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Akwo JD, Trieu P, Lewis S. Does the availability of prior mammograms improve radiologists' observer performance?-a scoping review. BJR Open 2023; 5:20230038. [PMID: 37942498 PMCID: PMC10630973 DOI: 10.1259/bjro.20230038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The objective of this review was to examine the impact of previous mammogram availability on radiologists' performance from screening populations and experimental studies. Materials and Methods A search of the literature was conducted using five databases: MEDLINE, PubMed, Web of Science, ScienceDirect, and CINAHL as well as Google and reference lists of articles. Keywords were combined with "AND" or "OR" or "WITH" and included "prior mammograms, diagnostic performance, initial images, diagnostic efficacy, subsequent images, previous imaging, and radiologist's performance". Studies that assessed the impact of previous mammogram availability on radiologists' performance were reviewed. The Standard for Reporting Diagnostic Accuracy guidelines was used to critically appraise individual sources of evidence. Results A total of 15 articles were reviewed. The sample of mammogram cases used across these studies varied from 36 to 1,208,051. Prior mammograms did not affect sensitivity [with priors: 62-86% (mean = 73.3%); without priors: 69.4-87.4% (mean = 75.8%)] and cancer detection rate, but increased specificity [with priors: 72-96% (mean = 87.5%); without priors: 63-87% (mean = 80.5%)] and reduced false-positive rates [with priors: 3.7 to 36% (mean = 19.9%); without priors 13.3-49% (mean = 31.4%)], recall rates [with priors: 3.8-57% (mean = 26.6%); without priors: [4.9%-67.5% (mean = 37.9%)], and abnormal interpretation rate decreased by 4% with priors. Evidence for the associations between the availability of prior mammograms and positive-predictive value, area under the curve (AUC) from the receiver operating characteristic curve (ROC) and localisation ROC AUC, and positive-predictive value of recall is limited and unclear. Conclusion Availability of prior mammograms reduces recall rates, false-positive rates, abnormal interpretation rates, and increases specificity without affecting sensitivity and cancer detection rate.
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Affiliation(s)
| | - Phuong Trieu
- Medical Image Optimisation and Perception Group, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Sarah Lewis
- Medical Image Optimisation and Perception Group, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Geertse TD, van der Waal D, Vreuls W, Tetteroo E, Duijm LEM, Pijnappel RM, Broeders MJM. The dilemma of recalling well-circumscribed masses in a screening population: A narrative literature review and exploration of Dutch screening practice. Breast 2023:S0960-9776(23)00451-4. [PMID: 37169601 DOI: 10.1016/j.breast.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND In Dutch breast cancer screening, solitary, new or growing well-circumscribed masses should be recalled for further assessment. This results in cancers detected but also in false positive recalls, especially at initial screening. The aim of this study was to determine characteristics of well-circumscribed masses at mammography and identify potential methods to improve the recall strategy. METHODS A systematic literature search was performed using PubMed. In addition, follow-up data were retrieved on all 8860 recalled women in a Dutch screening region from 2014 to 2019. RESULTS Based on 15 articles identified in the literature search, we found that probably benign well-circumscribed masses that were kept under surveillance had a positive predictive value (PPV) of 0-2%. New or enlarging solitary well-circumscribed masses had a PPV of 10-12%. In general the detected carcinomas had a favorable prognosis. In our exploration of screening practice, 25% of recalls (2133/8860) were triggered by a well-circumscribed mass. Those recalls had a PPV of 2.0% for initial and 10.6% for subsequent screening. Most detected carcinomas had a favorable prognosis as well. CONCLUSION To recognize malignancies presenting as well-circumscribed masses, identifying solitary, new or growing lesions is key. This information is missing at initial screening since prior examinations are not available, leading to a low PPV. Access to prior clinical examinations may therefore improve this PPV. In addition, given the generally favorable prognosis of screen-detected malignant well-circumscribed masses, one may opt to recall these lesions at subsequent screening, if grown, rather than at initial screening.
