BACKGROUND: Extensive variability has been noted in the interpretive performance of screening mammography; however, less is known about variability in diagnostic mammography performance. METHODS: We examined the performance of 123 radiologists who interpreted 35895 diagnostic mammography examinations that were obtained to evaluate a breast problem from January 1, 1996, through December 31, 2003, at 72 facilities that contribute data to the Breast Cancer Surveillance Consortium. We modeled the influence of radiologist characteristics on the sensitivity and false-positive rate of diagnostic mammography, adjusting for patient characteristics by use of a Bayesian hierarchical logistic regression model. RESULTS: The median sensitivity was 79% (range = 27%-100%) and the median false-positive rate was 4.3% (range = 0%-16%). Radiologists in academic medical centers, compared with other radiologists, had higher sensitivity (88%, 95% confidence interval [CI] = 77% to 94%, versus 76%, 95% CI = 72% to 79%; odds ratio [OR] = 5.41, 95% Bayesian posterior credible interval [BPCI] = 1.55 to 21.51) with a smaller increase in their false-positive rates (7.8%, 95% CI = 4.8% to 12.7%, versus 4.2%, 95% CI = 3.8% to 4.7%; OR = 1.73, 95% BPCI = 1.05 to 2.67) and a borderline statistically significant improvement in accuracy (OR = 3.01, 95% BPCI = 0.97 to 12.15). Radiologists spending 20% or more of their time on breast imaging had statistically significantly higher sensitivity than those spending less time on breast imaging (80%, 95% CI = 76% to 83%, versus 70%, 95% CI = 64% to 75%; OR = 1.60, 95% BPCI = 1.05 to 2.44) with non-statistically significant increased false-positive rates (4.6%, 95% CI = 4.0% to 5.3%, versus 3.9%, 95% CI = 3.3% to 4.6%; OR = 1.17, 95% BPCI = 0.92 to 1.51). More recent training in mammography and more experience performing breast biopsy examinations were associated with a decreased threshold for recalling patients, resulting in similar statistically significant increases in both sensitivity and false-positive rates. CONCLUSIONS: We found considerable variation in the interpretive performance of diagnostic mammography across radiologists that was not explained by the characteristics of the patients whose mammograms were interpreted. This variability is concerning and likely affects many women with and without breast cancer.
BACKGROUND: Extensive variability has been noted in the interpretive performance of screening mammography; however, less is known about variability in diagnostic mammography performance. METHODS: We examined the performance of 123 radiologists who interpreted 35895 diagnostic mammography examinations that were obtained to evaluate a breast problem from January 1, 1996, through December 31, 2003, at 72 facilities that contribute data to the Breast Cancer Surveillance Consortium. We modeled the influence of radiologist characteristics on the sensitivity and false-positive rate of diagnostic mammography, adjusting for patient characteristics by use of a Bayesian hierarchical logistic regression model. RESULTS: The median sensitivity was 79% (range = 27%-100%) and the median false-positive rate was 4.3% (range = 0%-16%). Radiologists in academic medical centers, compared with other radiologists, had higher sensitivity (88%, 95% confidence interval [CI] = 77% to 94%, versus 76%, 95% CI = 72% to 79%; odds ratio [OR] = 5.41, 95% Bayesian posterior credible interval [BPCI] = 1.55 to 21.51) with a smaller increase in their false-positive rates (7.8%, 95% CI = 4.8% to 12.7%, versus 4.2%, 95% CI = 3.8% to 4.7%; OR = 1.73, 95% BPCI = 1.05 to 2.67) and a borderline statistically significant improvement in accuracy (OR = 3.01, 95% BPCI = 0.97 to 12.15). Radiologists spending 20% or more of their time on breast imaging had statistically significantly higher sensitivity than those spending less time on breast imaging (80%, 95% CI = 76% to 83%, versus 70%, 95% CI = 64% to 75%; OR = 1.60, 95% BPCI = 1.05 to 2.44) with non-statistically significant increased false-positive rates (4.6%, 95% CI = 4.0% to 5.3%, versus 3.9%, 95% CI = 3.3% to 4.6%; OR = 1.17, 95% BPCI = 0.92 to 1.51). More recent training in mammography and more experience performing breast biopsy examinations were associated with a decreased threshold for recallingpatients, resulting in similar statistically significant increases in both sensitivity and false-positive rates. CONCLUSIONS: We found considerable variation in the interpretive performance of diagnostic mammography across radiologists that was not explained by the characteristics of the patients whose mammograms were interpreted. This variability is concerning and likely affects many women with and without breast cancer.
