Variability in Radiologists' Interpretations of Mammograms

Elmore, Joann G.; Wells, Carolyn K.; Lee, Carol H.; Howard, Debra H.; Feinstein, Alvan R.

doi:10.1056/nejm199412013312206

Cited by 547 publications

(267 citation statements)

References 22 publications

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“…Therefore, the results closely approximate that expected in actual practice. Secondly, literature has shown that interobserver agreement for the BI-RADS assessment is only fair to moderate (Elmore et al, 1994;Beam et al, 1996;Kerlikowske et al, 1998 ;Redondo et al, 2012 ). To warrant consistent interpreting, the study was designed to exclude the factor of interobserver variation that all breast imaging were interpreted by the same experienced radiologist.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

Boonlikit¹

2013

Asian Pacific Journal of Cancer Prevention

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Section: Discussionmentioning

confidence: 99%

Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

Boonlikit¹

2013

Asian Pacific Journal of Cancer Prevention

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“…However, for screening mammography, radiologists' experience and annual volume have been studied. In general, radiologist training has been associated with increased performance, [12][13][14][15][16][17] but the literature is conflicting on the relationship between annual volume per radiologist and performance. Our study support findings from five studies showing volume to be of importance.…”

Section: Discussionmentioning

confidence: 99%

“…Radiologist training in general has been associated with increased performance. [12][13][14][15][16][17] Data on the relationship between volume read per radiologist and performance are, however, conflicting, 13,[18][19][20][21][22] whereas associations have been found between some other indicators of radiologists' experience and performance. [23][24][25] However, most studies focused on mammography screening, and no large community based study has evaluated the association between organisational factors and performance of diagnostic mammography.…”

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confidence: 99%

Performance of clinical mammography: A nationwide study from Denmark

Jensen

Vejborg

Severinsen

et al. 2006

Intl Journal of Cancer

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Clinical mammography is the key tool for breast cancer diagnosis, but little is known about the impact of the organisational set-up on the performance. We evaluated whether organisatorial factors influence the performance of clinical mammography. Clinical mammography data from all clinics in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine sensitivity, specificity and accuracy, the latter using a receiver-operating characteristics (ROC) analysis. In 96,534 clinical mammography examinations, sensitivity was 75% and specificity 99%. The presence of at least one high volumereading radiologist in the clinic increased accuracy (AUC 5 0.91 for <1,000 examinations/year and 0.92 for >2,000 examinations/ year, p 5 0.017). The examination volume per clinic showed no clear effect on performance, as accuracy was significantly higher in clinics with a medium number of examinations (AUC 5 0.93 for 2,000-4,000 examinations/year and 0.90 for >6,000 examinations/year, p 5 0.003). Accuracy was significantly lower in regions with high annual utilisation rate of clinical mammography, which means the proportion of examined women in a region (AUC 5 0.90 for 3.0-5.0% annual utilisation rate and AUC 5 0.93 for 2.0-2.5% annual utilisation rate, and p 5 0.001), indicating that clinical mammography worked best in patient populations of purely symptomatic women. Our data indicate that to increase the accuracy of clinical mammography at the community level, the presence of an experienced radiologist should be prioritised ahead of raising the clinic size. ' 2006 Wiley-Liss, Inc.Key words: mammography; breast cancer; organization; sensitivity; specificity; accuracy Diagnostic mammography is the most commonly used tool for diagnosing breast cancers in women with signs or symptoms of this disease. It is most often undertaken in combination with a clinical examination and supplemented with ultrasound or other imaging techniques. 1 In contrast to mammography screening, performance of diagnostic mammography has been examined only in a few studies. In addition, the majority of these studies are singleclinic studies covering small populations, 1-5 and only two studies have evaluated the performance of diagnostic mammography at the community level. 6,7 Performance of mammography is known to be influenced by factors related to woman characteristics, such as age, breast density, history of previous breast lesions and presence of symptoms. 6,[8][9][10][11] However, performance of mammography may also be related to the organisational setup, such as the type of clinic, the number of examinations undertaken and the experience of the radiologists. Radiologist training in general has been associated with increased performance. 12-17 Data on the relationship between volume read per radiologist and performan...

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“…They observed an average intraobserver variability of approximately 8% in addition to a 19% interobserver variability for the diagnosis of cancer, for which the variability in management recommendations was 25%. They also found that 9 out of 10 radiologists recognized fewer than 3% of the mammograms which they screened 5 months prior, while 1 out of 10 claimed to have recognized about 25% of the cases (5). These startling statistics and other discussions on computer-aided diagnosis (CAD) (6)(7)(8) clearly demonstrate the need for (and the possible magnitude of) improvements in the reliability of breast cancer diagnosis.…”

Section: Introductionmentioning

confidence: 96%

The Reliability Issue of Computer-Aided Breast Cancer Diagnosis

Kovalerchuk

Triantaphyllou

Ruiz

et al. 2000

Computers and Biomedical Research

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This paper introduces a number of reliability criteria for computer-aided diagnostic systems for breast cancer. These criteria are then used to analyze some published neural network systems. It is also shown that the property of monotonicity for the data is rather natural in this medical domain, and it has the potential to significantly improve the reliability of breast cancer diagnosis while maintaining a general representation power. A central part of this paper is devoted to the representation/narrow vicinity hypothesis, upon which existing computer-aided diagnostic methods heavily rely. The paper also develops a framework for determining the validity of this hypothesis. The same framework can be used to construct a diagnostic procedure with improved reliability. ᭧

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Variability in Radiologists' Interpretations of Mammograms

Cited by 547 publications

References 22 publications

Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

Performance of clinical mammography: A nationwide study from Denmark

The Reliability Issue of Computer-Aided Breast Cancer Diagnosis

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