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Affiliation(s)
- Tanya D Geertse
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands.
| | - Daniëlle van der Waal
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands
| | - Willem Vreuls
- Canisius Wilhelmina Hospital, Department of Radiology Weg Door, Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Eric Tetteroo
- Amphia Hospital, Department of Radiology Molengracht 21, 4818 CK, Breda, the Netherlands
| | - Lucien E M Duijm
- Canisius Wilhelmina Hospital, Department of Radiology Weg Door, Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Ruud M Pijnappel
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; University Medical Centre Utrecht, Utrecht UniversityDepartment of Radiology, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Mireille J M Broeders
- Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands; Radboud University Medical CenterDepartment for Health Evidence Geert Grooteplein 21, 6525 EZ, Nijmegen, the Netherlands
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Risk-Based Screening Mammography for Women Aged <40: Outcomes From the National Mammography Database. J Am Coll Radiol 2019; 17:368-376. [PMID: 31541655 DOI: 10.1016/j.jacr.2019.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/16/2019] [Accepted: 08/25/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There is insufficient large-scale evidence for screening mammography in women <40 years at elevated risk. This study compares risk-based screening of women aged 30 to 39 with risk factors versus women aged 40 to 49 without risk factors in the National Mammography Database (NMD). METHODS This retrospective, HIPAA-compliant, institutional review board-exempt study analyzed data from 150 NMD mammography facilities in 31 states. Patients were stratified by 5-year age intervals, availability of prior mammograms, and specific risk factors for breast cancer: family history of breast cancer, personal history of breast cancer, and dense breasts. Four screening performance metrics were calculated for each age and risk group: recall rate (RR), cancer detection rate (CDR), and positive predictive values for biopsy recommended (PPV2) and biopsy performed (PPV3). RESULTS Data from 5,986,131 screening mammograms performed between January 2008 and December 2015 in 2,647,315 women were evaluated. Overall, mean CDR was 3.69 of 1,000 (95% confidence interval: 3.64-3.74), RR was 9.89% (9.87%-9.92%), PPV2 was 20.1% (19.9%-20.4%), and PPV3 was 28.2% (27.0%-28.5%). Women aged 30 to 34 and 35 to 39 had similar CDR, RR, and PPVs, with the presence of the three evaluated risk factors associated with significantly higher CDR. Moreover, compared with a population currently recommended for screening mammography in the United States (aged 40-49 at average risk), incidence screening (at least one prior screening examination) of women aged 30 to 39 with the three evaluated risk factors has similar cancer detection rates and recall rates. DISCUSSION Women with one or more of these three specific risk factors likely benefit from screening commencing at age 30 instead of age 40.
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Horsley RK, Kling JM, Vegunta S, Lorans R, Temkit H, Patel BK. Baseline Mammography: What Is It and Why Is It Important? A Cross-Sectional Survey of Women Undergoing Screening Mammography. J Am Coll Radiol 2018; 16:164-169. [PMID: 30219346 DOI: 10.1016/j.jacr.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Studies have shown that having a baseline mammogram, the first screening mammogram, available for comparison at the time of interpreting a subsequent mammogram significantly decreases the potential of a false-positive examination. Our aim was to evaluate knowledge of and perception about the significance of baseline mammograms in those women undergoing screening mammography. MATERIALS AND METHODS A cross-sectional prospective survey study was conducted in women without a history of breast cancer presenting for their screening mammogram. Respondents were surveyed anonymously between March and April 2017. The questionnaire was developed by primary care providers and radiologists and pretested for readability and clarity. RESULTS In all, 401 women (87% white, 93% educated beyond high school) completed surveys in which 77% of women reported having yearly mammograms, 31% reported having a history of an abnormal mammogram, and 45% had not heard the term baseline mammogram. Of those who had heard the term, the most commonly reported source was their primary care provider (31%). Although 74% chose the correct definition of a baseline mammogram, 67% did not think that a baseline mammogram was important for decreasing associated cost, time, and discomfort due to the number of mammograms incorrectly read as abnormal. CONCLUSION In a group of educated women who routinely get mammograms, almost one-half had not heard the term baseline mammogram. Furthermore, most women did not think baseline mammography was important for decreasing associated cost, time, and discomfort due to mammograms incorrectly read as abnormal. This study suggests that efforts to improve women's understanding of baseline mammograms and their importance are warranted, with greatest opportunity for health care providers and radiologists.
