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

Buist, Diana S.M.; Anderson, Melissa L.; Haneuse, Sebastien; Sickles, Edward A.; Smith, Robert A.; Carney, Patricia A.; Taplin, Stephen H.; Rosenberg, Robert D.; Geller, Berta M.; Onega, Tracy; Monsees, Barbara; Bassett, Lawrence W.; Yankaskas, Bonnie C.; Elmore, Joann G.; Kerlikowske, Karla; Miglioretti, Diana L.

doi:10.1148/radiol.10101698

Cited by 88 publications

(86 citation statements)

References 27 publications

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“…The USA has a high rate of malpractice suits for missing breast cancer [26], while this is likely to be low in Norway. Independent double readings have been shown to improve performance [27,28], while results from studies about reading volume and sensitivity are inconsistent [29,30]. As far as we know, there are no studies regarding type of payment and accuracy.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of mammographic screening as practised in Vermont and Norway

Hofvind¹,

Geller²,

Skelly³

et al. 2012

BJR

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Objective: The aim of this study was to examine the sensitivity and specificity of screening mammography as performed in Vermont, USA, and Norway. Methods: Incident screening data from 1997 to 2003 for female patients aged 50-69 years from the Vermont Breast Cancer Surveillance System (116 996 subsequent screening examinations) and the Norwegian Breast Cancer Screening Program (360 872 subsequent screening examinations) were compared. Sensitivity and specificity estimates for the initial (based on screening mammogram only) and final (screening mammogram plus any further diagnostic imaging) interpretations were directly adjusted for age using 5-year age intervals for the combined Vermont and Norway population, and computed for 1 and 2 years of follow-up, which ended at the time of the next screening mammogram. Results: For the 1-year follow-up, sensitivities for initial assessments were 82.0%, 88.2% and 92.5% for 1-, 2-and .2-year screening intervals, respectively, in Vermont (p50.022). For final assessments, the values were 73.6%, 83.3% and 81.2% (p50.047), respectively. For Norway, sensitivities for initial assessments were 91.0% and 91.3% (p50.529) for 2-and .2-year intervals, and 90.7% and 91.3%, respectively, for final assessments (p50.630). Specificity was lower in Vermont than in Norway for each screening interval and for all screening intervals combined, for both initial (90.6% vs 97.8% for all intervals; p,0.001) and final (98.8% vs 99.5% for all intervals; p,0.001) assessments. Conclusion: Our study showed higher sensitivity and specificity in a biennial screening programme with an independent double reading than in a predominantly annual screening program with a single reading. Advances in knowledge: This study demonstrates that higher recall rates and lower specificity are not always associated with higher sensitivity of screening mammography. Differences in the screening processes in Norway and Vermont suggest potential areas for improvement in the latter.

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Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of mammographic screening as practised in Vermont and Norway

Hofvind¹,

Geller²,

Skelly³

et al. 2012

BJR

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“…Volume measures were analyzed in relation to performance in the subsequent year. For instance, 2005 volume was linked to 2006 performance ( 18 ).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Diagnostic volume included examinations performed for additional evaluation of a prior mammogram, short-interval follow-up, or evaluation of a breast concern or problem. Total volume included all diagnostic and screening examinations; diagnostic and screening mammograms obtained in the same woman and interpreted by the same radiologist on the same day counted as one study ( 18 ). This differs from Breast Imaging Reporting and Data System audits ( 19 ), where screening and diagnostic mammography performed on the same day independently contribute to total volume.…”

Section: Interpretive Volumementioning

confidence: 99%

Mammographic Interpretive Volume and Diagnostic Mammogram Interpretation Performance in Community Practice

