Advertisement

European Radiology

, Volume 29, Issue 1, pp 337–344 | Cite as

Characteristics of screen-detected cancers following concordant or discordant recalls at blinded double reading in biennial digital screening mammography

  • Angela M. P. CoolenEmail author
  • Joost R. C. Lameijer
  • Adri C. Voogd
  • Marieke W. J. Louwman
  • Luc J. Strobbe
  • Vivianne C. G. Tjan-Heijnen
  • Lucien E. M. Duijm
Breast
  • 131 Downloads

Abstract

Objectives

To analyse which mammographic and tumour characteristics led to concordant versus discordant recalls at blinded double reading to further optimise our breast cancer screening programme.

Methods

We included a consecutive series of 99,013 screening mammograms obtained between July 2013 and January 2015. All mammograms were double read in a blinded fashion. Discordant readings were routinely recalled without consensus or arbitration. During the 2-year follow-up, relevant data of the recalled women were collected. We compared mammographic characteristics, screening outcome and tumour characteristics between concordant and discordant recalls.

Results

There were 2,543 concordant recalls (71.4%) and 997 discordant recalls (28.0%). The positive predictive value of a concordant recall was significantly higher (23.5% vs. 10.0%, p < 0.001). The proportion of BI-RADS 0 was significantly higher in the discordant recall group (75.7% vs. 56.3%, p < 0.001). Discordant recalls were more often an asymmetry or architectural distortion (21.8% vs. 13.2% and 9.3% vs. 6.5%, respectively, p < 0.001). There were no differences in the distribution of DCIS and invasive cancers and tumour characteristics were comparable for the two groups, except for a more favourable tumour grade in the discordant recall group (54.7% vs. 39.9% grade I tumours, p = 0.022).

Conclusions

Screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall. The higher proportion of asymmetries and architectural distortions in this group provide a possible target for improving screening programmes by additional training of screening radiologists and the implementation of digital breast tomosynthesis.

Key Points

With blinded double reading of screening mammograms, screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall.

The proportions of asymmetries and architectural distortions are higher in case of a discordant reading.

Possible improvement strategies could target additional training of screening radiologists and the implementation of digital breast tomosynthesis in breast cancer screening programmes.

Keywords

Mass screening Early detection of cancer Breast neoplasms Mammography Follow-up studies 

Abbreviations

CAD

Computer-aided detection

CDR

Cancer detection rate

DCIS

Ductal carcinoma in-situ

FFDM

Full-field digital mammography

FNAC

Fine needle aspiration cytology

FPR

False positive rate

LCIS

Lobular carcinoma in-situ

PACS

Picture-archiving and communication system

SFM

Screen-film mammography

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Lucien E.M. Duijm.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was not required.

We have previously reported our screening studies, derived from our screening database, to the Medical Ethics Review Committee of the Catharina Hospital Eindhoven, The Netherlands (www.catharina-ziekenhuis.nl/metc/). This committee reviewed our studies and replied that according to the Medical Research Involving Human Subject Acts (WMO; www.ccmo.nl ) our kind of study does not need the approval of the committee. We have contacted CCMO in the past to obtain an official letter from this institute, stating that our descriptive screening studies do not warrant ethical approval for the trial.