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Affiliation(s)
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Roxanne Lorans
- Department of Diagnostic Radiology, Mayo Clinic, Phoenix, Arizona
| | - H'hamed Temkit
- Department of Research Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Bhavika K Patel
- Department of Diagnostic Radiology, Mayo Clinic, Phoenix, Arizona
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Hardesty LA, Lind KE, Gutierrez EJ. Effect of Arrival of Prior Mammograms on Recall Negation for Screening Mammograms Performed With Digital Breast Tomosynthesis in a Clinical Setting. J Am Coll Radiol 2018; 15:1293-1299. [DOI: 10.1016/j.jacr.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/22/2017] [Accepted: 05/02/2018] [Indexed: 12/01/2022]
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Improving Screening Mammography Outcomes Through Comparison With Multiple Prior Mammograms. AJR Am J Roentgenol 2016; 207:918-924. [PMID: 27385404 DOI: 10.2214/ajr.15.15917] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the present study is to evaluate the effect of comparison with multiple prior mammograms on the outcomes of screening mammography relative to comparison with a single prior mammogram. MATERIALS AND METHODS We retrospectively analyzed 46,288 consecutive screening mammograms performed at our institution for 22,792 women. We divided these examinations into three groups: those interpreted without comparison with prior mammograms, those interpreted in comparison with one prior examination, and those interpreted in comparison with two or more prior examinations. For each group, we determined the rate of examination recall. We also calculated the positive predictive value of recall (i.e., positive predictive value level 1 [PPV1]) and the cancer detection rate (CDR) for both the group of examinations compared with a single prior mammogram and the group compared with multiple prior mammograms. Generalized estimating equations with the logistic link function were used to determine the relative odds ratio of recall as a function of the number of comparisons, with adjustment made for age as a confounding variable. The Fisher exact test was performed to compare the PPV1 and the CDR in the different cohorts. RESULTS The recall rate for mammograms interpreted without comparison with prior examinations was 16.6%, whereas that for mammograms compared with one prior examination was 7.8% and that for mammograms compared with two or more prior examinations was 6.3%. After adjustment was made for age, the odds ratio of recall for the group with multiple prior examinations relative to the group with a single prior examination was 0.864 (95% CI, 0.776-0.962; p = 0.0074). Statistically significant increases in the PPV1 of 0.05 (p = 0.0009) and in the CDR of 2.3 cases per 1000 examinations (p = 0.0481) were also noted for mammograms compared with multiple prior examinations relative to those compared with a single prior examination. CONCLUSION Comparison with two or more prior mammograms resulted in a statistically significant reduction in the screening mammography recall rate and increases in the CDR and PPV1 relative to comparison with a single prior mammogram.
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Racial differences in false-positive mammogram rates: results from the ACRIN Digital Mammographic Imaging Screening Trial (DMIST). Med Care 2015; 53:673-8. [PMID: 26125419 DOI: 10.1097/mlr.0000000000000393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mammography screening reduces breast cancer mortality, but false-positive tests are common. Few studies have assessed racial differences in false-positive rates. OBJECTIVES We compared false-positive mammography rates for black and white women, and the effect of patient and facility characteristics on false positives. RESEARCH DESIGN AND SUBJECTS A prospective cohort study. From a sample of the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST), we identified black/African American (N=3176) or white (N=26,446) women with no prior breast surgery or breast cancer. MEASURES Race, demographics, and breast cancer risk factors were self-reported. Results of initial digital and film mammograms were assessed. False positives were defined as a positive mammogram (Breast Imaging Reporting and Data System category 0, 4, 5) with no cancer diagnosis within 15 months. RESULTS The false-positive rate for digital mammograms was 9.2% for black women compared with 7.8% for white women (P=0.009). After adjusting for age, black women had 17% increased odds of false-positive digital mammogram compared with whites (OR=1.17; 95% CI, 1.01-1.35; P=0.033). This association was attenuated after adjusting for patient factors, prior films, and study site (OR=1.04; 95% CI, 0.91-1.20; P=0.561). There was no difference in the occurrence of false positives by race for film mammography. CONCLUSIONS Black women had higher frequency of false-positive digital mammograms explained by lack of prior films and study site.The variation in the disparity between the established technique (film) and the new technology (digital) raises the possibility that racial differences in screening quality may be greatest for new technologies.
