Working own recalled cases may help rads improve mammography screening performance

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Radiologists who interpret more annual diagnostic mammograms that resulted from recall of screening mammograms they themselves interpreted had higher sensitivity and cancer detection rates, according to a study published online June 24 in Radiology.

Given the findings, radiologists might be able to improve screening performance by directly receiving feedback on their decision to recall by performing the diagnostic work-up on their own recalled screening exams, according to Diana S. M. Buist, PhD, MPH, of the Group Health Research Institute, part of the Group Health Cooperative in Seattle, and colleagues.

To examine screening performance in relation to the number of diagnostic work-ups performed by the same radiologist who initially discovered an abnormality, Buist and colleagues linked more than 650,000 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries.

“We expected that a higher volume of diagnostic work-ups for a radiologist who interpreted the screening mammogram would be associated with better screening performance because of the radiologist’s involvement throughout a case, possibly including interventional procedures,” wrote the authors.

Results showed that, annually, 38 percent of radiologists performed diagnostic work-up for 25 or fewer of their own recalled screening mammograms, while 39 percent performed work-up for more than 50.

As the number of work-ups for their own recalled mammograms increased, radiologists demonstrated higher sensitivity and cancer detection rate, but also a higher false-positive rate. Sensitivity for 0-25 mammograms was 81.1 percent compared with 87.0 percent for more than 50 mammograms, and the cancer detection rate jumped from 3.1 to 4.5 per 1,000 screening mammograms when comparing radiologists with higher annual diagnostic work-ups to those with lower numbers. The false-positive rate was 10.3 percent for those with more than 50 annual diagnostic mammograms, up from 6.7 percent for those with less than 25 annual diagnostic mammograms that resulted from their own screening recall.

As the number of work-ups for their own recalled mammograms increased for the radiologists, there was a stepped increase in women recalled per cancer detected from 17.5 for those with 25 or fewer mammograms to 24.6 for more than 50 mammograms, according to Buist and colleagues.

“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,” wrote the authors.