© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 18, 1373-1380,
September 18, 2002
© 2002 Oxford University Press
ARTICLE |
Screening Mammograms by Community Radiologists: Variability in False-Positive Rates
Affiliations of authors: J. G. Elmore, L. M. Reisch, W. Kreuter, Department of Medicine, University of Washington School of Medicine, Seattle; D. L. Miglioretti, Center for Health Studies, Group Health Cooperative of Puget Sound, and Department of Biostatistics, University of Washington School of Public Health, Seattle; C. L. Christiansen, Boston University School of Public Health, Health Services Department, and Center for Health Quality, Outcomes and Economic Research at Veterans Affairs Health Services Research and Development, Boston, MA; M. B. Barton, S. W. Fletcher, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, and Harvard Medical School, Boston.
Correspondence to: Joann G. Elmore, M.D., M.P.H., Associate Professor, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359780, Seattle, WA 98104–2499 (e-mail: jelmore{at}u.washington.edu).
Background: Previous studies have shown that the agreement among radiologists interpreting a test set of mammograms is relatively low. However, data available from real-world settings are sparse. We studied mammographic examination interpretations by radiologists practicing in a community setting and evaluated whether the variability in false-positive rates could be explained by patient, radiologist, and/or testing characteristics. Methods: We used medical records on randomly selected women aged 40–69 years who had had at least one screening mammographic examination in a community setting between January 1, 1985, and June 30, 1993. Twenty-four radiologists interpreted 8734 screening mammograms from 2169 women. Hierarchical logistic regression models were used to examine the impact of patient, radiologist, and testing characteristics. All statistical tests were two-sided. Results: Radiologists varied widely in mammographic examination interpretations, with a mass noted in 0%–7.9%, calcification in 0%–21.3%, and fibrocystic changes in 1.6%–27.8% of mammograms read. False-positive rates ranged from 2.6% to 15.9%. Younger and more recently trained radiologists had higher false-positive rates. Adjustment for patient, radiologist, and testing characteristics narrowed the range of false-positive rates to 3.5%–7.9%. If a woman went to two randomly selected radiologists, her odds, after adjustment, of having a false-positive reading would be 1.5 times greater for the radiologist at higher risk of a false-positive reading, compared with the radiologist at lowest risk (95% highest posterior density interval [similar to a confidence interval] = 1.17 to 2.08). Conclusion: Community radiologists varied widely in their false-positive rates in screening mammograms; this variability range was reduced by half, but not eliminated, after statistical adjustment for patient, radiologist, and testing characteristics. These characteristics need to be considered when evaluating false-positive rates in community mammographic examination screening.
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