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Othman E, Wang J, Sprague BL, Rounds T, Ji Y, Herschorn SD, Wood ME. Comparison of false positive rates for screening breast magnetic resonance imaging (MRI) in high risk women performed on stacked versus alternating schedules. SPRINGERPLUS 2015; 4:77. [PMID: 25741458 PMCID: PMC4340856 DOI: 10.1186/s40064-015-0793-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/05/2015] [Indexed: 11/25/2022]
Abstract
Purpose Breast MRI added to mammography increases screening sensitivity for high-risk women but false-positive (FP) rates are higher and the optimal screening schedule for coordination with mammography is unclear. We compare rates of FP MRI when studies were performed on two different schedules. Patients and methods High-risk women at the University of Vermont who had at least 1 MRI and 1 mammogram performed within one year between 2004–2012 were eligible for inclusion in this study. Screening was considered stacked if both studies were performed within 90 days and alternating if studies were 4–8 months apart. False positive was defined in one of three ways. Results 137 women had screening which met inclusion criteria and 371 MRIs were reviewed. The FP rates were similar for the two schedules when considering BI-RAD 4, 5, 0 or biopsy as a positive test. FP rates were significantly higher for the stacked schedule (18.2 vs. 10.2%, p = 0.026) when considering BI-RADS 3-4-5-0 as positive test, due to the elevated rate of BI-RADS 3 assessments among stacked exams. Conclusion False positive rates differ based on the type of exam (baseline or subsequent) and definition of positive but do not differ based on imaging schedule (stacked or alternating); suggesting that women and their providers may choose the imaging schedule they prefer. This is significant as a randomized clinical trial comparing the two schedules is not likely to be performed, given the high cost and large number of women needed for such a study.
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Affiliation(s)
- Edress Othman
- Department of Medicine, University of Vermont, Burlington, VT USA
| | - Jue Wang
- Division of Biostatistics, University of Texas Health Science Center, Austin, TX USA
| | - Brian L Sprague
- Department of Surgery, Vermont Cancer Center, University of Vermont, Burlington, VT USA
| | - Tiffany Rounds
- Department of Medicine, University of Vermont, Burlington, VT USA
| | - YongLi Ji
- Department of Medicine, University of Vermont, Burlington, VT USA
| | | | - Marie E Wood
- Department of Medicine, University of Vermont, Burlington, VT USA
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van der Gijp A, van der Schaaf MF, van der Schaaf IC, Huige JCBM, Ravesloot CJ, van Schaik JPJ, Ten Cate TJ. Interpretation of radiological images: towards a framework of knowledge and skills. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2014; 19:565-80. [PMID: 24449126 DOI: 10.1007/s10459-013-9488-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/26/2013] [Indexed: 05/19/2023]
Abstract
The knowledge and skills that are required for radiological image interpretation are not well documented, even though medical imaging is gaining importance. This study aims to develop a comprehensive framework of knowledge and skills, required for two-dimensional and multiplanar image interpretation in radiology. A mixed-method study approach was applied. First, a literature search was performed to identify knowledge and skills that are important for image interpretation. Three databases, PubMed, PsycINFO and Embase, were searched for studies using synonyms of image interpretation skills or visual expertise combined with synonyms of radiology. Empirical or review studies concerning knowledge and skills for medical image interpretation were included and relevant knowledge and skill items were extracted. Second, a preliminary framework was built and discussed with nine selective experts in individual semi-structured interviews. The expert team consisted of four radiologists, one radiology resident, two education scientists, one cognitive psychologist and one neuropsychologist. The framework was optimised based on the experts comments. Finally, the framework was applied to empirical data, derived from verbal protocols of ten clerks interpreting two-dimensional and multiplanar radiological images. In consensus meetings adjustments were made to resolve discrepancies of the framework with the verbal protocol data. We designed a framework with three main components of image interpretation: perception, analysis and synthesis. The literature study provided four knowledge and twelve skill items. As a result of the expert interviews, one skill item was added and formulations of existing items were adjusted. The think-aloud experiment showed that all knowledge items and three of the skill items were applied within all three main components of the image interpretation process. The remaining framework items were apparent only within one of the main components. After combining two knowledge items, we finally identified three knowledge items and thirteen skills, essential for image interpretation by trainees. The framework can serve as a guideline for education and assessment of two- and three-dimensional image interpretation. Further validation of the framework in larger study groups with different levels of expertise is needed.