Authors: S Ciatto; N Houssami; A Apruzzese; E Bassetti; B Brancato; F Carozzi; S Catarzi; M P Lamberini; G Marcelli; R Pellizzoni; B Pesce; G Risso; F Russo; A Scorsolini Journal: Breast Date: 2005-08-01 Impact factor: 4.380
Authors: Elizabeth Lazarus; Martha B Mainiero; Barbara Schepps; Susan L Koelliker; Linda S Livingston Journal: Radiology Date: 2006-03-28 Impact factor: 11.105
Authors: Berta M Geller; Laura E Ichikawa; Diana S M Buist; Edward A Sickles; Patricia A Carney; Bonnie C Yankaskas; Mark Dignan; Karla Kerlikowske; K Robin Yabroff; William Barlow; Robert D Rosenberg Journal: Radiology Date: 2006-10 Impact factor: 11.105
Authors: Edward A Sickles; Diana L Miglioretti; Rachel Ballard-Barbash; Berta M Geller; Jessica W T Leung; Robert D Rosenberg; Rebecca Smith-Bindman; Bonnie C Yankaskas Journal: Radiology Date: 2005-06 Impact factor: 11.105
Authors: Joann G Elmore; Diana L Miglioretti; Lisa M Reisch; Mary B Barton; William Kreuter; Cindy L Christiansen; Suzanne W Fletcher Journal: J Natl Cancer Inst Date: 2002-09-18 Impact factor: 13.506
Authors: Laura M Newcomer; Polly A Newcomb; Amy Trentham-Dietz; Barry E Storer; Yutaka Yasui; Janet R Daling; John D Potter Journal: Cancer Date: 2002-08-01 Impact factor: 6.860
Authors: Joann G Elmore; Erin J Aiello Bowles; Berta Geller; Natalia Vukshich Oster; Patricia A Carney; Diana L Miglioretti; Diana S M Buist; Karla Kerlikowske; Edward A Sickles; Tracy Onega; Robert D Rosenberg; Bonnie C Yankaskas Journal: Acad Radiol Date: 2010-06 Impact factor: 3.173
Authors: Sebastien Haneuse; Diana S M Buist; Diana L Miglioretti; Melissa L Anderson; Patricia A Carney; Tracy Onega; Berta M Geller; Karla Kerlikowske; Robert D Rosenberg; Bonnie C Yankaskas; Joann G Elmore; Stephen H Taplin; Robert A Smith; Edward A Sickles Journal: Radiology Date: 2011-11-21 Impact factor: 11.105
Authors: Joann G Elmore; Andrea J Cook; Andy Bogart; Patricia A Carney; Berta M Geller; Stephen H Taplin; Diana S M Buist; Tracy Onega; Christoph I Lee; Diana L Miglioretti Journal: Clin Imaging Date: 2016-07-01 Impact factor: 1.605
Authors: Patricia A Carney; Andrea J Cook; Diana L Miglioretti; Stephen A Feig; Erin Aiello Bowles; Berta M Geller; Karla Kerlikowske; Mark Kettler; Tracy Onega; Joann G Elmore Journal: J Clin Epidemiol Date: 2011-10-15 Impact factor: 6.437
Authors: Patricia A Carney; Mark Kettler; Andrea J Cook; Berta M Geller; Leah Karliner; Diana L Miglioretti; Erin Aiello Bowles; Diana S Buist; Thomas H Gallagher; Joann G Elmore Journal: Acad Radiol Date: 2009-05-12 Impact factor: 3.173
Authors: Diana L Miglioretti; Charlotte C Gard; Patricia A Carney; Tracy L Onega; Diana S M Buist; Edward A Sickles; Karla Kerlikowske; Robert D Rosenberg; Bonnie C Yankaskas; Berta M Geller; Joann G Elmore Journal: Radiology Date: 2009-09-29 Impact factor: 11.105
Authors: Louise M Henderson; Mary W Marsh; Thad Benefield; Elizabeth Pearsall; Danielle Durham; Bruce F Schroeder; J Michael Bowling; Cheryl A Viglione; Bonnie C Yankaskas Journal: J Am Coll Radiol Date: 2015-12 Impact factor: 5.532