Measuring the accuracy of diagnostic imaging in symptomatic breast patients: team and individual performance

Abstract

Objective: The combination of mammography and/or ultrasound remains the mainstay in current breast cancer diagnosis. The aims of this study were to evaluate the reliability of standard breast imaging and individual radiologist performance and to explore ways that this can be improved. Methods: A total of 16 603 separate assessment episodes were undertaken on 13 958 patients referred to a specialist symptomatic breast clinic over a 6 year period. Each mammogram and ultrasound was reported prospectively using a five-point reporting scale and compared with final outcome. Results: Mammographic sensitivity, specificity and receiver operating curve (ROC) area were 66.6%, 99.7% and 0.83, respectively. The sensitivity of mammography improved dramatically from 47.6 to 86.7% with increasing age. Overall ultrasound sensitivity, specificity and ROC area was 82.0%, 99.3% and 0.91, respectively. The sensitivity of ultrasound also improved dramatically with increasing age from 66.7 to 97.1%. Breast density also had a profound effect on imaging performance, with mammographic sensitivity falling from 90.1 to 45.9% and ultrasound sensitivity reducing from 95.2 to 72.0% with increasing breast density. Conclusion: The sensitivity ranges widely between radiologists (53.1-74.1% for mammography and 67.1-87.0% for ultrasound). Reporting sensitivity was strongly correlated with radiologist experience. Those radiologists with less experience (and lower sensitivity) were relatively more likely to report a cancer as indeterminate/ uncertain. To improve radiology reporting performance, the sensitivity of cancer reporting should be closely monitored; there should be regular feedback from needle biopsy results and discussion of reporting classification with colleagues.

Evaluation of mammographic surveillance services in women aged 40–49 years with a moderate family history of breast cancer: a single-arm cohort study

“…The procedures associated with screen detection were directly observed in the cohort. Since we did not have information on negative symptomatic consultations, we used data from 16,603 symptomatic breast clinic visits reported by Britton et al 39 to estimate these. In the 16,603 symptomatic clinic visits, 1235 (7.4%) breast cancers were diagnosed, suggesting 13.44 visits for each cancer diagnosed.…”

“…In the 16,603 symptomatic clinic visits, 1235 (7.4%) breast cancers were diagnosed, suggesting 13.44 visits for each cancer diagnosed. This would imply 578 symptomatic clinic visits in the FH01 cohort, with the numbers of procedures incurred estimated from the proportions observed by Britton et al 39 We also used the Britton et al 39 data to estimate the diagnostic activity taking place in the notional comparison groups. With estimation strategy 1, we would expect 1935 clinic visits (13.44 × 144) and with strategy 2, 2097 (13.44 × 156).…”

“…With estimation strategy 1, we would expect 1935 clinic visits (13.44 × 144) and with strategy 2, 2097 (13.44 × 156). Corresponding expected numbers of procedures also calculated from the proportions in Britton et al 39 are shown in Table 15. Since the diagnostic activity took place in the twentyfirst century, the majority of percutaneous biopsies are likely to be core biopsies.…”

Mammographic Breast Density: Comparison Across Women with Conclusive and Inconclusive Mammography Reports

“…A major patient-related factor that impacts cancer detection with mammography is breast density (BD) [14]. Clinical breast examination and two-dimensional mammography are somewhat limited in dense breasts [16,17]. Radiographically, breast cancer and dense tissue have a similar appearance, and together with the heterogeneity of the breast parenchyma, reduce the ability of radiologists to detect cancer early [16,17].…”

“…Clinical breast examination and two-dimensional mammography are somewhat limited in dense breasts [16,17]. Radiographically, breast cancer and dense tissue have a similar appearance, and together with the heterogeneity of the breast parenchyma, reduce the ability of radiologists to detect cancer early [16,17]. In addition to masking effect (concealment of cancer in dense breasts) [17], high BD also accounts for about 50% of interval breast cancer and is associated with a fourfold to sixfold risk of breast cancer compared with fatty breast [18].…”