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Affiliation(s)
- A van der Gijp
- Radiology Department, E01.132, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands,
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Soh BP, Lee WB, McEntee MF, Kench PL, Reed WM, Heard R, Chakraborty DP, Brennan PC. Mammography test sets: reading location and prior images do not affect group performance. Clin Radiol 2014; 69:397-402. [PMID: 24418670 DOI: 10.1016/j.crad.2013.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/29/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
Abstract
AIM To examine how the location where reading takes place and the availability of prior images can affect performance in breast test-set reading. MATERIALS AND METHODS Under optimized viewing conditions, 10 expert screen readers each interpreted a reader-specific set of images containing 200 mammographic cases. Readers, randomly divided into two groups read images under one of two pairs of conditions: clinical read with prior images and laboratory read with prior images; laboratory read with prior images and laboratory read without prior images. Region-of-interest (ROI) figure-of-merit (FOM) was analysed using JAFROC software. Breast side-specific sensitivity and specificity were tested using Wilcoxon matched-pairs signed rank tests. Agreement between pairs of readings was measured using Kendall's coefficient of concordance. RESULTS Group performances between test-set readings demonstrated similar ROI FOMs, sensitivity and specificity median values, and acceptable levels of agreement between pairs of readings were shown (W = 0.75-0.79, p < 0.001) for both pairs of reading conditions. On an individual reader level, two readers demonstrated significant decreases (p < 0.05) in ROI FOMs when prior images were unavailable. Reading location had an inconsistent impact on individual performance. CONCLUSION Reading location and availability of prior images did not significantly alter group performance.
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Affiliation(s)
- B P Soh
- Medical Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, University of Sydney, Sydney, NSW, Australia; Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
| | - W B Lee
- Cancer Institute NSW, Alexandria, NSW, Australia
| | - M F McEntee
- Medical Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, University of Sydney, Sydney, NSW, Australia
| | - P L Kench
- Medical Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, University of Sydney, Sydney, NSW, Australia
| | - W M Reed
- Medical Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, University of Sydney, Sydney, NSW, Australia
| | - R Heard
- Medical Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, University of Sydney, Sydney, NSW, Australia
| | - D P Chakraborty
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - P C Brennan
- Medical Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, University of Sydney, Sydney, NSW, Australia
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Yankaskas BC, May RC, Matuszewski J, Bowling JM, Jarman MP, Schroeder BF. Effect of observing change from comparison mammograms on performance of screening mammography in a large community-based population. Radiology 2011; 261:762-70. [PMID: 22031709 DOI: 10.1148/radiol.11110653] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of comparison mammograms on accuracy, sensitivity, specificity, positive predictive value (PPV(1)), and cancer detection rate (CDR) of screening mammography to determine the role played by identification of change on comparison mammograms. MATERIALS AND METHODS This HIPAA-compliant and institutional review board-approved prospective study was performed with waiver of patient informed consent. A total of 1,157,980 screening mammograms obtained between 1994 and 2008 in 435,183 women aged at least 40 years were included. Radiologists recorded presence of comparison mammograms and change, if seen. Women were followed for 1 year to monitor cancer occurrence. Performance measurements were calculated for screening with comparison mammograms versus screening without comparison mammograms and for screening with comparison mammograms that showed a change versus screening with comparison mammograms that did not show a change while controlling for age, breast density, and data