Assessing mammographers' accuracy. A comparison of clinical and test performance.

Direct estimation of mammographers' clinical accuracy requires the ability to capture screening assessments and correctly identify which screened women have breast cancer. This clinical information is often unavailable and when it is available its observational nature can cause analytic problems. Problems with clinical data have led some researchers to evaluate mammographers using a single set of films. Research based on these test film sets implicitly assumes a correspondence between mammographers' accuracy in the test setting and their accuracy in a clinical setting. However, there is no evidence supporting this basic assumption. In this article we use hierarchical models and data from 27 mammographers to directly compare accuracy estimated from clinical practice data to accuracy estimated from a test film set. We found moderate positive correlation [ rho; = 0.206 with 95% credible interval (-0.142-0. 488)] between mammographers' overall preponderance to call a mammogram positive. However, we found no evidence of correlation between clinical and test accuracy [ rho; = -0.025 with 95% credible interval (-0.484-0.447)]. This study is limited by the relatively small number of mammographers evaluated, by the somewhat restricted range of observed sensitivities and specificities, and by differences in the types of films evaluated in test and clinical datasets. Nonetheless, these findings raise important questions about how mammographer accuracy should be measured.