Haneuse¹,

Buist²,

Miglioretti³

et al. 2012

Radiology

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Purpose:To investigate the association between radiologist interpretive volume and diagnostic mammography performance in community-based settings. Materials and Methods:This study received institutional review board approval and was HIPAA compliant. A total of 117 136 diagnostic mammograms that were interpreted by 107 radiologists between 2002 and 2006 in the Breast Cancer Surveillance Consortium were included. Logistic regression analysis was used to estimate the adjusted effect on sensitivity and the rates of false-positive fi ndings and cancer detection of four volume measures: annual diagnostic volume, screening volume, total volume, and diagnostic focus (percentage of total volume that is diagnostic). Analyses were stratifi ed by the indication for imaging: additional imaging after screening mammography or evaluation of a breast concern or problem. Results:Diagnostic volume was associated with sensitivity; the odds of a true-positive fi nding rose until a diagnostic volume of 1000 mammograms was reached; thereafter, they either leveled off ( P , .001 for additional imaging) or decreased ( P = .049 for breast concerns or problems) with further volume increases. Diagnostic focus was associated with false-positive rate; the odds of a false-positive fi nding increased until a diagnostic focus of 20% was reached and decreased thereafter ( P , .024 for additional imaging and P , .001 for breast concerns or problems with no selfreported lump). Neither total volume nor screening volume was consistently associated with diagnostic performance. Conclusion:Interpretive volume and diagnostic performance have complex multifaceted relationships. Our results suggest that diagnostic interpretive volume is a key determinant in the development of thresholds for considering a diagnostic mammogram to be abnormal. Current volume regulations do not distinguish between screening and diagnostic mammography, and doing so would likely be challenging.q RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup /suppl

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“…When using new KNN, the classification performance level of the interactive CAD system is significantly increased (p < 0.001) to AUC 00.897 with the corresponding 95% CI of [0.887, 0.907]. (1) to the bottom right ROI (12), the reference image set of CC view includes three ROIs (6, 9, and 10) depicting malignant masses, three ROIs (3, 5, and 11) depicting benign masses, and six ROIs (1, 2, 4, 7, 8, and 12) depicting CAD-cued falsepositive regions, while the reference image set of MLO view includes five malignant ROIs (3,5,6,9, and 12), one benign ROI (2), and six CAD-cued false-positive ROIs (1,4,7,8,10, and 11) Fig. 4 Comparison of two ROC-type performance curves of our interactive CAD scheme evaluated using a leave-one-out testing method involving 3,600 ROIs in the reference database.…”

Section: Resultsmentioning

confidence: 99%

“…Although a number of screening tools such as breast magnetic resonance imaging [3,4] have been approved and used as adjunct screening tools for the highrisk women identified by epidemiology-based risk models [5], periodic screening with mammography is the only clinically accepted imaging modality for screening the general population to date. However, interpreting mammograms by radiologists is difficult and time-consuming due to the low cancer prevalence in the screening environment (i.e., less than three to five cancers detected per every 1,000 screening examinations), as well as a large variability of depicted breast abnormalities and overlapped dense fibro-glandular tissue on the two-dimensional projected images [6,7]. As a result, both detection sensitivity and specificity of screening mammography are not satisfactory [8] particularly in younger women with dense breasts and in other high-risk groups.…”

Section: Introductionmentioning

confidence: 99%

An Interactive System for Computer-Aided Diagnosis of Breast Masses

Wang

Liu

et al. 2012

J Digit Imaging

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Although mammography is the only clinically accepted imaging modality for screening the general population to detect breast cancer, interpreting mammograms is difficult with lower sensitivity and specificity. To provide radiologists "a visual aid" in interpreting mammograms, we developed and tested an interactive system for computeraided detection and diagnosis (CAD) of mass-like cancers. Using this system, an observer can view CAD-cued mass regions depicted on one image and then query any suspicious regions (either cued or not cued by CAD). CAD scheme automatically segments the suspicious region or accepts manually defined region and computes a set of image features. Using content-based image retrieval (CBIR) algorithm, CAD searches for a set of reference images depicting "abnormalities" similar to the queried region. Based on image retrieval results and a decision algorithm, a classification score is assigned to the queried region. In this study, a reference database with 1,800 malignant mass regions and 1,800 benign and CAD-generated false-positive regions was used. A modified CBIR algorithm with a new function of stretching the attributes in the multi-dimensional space and decision scheme was optimized using a genetic algorithm. Using a leave-one-out testing method to classify suspicious mass regions, we compared the classification performance using two CBIR algorithms with either equally weighted or optimally stretched attributes. Using the modified CBIR algorithm, the area under receiver operating characteristic curve was significantly increased from 0.865 ±0.006 to 0.897±0.005 (p<0.001). This study demonstrated the feasibility of developing an interactive CAD system with a large reference database and achieving improved performance.

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

Cited by 88 publications

References 27 publications

Sensitivity and specificity of mammographic screening as practised in Vermont and Norway

Sensitivity and specificity of mammographic screening as practised in Vermont and Norway

Mammographic Interpretive Volume and Diagnostic Mammogram Interpretation Performance in Community Practice

An Interactive System for Computer-Aided Diagnosis of Breast Masses

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