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



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.


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.


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).


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.


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



Computer-aided detection


Cancer detection rate


Ductal carcinoma in-situ


Full-field digital mammography


Fine needle aspiration cytology


False positive rate


Lobular carcinoma in-situ


Picture-archiving and communication system


Screen-film mammography



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

Compliance with ethical standards


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 ( This committee reviewed our studies and replied that according to the Medical Research Involving Human Subject Acts (WMO; ) 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.


• prospective

• diagnostic or prognostic

• performed at one institution


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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

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