Breast Cancer Research and Treatment

, Volume 171, Issue 1, pp 143–149 | Cite as

Incorporation of the technologist’s opinion for arbitration of discrepant assessments among radiologists at screening mammography

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



We determined whether the addition of the technologist’s opinion may be helpful in deciding if discordant readings at blinded double reading should be recalled.


A consecutive series of 99,013 digital screening mammograms, obtained between July 2013 and January 2015, were included. All mammograms were first interpreted by a technologist and then double read in a blinded fashion by a team of 13 screening radiologists. All concordant and discordant positive readings among radiologists were recalled.


Out of 3562 recalls, 998 women were recalled after a discordant reading. Of these women, 337 (33.8%) had a positive technologist assessment, of which 40 (11.9%) were diagnosed with breast cancer. Sixty women with a negative technologist assessment (60/661, 9.1%) were diagnosed with breast cancer (p = 0.16). Recall rate would have decreased with technologist arbitration (3.6% vs. 2.9%, p < 0.001). Cancer detection rate decreased with 8.5%, from 7.1/1000 screens to 6.5/1000 screens (p = 0.10). Among women with a positive technologist assessment, the probability of breast cancer was highest in case of suspicious microcalcifications and lowest for suspicious masses (30.4% (17/56) versus 7.0% (16/212), p < 0.001). Breast cancers were diagnosed in all groups of mammographic abnormalities, except in women with a suspicious asymmetry and a negative technologist assessment.


Assessment by a technologist does not provide a significant discriminating ability in case of a discordant radiologist reading and, taking into account the decrease in cancer detection rate, does not appear to be a suitable arbitration strategy for discordant recalls at blinded double reading.


Breast cancer screening Digital mammography Radiologist blinded double reading Mammography technologist 



The authors thank the entire team of screening radiologists, mammographers, data analysts, and secretarial support of our screening region (BOZ, Bevolkingsonderzoek Zuid).


The authors have no sources of study funding to declare.

Compliance with Ethical Standards

Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflict of interest

The authors declare no conflict of interest.

Ethical standards The need for ethical approval was waived by the Central Committee on Research Involving Human Subjects (CCMO) in The Hague, The Netherlands. All women participating in the Dutch nationwide breast cancer screening program are asked to give informed consent to use their data for scientific and educational purposes. All women participating in our study had given this written informed consent.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Angela M. P. Coolen
    • 1
    Email author
  • Joost R. C. Lameijer
    • 2
  • Adri C. Voogd
    • 3
    • 4
  • Luc J. Strobbe
    • 5
  • Marieke W. J. Louwman
    • 4
  • Vivianne C. G. Tjan-Heijnen
    • 6
  • 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 Epidemiology, GROWMaastricht UniversityMaastrichtThe Netherlands
  4. 4.Department of ResearchNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
  5. 5.Department of SurgeryCanisius Wilhelmina HospitalNijmegenThe Netherlands
  6. 6.Department of Internal Medicine, Division of Medical Oncology, GROWMaastricht University Medical CenterMaastrichtThe Netherlands
  7. 7.Department of RadiologyCanisius Wilhelmina HospitalNijmegenThe Netherlands
  8. 8.Dutch Expert Centre for ScreeningNijmegenThe Netherlands

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