© 2004 by Oxford University Press
© 2004 Oxford University Press
ARTICLE |
Accuracy of Screening Mammography Interpretation by Characteristics of Radiologists
Affiliations of authors: Cancer Research and Biostatistics, Seattle, WA (WEB); Center for Health Studies, Group Health Cooperative, Seattle, WA (WEB, SHT); Department of Biostatistics, University of Washington, Seattle, WA (WEB); Fred Hutchinson Cancer Research Center, Seattle, WA (CC); Office of Medical Education, Dartmouth University, Hanover, NH (PAC); Department of Radiology, Emory University, Atlanta, GA (CD); Center for Research Design and Statistical Methods, University of Nevada, Reno, NV (GC); Lynn Sage Comprehensive Breast Center, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (REH); Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA (JGE)
Correspondence to: William Barlow, PhD, Cancer Research and Biostatistics, 1730 Minor Ave, Ste. 1900, Seattle WA 98101 (e-mail: williamb{at}crab.org)
Background: Radiologists differ in their ability to interpret screening mammograms accurately. We investigated the relationship of radiologist characteristics to actual performance from 1996 to 2001. Methods: Screening mammograms (n = 469 512) interpreted by 124 radiologists were linked to cancer outcome data. The radiologists completed a survey that included questions on demographics, malpractice concerns, years of experience interpreting mammograms, and the number of mammograms read annually. We used receiver operating characteristics (ROC) analysis to analyze variables associated with sensitivity, specificity, and the combination of the two, adjusting for patient variables that affect performance. All P values are two-sided. Results: Within 1 year of the mammogram, 2402 breast cancers were identified. Relative to low annual interpretive volume (
1000 mammograms), greater interpretive volume was associated with higher sensitivity (P = .001; odds ratio [OR] for moderate volume [1001–2000] = 1.68, 95% CI = 1.18 to 2.39; OR for high volume [>2000] = 1.89, 95% CI = 1.36 to 2.63). Specificity decreased with volume (OR for 1001–2000 = 0.65, 95% CI = 0.52 to 0.83; OR for more than 2000 = 0.76, 95% CI = 0.60 to 0.96), compared with 1000 or less (P = .002). Greater number of years of experience interpreting mammograms was associated with lower sensitivity (P = .001), but higher specificity (P = .003). ROC analysis using the ordinal BI-RADS interpretation showed an association between accuracy and both previous mammographic history (P = .012) and breast density (P<.001). No association was observed between accuracy and years interpreting mammograms (P = .34) or mammography volume (P = .94), after adjusting for variables that affect the threshold for calling a mammogram positive. Conclusions: We found no evidence that greater volume or experience at interpreting mammograms is associated with better performance. However, they may affect sensitivity and specificity, possibly by determining the threshold for calling a mammogram positive. Increasing volume requirements is unlikely to improve overall mammography performance.
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- Re: Accuracy of Screening Mammography Interpretation by Characteristics of Radiologists
- Robert Clark
J Natl Cancer Inst 2005 97: 936.[Extract] [Full Text] [PDF]
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R. Clark Re: Accuracy of Screening Mammography Interpretation by Characteristics of Radiologists J Natl Cancer Inst, June 15, 2005; 97(12): 936 - 936. [Full Text] [PDF]
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