Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation-training for mammogram-readers: a multicentre study assessing diagnostic performance, using an enriched dataset

Abstract

Background: Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram-readers to learn to effectively interpret abMRI. The purpose of this study was to examine the diagnostic accuracy of mammogram-readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram-readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2).Methods: Mammogram-readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first-post-contrast-subtracted-images (FAST MRI), displayed as maximum-intensity-projection (MIP) and subtracted slice-stack), was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset.Results: 37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% Confidence Interval (CI) 84-87%; 1776/2072) and specificity, 86% (95%CI 85-86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86-91%) and higher specificity (2957/3298; 90%; 95%CI 89-91%) than Group 2 (sensitivity = 83%; 95%CI 81-85% (933/1120) p<0.0001; specificity = 82%; 95%CI 81-83% (3183/3880) p<0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68-0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45-0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p=0.02) but not for Group 1 (90% to 89% p=0.44); whereas sensitivity remained consistent for both Group 1 (88% to 89%) and Group 2 (83% to 84%).Conclusions: Single day abMRI interpretation-training for mammogram-readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram-readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting additional training could further narrow this performance gap.

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