Identifying Minimally Acceptable Interpretive Performance Criteria for Screening Mammography

Carney, Patricia A.; Sickles, Edward A.; Monsees, Barbara; Bassett, Lawrence W.; Brenner, R. James; Feig, Stephen A.; Smith, Robert A.; Rosenberg, Robert D.; Bogart, T. Andrew; Browning, Sally A.; Barry, Jane W.; Kelly, Mary Margaret; Tran, Khai; Miglioretti, Diana L.

doi:10.1148/radiol.10091636

Cited by 99 publications

(71 citation statements)

References 13 publications

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“…To achieve higher sensitivity while lowering false-positive rates, further studies need to elucidate the interrelationships between training, experience, volume, and performance measures. Several requirements may need to be considered simultaneously, such as minimum volume in addition to combined minimum performance requirements ( 36 ). year, which makes it diffi cult to measure sensitivity accurately in this group ( 33 ).…”

Section: Breast Imaging: Infl Uence Of Annual Interpretive Volume On mentioning

confidence: 99%

Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States

et al. 2011

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Purpose:To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance. Materials and Methods:Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certifi cate of Confi dentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act. Results:Mean sensitivity was 85.2% (95% confi dence interval [CI]: 83.7%, 86.6%) and was signifi cantly lower for radiologists with a greater screening focus ( P = .023) but did not signifi cantly differ by total ( P = .47), screening ( P = .33), or diagnostic ( P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates signifi cantly higher for radiologists who had the lowest total ( P = .008) and screening ( P = .015) volumes. Radiologists with low diagnostic volume ( P = .004 and P = .008) and a greater screening focus ( P = .003 and P = .002) had signifi cantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume. Conclusion:Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements.

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Section: Breast Imaging: Infl Uence Of Annual Interpretive Volume On mentioning

confidence: 99%

Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States

et al. 2011

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“…Expert radiologists reviewed and signed consent forms and completed a brief survey of their demographic and practice characteristics at the 1-day meeting. Seven of the 11 expert radiologists participated in our previous study (12) in which we set criteria for low performance in interpreting screening mammography studies. Two radiologists were members of the BCSC, and none were in practice together.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Mammography: Identifying Minimally Acceptable Interpretive Performance Criteria

Carney¹,

Parikh²,

Sickles³

et al. 2013

Radiology

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Purpose:To develop criteria to identify thresholds for the minimally acceptable performance of physicians interpreting diagnostic mammography studies. Materials and Methods:In an institutional review board-approved HIPAA-compliant study, an Angoff approach was used to set criteria for identifying minimally acceptable interpretive performance for both workup after abnormal screening examinations and workup of a breast lump. Normative data from the Breast Cancer Surveillance Consortium (BCSC) was used to help the expert radiologist identify the impact of cut points. Simulations, also using data from the BCSC, were used to estimate the expected clinical impact from the recommended performance thresholds. Results:Final cut points for workup of abnormal screening examinations were as follows: sensitivity, less than 80%; specificity, less than 80% or greater than 95%; abnormal interpretation rate, less than 8% or greater than 25%; positive predictive value (PPV) of biopsy recommendation (PPV 2 ), less than 15% or greater than 40%; PPV of biopsy performed (PPV 3 ), less than 20% or greater than 45%; and cancer diagnosis rate, less than 20 per 1000 interpretations. Final cut points for workup of a breast lump were as follows: sensitivity, less than 85%; specificity, less than 83% or greater than 95%; abnormal interpretation rate, less than 10% or greater than 25%; PPV 2 , less than 25% or greater than 50%; PPV 3 , less than 30% or greater than 55%; and cancer diagnosis rate, less than 40 per 1000 interpretations. If underperforming physicians moved into the acceptable range after remedial training, the expected result would be (a) diagnosis of an additional 86 cancers per 100 000 women undergoing workup after screening examinations, with a reduction in the number of false-positive examinations by 1067 per 100 000 women undergoing this workup, and (b) diagnosis of an additional 335 cancers per 100 000 women undergoing workup of a breast lump, with a reduction in the number of false-positive examinations by 634 per 100 000 women undergoing this workup. Conclusion:Interpreting physicians who fall outside one or more of the identified cut points should be reviewed in the context of an overall assessment of all their performance measures and their specific practice setting to determine if remedial training is indicated.q RSNA, 2013

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“…Radiologists interpreting moderate (1001-2000) and those with high volume (>2000) had a higher sensitivity [17]. It is of interest to note that the recall rate in the United States is twice the recall rate in the United Kingdom (eg, 12.5%-14.4% vs. 7.6%), with no difference in cancer detection rate [18].…”

Section: Mammography Interpretation Benchmarksmentioning

confidence: 98%

“…The study was aimed to identify minimally acceptable performance standards for interpreting screening mammograms. They reported that a sensitivity of less than 75%, specificity less than 88% or greater than 95%, recall rate less than 5% and greater than 12%, PPV2 of less than 20% or greater than 40% and cancer detection rate of 2.5 per 1000 interpretations as indicating low performance [17]. If underperforming physicians moved into the acceptable range by additional training, detection of an additional 14 cancers per 100 000 women screened and a reduction in the number of false positive examinations by 880 per 100 000 women screened would be expected [17].…”

Section: Mammography Interpretation Benchmarksmentioning

confidence: 99%

Screening for Breast Cancer with Mammography: Current Status and An Overview

Shetty

2010

Indian J Surg Oncol

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This article reviews the current status of Mammographic screening in early detection of Breast cancer. A brief introduction on the global breast cancer burden is followed by an overview of the data proving the benefits of screening mammography in those countries where screening programs are in place. The screening recommendations, the benchmarks of a successful mammographic screening program and an overview of the guidelines that have been implemented for ensuring quality assurance in the USA and Europe are presented. The pertinent aspects of mammographic interpretation and the role of non mammographic screening methods are also discussed.

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Identifying Minimally Acceptable Interpretive Performance Criteria for Screening Mammography

Cited by 99 publications

References 13 publications

Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States

Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States

Diagnostic Mammography: Identifying Minimally Acceptable Interpretive Performance Criteria

Screening for Breast Cancer with Mammography: Current Status and An Overview

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