Can Peer Review Contribute to Earlier Detection of Breast Cancer? A Quality Initiative to Learn from False-Negative Mammograms

Abstract

Although Mammography Quality Standards Act requires tracking true positives, tracking false negatives is not required. We describe a peer review process implemented at Lahey Clinic to identify false-negative mammograms. We defined a false-negative mammogram as one which was read as negative within 12 months of a cancer diagnosis, and in which two of three radiologists correctly identified the site of cancer. Reviewing radiologists were blinded to each other and to computer-aided design (CAD), but were aware that somewhere in the mammogram was cancer. 25/64, 983, or 0.038% were classified as misses. The false-negative rate of any one radiologist averaged <0.1% without outliers. Of the false negatives, 60% were in heterogeneously dense tissue, 72% were asymmetries or masses rather than calcifications, and 24% were correctly identified by CAD in two views. We use these data for quality assurance, educational purposes, and to help identify patterns of undetected cancers to aid in earlier and improved detection of breast cancers.

Can missed breast cancer be recognized by regular peer auditing on screening mammography?

“…13 As to the laser-printed images reread by three specialists in our review, 54% of the false negatives were interpreted as missed cancers, which is slightly higher than that in Siegal et al's series (39%). It may be due to more dense breasts tissue in our patients (77% vs. 60%).…”

“…reports of 70e72%. 13,14 Calcifications constitute the rest (27e30%) of the mammographically missed cancers. From the peer review process, we can identify any radiologists who may require additional training, and the mammographic features of the missed cancers can be used for later education.…”

Web-Based Mammography Audit Feedback

“…The BCSC does not have access to names of patients and cannot provide this information yet it is vitally important for radiologists to learn from the review false negative cases. (19) An important function of radiology information systems would be to produce these types of lists for radiologist review.…”

Image analysis in medical imaging: recent advances in selected examples

“…It can detect disease at an early stage when therapy or surgery is most effective. However, the interpretation of screening mammograms is a repetitive task involving subtle signs, and suffers from a high rate of false negatives (10%–30% [1, 2]), and false positives (10–20% [3, 4]). Computer-aided diagnosis (CAD) aims to increase the predictive value of the technique by pre-reading mammograms to indicate the locations of suspicious abnormalities and analyse their characteristics, as an aid to the radiologist.…”