Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
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References
Sankatsing VDV, van Ravesteyn NT, Heijnsdijk EAM et al (2017) The effect of population-based mammography screening in Dutch municipalities on breast cancer mortality: 20 years of follow-up. Int J Cancer 141:671–677
European Commission. Directorate-general for health and consumer protection, Perry N, Puthaar E (2006) European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. Office for Official Publications of the European Communities, Luxembourg
Duijm LE, Louwman MW, 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 100:901–907
Gur D, Sumkin JH, Hardesty LA et al (2004) Recall and detection rates in screening mammography. Cancer 100:1590–1594
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 25:2821–2829
Shaw CM, Flanagan FL, Fenlon HM, McNicholas MM (2009) Consensus review of discordant findings maximizes cancer detection rate in double-reader screening mammography: Irish National Breast Screening Program experience. Radiology 250:354–362
Duijm LE, Groenewoud JH, Fracheboud J, de Koning HJ (2007) Additional double reading of screening mammograms by radiologic technologists: impact on screening performance parameters. J Natl Cancer Inst 99:1162–1170
Torres-Mejia G, Smith RA, Carranza-Flores Mde L et al (2015) Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists. BMC Cancer 15:410
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 51:391–399
American College of Radiology. BI-RADS Committee (2013) ACR BI-RADS atlas: breast imaging reporting and data system, 5th edn. American College of Radiology, Reston
Pauli R, Hammond S, Cooke J, Ansell J (1996) Comparison of radiographer/radiologist double film reading with single reading in breast cancer screening. J Med Screen 3:18–22
van den Biggelaar FJ, Nelemans PJ, Flobbe K (2008) Performance of radiographers in mammogram interpretation: a systematic review. Breast 17:85–90
Debono JC, Poulos AE, Houssami N, Turner RM, Boyages J (2015) Evaluation of radiographers’ mammography screen-reading accuracy in Australia. J Med Radiat Sci 62:15–22
Tonita JM, Hillis JP, Lim CH (1999) Medical radiologic technologist review: effects on a population-based breast cancer screening program. Radiology 211:529–533
Pisano ED, Gatsonis C, Hendrick E et al (2005) Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 353:1773–1783
Bluekens AM, Holland R, Karssemeijer N, Broeders MJ, 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 265:707–714
van Luijt PA, Fracheboud J, Heijnsdijk EA, den Heeten GJ, de Koning HJ, National Evaluation Team for Breast Cancer Screening in Netherlands Study G (2013) Nation-wide data on screening performance during the transition to digital mammography: observations in 6 million screens. Eur J Cancer 49:3517–3525
Posso M, Puig T, Carles M, Rue M, Canelo-Aybar C, Bonfill X (2017) Effectiveness and cost-effectiveness of double reading in digital mammography screening: A systematic review and meta-analysis. Eur J Radiol 96:40–49
Klompenhouwer EG, Weber RJ, 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 24:601–607
Otten JD, Karssemeijer N, Hendriks JH et al (2005) Effect of recall rate on earlier screen detection of breast cancers based on the Dutch performance indicators. J Natl Cancer Inst 97:748–754
Acknowledgements
The authors thank the entire team of screening radiologists, mammographers, data analysts, and secretarial support of our screening region (BOZ, Bevolkingsonderzoek Zuid).
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The authors have no sources of study funding to declare.
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Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request.
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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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Coolen, A.M.P., Lameijer, J.R.C., Voogd, A.C. et al. Incorporation of the technologist’s opinion for arbitration of discrepant assessments among radiologists at screening mammography. Breast Cancer Res Treat 171, 143–149 (2018). https://doi.org/10.1007/s10549-018-4800-4
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DOI: https://doi.org/10.1007/s10549-018-4800-4