,5), which suggests that having some element of diagnostic work-up could increase sensitivity and CDR. To our knowledge, only one study has examined whether radiologists' accuracy (defined as positive predictive value for biopsy recommendation) was influenced by monitoring a woman's images throughout the diagnostic process and found no significant influence (6).…”

Section: Subjectsmentioning

confidence: 80%

“…To address these gaps between observed and optimal screening accuracy (1), previous studies examined the relationship between interpretive volume and screening and diagnostic performance (4,5).…”

Section: Subjectsmentioning

confidence: 99%

“…This study included data from six BCSC mammography registries (in California, North Carolina, New Hampshire, Vermont, Washington, and New Mexico). Because planned analysis required complete capture of all screening and diagnostic images for each radiologist, we limited our sample to radiologists who interpreted mammograms only in BCSC facilities (436 reader-years, 106 radiologists) (4,5). Eligible radiologists from the six registries who interpreted screening mammograms from 2005 to 2006 were invited to complete a self-administered mailed survey between January 1, 2006, and September 30, 2007 (10), and survey information was linked to BCSC data.…”

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confidence: 99%

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Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Buist¹,

Anderson²,

Smith³

et al. 2014

Radiology

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Purpose:To examine radiologists' screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. Materials andMethods:In an institutional review board-approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [FPR], and cancer detection rate [CDR]). Logistic regression was used to assess the association between the volume of recalled screening mammograms ("own" mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and "any" mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Results:Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0-50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0-50 mammograms, 32% performed the work-up for 51-125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist workups for their own recalled mammograms, the sensitivity (P = .039), FPR (P = .004), and CDR (P , .001) of screening mammography increased, yielding a stepped increase in women recalled per cancer detected from 17.4 for 25 or fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant increases in FPR (P = .011) and CDR (P = .001) and a nonsignificant increase in sensitivity (P = .15). Radiologists with a lower annual volume of any work-ups had consistently lower FPR, sensitivity, and CDR at all annual interpretive volumes. Conclusion:These findings support the hypothesis that radiologists may improve their screening performance by performing the diagnostic work-up for their own recalled screening mammograms and directly receiving feedback afforded by means of the outcomes associated with their initial decision to recall. Arranging for radiologists to work up a minimum number of their own recalled cases could improve screening performance but would need systems to facilitate this workflow.q RSNA, 2014

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Section: Subjectsmentioning

confidence: 70%

Section: Subjectsmentioning

confidence: 80%

Section: Subjectsmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Buist¹,

Anderson²,

Smith³

et al. 2014

Radiology

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“…Because of the fact that the evaluating specialist has long experience in BI-RADS for breast radiology, we believe in the accuracy of the categorical decisions made (34). As a matter of fact, the studies performed have shown that factors influencing correct decision-making in BI-RADS include the experience of radiologist, his/her interest in dense breast radiology and the high number of studies s/he evaluates on an annual basis (35)(36)(37).…”

Section: Discussionmentioning

confidence: 99%

How Many of the Biopsy Decisions Taken at Inexperienced Breast Radiology Units Were Correct?

2017

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Objective: In this study, we aimed to determine the need for biopsy in patients referred from other clinics for the performance of biopsy with the suspicion of breast cancer. Materials and Methods:112 patients were included in the study. It was decided that their biopsies be performed following examinations in other clinics and they presented to the breast radiology unit of our hospital for a second opinion. The demographic characteristics, diagnostic studies completed in the other centers, properties of lesions, decision made as a result of examinations and BI-RADS (Breast Imaging Reporting and Data Systems) categorizations were recorded on the registration forms of the study patients. In addition, the quality of examinations, reasons of repeat tests, additional tests features and the last decision of our clinic were documented. The obtained data were analyzed in terms of re-examination, additional tests and change in the biopsy decision. Changes in the biopsy decisions for patients were specifically inquired. Results:The biopsy decisions were cancelled in our breast radiology unit for 63 out of 112 patients (56.3%) whose biopsy decisions were made at an external institute. For 42 patients, examinations made by the other clinics were deemed adequate, yet there was no need for biopsy in 22 of them. The biopsy decisions were cancelled for 27 out of 47 patients (57.4%) with repeat examination and 18 out of 28 patients (64.3%) with additional tests because of the insufficient test quality. Conclusion:Incorrect, inadequate breast screening and false positivity were higher at inexperienced institutes.

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Evaluating the effects of rater and subject factors on measures of association

2018

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Large-scale agreement studies are becoming increasingly common in medical settings to gain better insight into discrepancies often observed between experts' classifications. Ordered categorical scales are routinely used to classify subjects' disease and health conditions. Summary measures such as Cohen's weighted kappa are popular approaches for reporting levels of association for pairs of raters' ordinal classifications. However, in large-scale studies with many raters, assessing levels of association can be challenging due to dependencies between many raters each grading the same sample of subjects' results and the ordinal nature of the ratings. Further complexities arise when the focus of a study is to examine the impact of rater and subject characteristics on levels of association. In this paper, we describe a flexible approach based upon the class of generalized linear mixed models to assess the influence of rater and subject factors on association between many raters' ordinal classifications. We propose novel model-based measures for large-scale studies to provide simple summaries of association similar to Cohen's weighted kappa while avoiding prevalence and marginal distribution issues that Cohen's weighted kappa is susceptible to. The proposed summary measures can be used to compare association between subgroups of subjects or raters. We demonstrate the use of hypothesis tests to formally determine if rater and subject factors have a significant influence on association, and describe approaches for evaluating the goodness-of-fit of the proposed model. The performance of the proposed approach is explored through extensive simulation studies and is applied to a recent large-scale cancer breast cancer screening study.

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Mammographic Interpretive Volume and Diagnostic Mammogram Interpretation Performance in Community Practice

Cited by 26 publications

References 22 publications

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

How Many of the Biopsy Decisions Taken at Inexperienced Breast Radiology Units Were Correct?

Evaluating the effects of rater and subject factors on measures of association

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