Methodology

• prospective

• diagnostic or prognostic

• performed at one institution

References

  1. 1.
    Duijm LEM, Groenewoud JH, Fracheboud J, van Ineveld BM, Roumen RMH, de Koning HJ (2008) Introduction of additional double reading of mammograms by radiographers: Effects on a biennial screening programme outcome. Eur J Cancer 44(9):1223–1228CrossRefGoogle Scholar
  2. 2.
    Caumo F, Brunelli S, Tosi E et al (2011) On the role of arbitration of discordant double readings of screening mammography: experience from two Italian programmes. Radiol Med 116(1):84–91CrossRefGoogle Scholar
  3. 3.
    Azavedo E, Zackrisson S, Mejàre I, Heibert Arnlind M (2012) Is single reading with computer-aided detection (CAD) as good as double reading in mammography screening? A systematic review. BMC Med Imaging 12(1):22CrossRefGoogle Scholar
  4. 4.
    Klompenhouwer EG, Voogd AC, Den Heeten GJ et al (2015) Blinded double reading yields a higher programme sensitivity than non-blinded double reading at digital screening mammography: A prospected population based study in the south of the Netherlands. Eur J Cancer 51(3):391–399CrossRefGoogle Scholar
  5. 5.
    Posso MC, Puig T, Quintana MJ, Solá-Roca J, Bonfill X (2016) Double versus single reading of mammograms in a breast cancer screening programme: a cost-consequence analysis. Eur Radiol 26(9):3262–3271CrossRefGoogle Scholar
  6. 6.
    Duijm LEM, Louwman MWJ, Groenewoud JH, van de Poll-Franse LV, Fracheboud J, Coebergh JW (2009) Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome. Br J Cancer 100(6):901–907CrossRefGoogle Scholar
  7. 7.
    European Commission (2013) European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition. Office for Official Publications of the European Communities. 138 p.Google Scholar
  8. 8.
    Gur D, Sumkin JH, Hardesty LA et al (2004) Recall and detection rates in screening mammography: a review of clinical experience - implications for practice guidelines. Cancer 100(8):1590–1594CrossRefGoogle Scholar
  9. 9.
    Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19(5):403–410CrossRefGoogle Scholar
  10. 10.
    Ciatto S, Ambrogetti D, Risso G et al (2005) The role of arbitration of discordant reports at double reading of screening mammograms. J Med Screen 12(3):125–127CrossRefGoogle Scholar
  11. 11.
    Klompenhouwer EG, Voogd AC, den Heeten GJ et al (2015) Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome. Eur Radiol 25(10):2821–2829CrossRefGoogle Scholar
  12. 12.
    Klompenhouwer EG, Weber RJP, Voogd AC et al (2015) Arbitration of discrepant BI-RADS 0 recalls by a third reader at screening mammography lowers recall rate but not the cancer detection rate and sensitivity at blinded and non-blinded double reading. Breast 24(5):601–607CrossRefGoogle Scholar
  13. 13.
    Bluekens AMJ, Holland R, Karssemeijer N, Broeders MJM, den Heeten GJ (2012) Comparison of Digital Screening Mammography and Screen-Film Mammography in the Early Detection of Clinically Relevant Cancers: A Multicenter Study. Radiology 265(3):707–714CrossRefGoogle Scholar
  14. 14.
    van Luijt PA, Heijnsdijk EAM, Fracheboud J et al (2016) The distribution of ductal carcinoma in situ (DCIS) grade in 4232 women and its impact on overdiagnosis in breast cancer screening. Breast Cancer Res 18(1):47CrossRefGoogle Scholar
  15. 15.
    Welch HG, Prorok PC, O’Malley AJ, Kramer BS (2016) Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med 375(15):1438–1447CrossRefGoogle Scholar
  16. 16.
    Lannin DR, Wang S (2017) Are small breast cancers good because they are small or small because they are good? N Engl J Med 376(23):2286–2291CrossRefGoogle Scholar
  17. 17.
    Riihimäki M, Thomsen H, Brandt A, Sundquist J, Hemminki K (2012) Death causes in breast cancer patients. Ann Oncol 23(3):604–610CrossRefGoogle Scholar
  18. 18.
    Lee AY, Wisner DJ, Aminololama-Shakeri S J et al (2017) Inter-reader variability in the use of BI-RADS descriptors for suspicious findings on diagnostic mammography: a multi-institution study of 10 academic radiologists. Acad Radiol 24(1):60–66Google Scholar
  19. 19.
    Ciatto S, Houssami N, Apruzzese A et al (2006) Reader variability in reporting breast imaging according to BI-RADS® assessment categories (the Florence experience). Breast 15(1):44–51CrossRefGoogle Scholar
  20. 20.
    Redondo A, Comas M, Macià F et al (2012) Inter- and intraradiologist variability in the BI-RADS assessment and breast density categories for screening mammograms. Br J Radiol 85:1465–1470CrossRefGoogle Scholar
  21. 21.
    Houssami N, Bernardi D, Pellegrini M et al (2017) Breast cancer detection using single-reading of breast tomosynthesis (3D-mammography) compared to double-reading of 2D-mammography: Evidence from a population-based trial. Cancer Epidemiol 47:94–99CrossRefGoogle Scholar
  22. 22.
    Dibble EH, Lourenco AP, Baird GL, Ward RC, Maynard AS, Mainiero MB (2018) Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion. Eur Radiol 28(1):3–10Google Scholar
  23. 23.
    Durand MA, Haas BM, Yao X et al (2015) Early clinical experience with digital breast tomosynthesis for screening mammography. Radiology 274(1):85–92CrossRefGoogle Scholar
  24. 24.
    Kooi T, Litjens G, van Ginneken B, Gubern-Mérida A et al (2017) Large scale deep learning for computer aided detection of mammographic lesions. Med Image Anal 35:303–312CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Angela M. P. Coolen
    • 1
    Email author
  • Joost R. C. Lameijer
    • 2
  • Adri C. Voogd
    • 3
    • 4
    • 5
  • Marieke W. J. Louwman
    • 4
  • Luc J. Strobbe
    • 6
  • Vivianne C. G. Tjan-Heijnen
    • 5
  • Lucien E. M. Duijm
    • 7
    • 8
  1. 1.Department of RadiologyElisabeth-Tweesteden Hospital (ETZ)TilburgThe Netherlands
  2. 2.Department of RadiologyCatharina HospitalEindhovenThe Netherlands
  3. 3.Department of EpidemiologyMaastricht University, GROWMaastrichtThe Netherlands
  4. 4.Department of Research, Netherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
  5. 5.Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical CentreMaastrichtThe Netherlands
  6. 6.Department of SurgeryCanisius-Wilhelmina HospitalNijmegenThe Netherlands
  7. 7.Department of RadiologyCanisius Wilhelmina HospitalNijmegenThe Netherlands
  8. 8.Dutch Expert Centre for ScreeningNijmegenThe Netherlands

Personalised recommendations