clustering. RESULTS Comparison mammograms were available in 93% of examinations. For screening with comparison mammograms versus screening without comparison mammograms, CDR per 1000 women was 3.7 versus 7.1; recall rate, 6.9% versus 14.9%; sensitivity, 78.9% versus 87.4%; specificity, 93.5% versus 85.7%; and PPV(1), 5.4% versus 4.8%. For screening with comparison mammograms that showed a change versus screening with comparison mammograms that did not show a change, CDR per 1000 women was 25.4 versus 0.8; recall rate, 41.4% versus 2.0%; sensitivity, 96.6% versus 43.5%; specificity, 60.4% versus 98.1%; and PPV(1), 6.0% versus 3.9%. Detected cancers with change were 21.1% ductal carcinoma in situ and 78.9% invasive carcinoma. Detected cancers with no change were 19.3% ductal carcinoma in situ and 80.7% invasive carcinoma. CONCLUSION Performance is affected when change from comparison mammograms is noted. Without change, sensitivity is low and specificity is high. With change, sensitivity is high, with a high false-positive rate (low specificity). Further work is needed to appreciate changes that might indicate cancer and to identify changes that are likely not indicative of cancer.
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Affiliation(s)
- Bonnie C Yankaskas
- Carolina Mammography Registry, Department of Radiology, University of North Carolina School of Medicine, Mason Farm Rd, CB 7515, Chapel Hill, NC 27599-7515, USA.
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Roberts-Klein S, Iuanow E, Slanetz PJ. Avoiding pitfalls in mammographic interpretation. Can Assoc Radiol J 2010; 62:50-9. [PMID: 20832240 DOI: 10.1016/j.carj.2010.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 07/14/2010] [Accepted: 07/16/2010] [Indexed: 10/19/2022] Open
Abstract
There is a public misconception that screening mammography detects all breast malignancies. The objective of this pictorial essay is to review classic mammographic features of malignancy that, if missed, could potentially result in malpractice litigation. By identifying radiologic themes, we attempt to improve awareness about the imaging characteristics of a variety of subtle malignancies.
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Affiliation(s)
- Shayna Roberts-Klein
- Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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The detection of small invasive breast cancers by mammography. Breast Cancer 2010. [DOI: 10.1017/cbo9780511676314.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Should previous mammograms be digitised in the transition to digital mammography? Eur Radiol 2009; 19:1890-6. [DOI: 10.1007/s00330-009-1366-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
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Timp S, Varela C, Karssemeijer N. Temporal change analysis for characterization of mass lesions in mammography. IEEE TRANSACTIONS ON MEDICAL IMAGING 2007; 26:945-53. [PMID: 17649908 DOI: 10.1109/tmi.2007.897392] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In this paper, we present a fully automated computer-aided diagnosis (CAD) program to detect temporal changes in mammographic masses between two consecutive screening rounds. The goal of this work was to improve the characterization of mass lesions by adding information about the tumor behavior over time. Towards this goal we previously developed a regional registration technique that finds for each mass lesion on the current view a location on the prior view where the mass was most likely to develop. For the task of interval change analysis, we designed two kinds of temporal features: difference features and similarity features. Difference features indicate the (relative) change in feature values determined on prior and current views. These features may be especially useful for lesions that are visible on both views. Similarity features measure whether two regions are comparable in appearance and may be useful for lesions that are visible on the prior view as well as for newly developing lesions. We evaluated the classification performance with and without the use of temporal features on a dataset consisting of 465 temporal mammogram pairs, 238 benign, and 227 malignant. We used cross validation to partition the dataset into a training set and a test set. The training set was used to train a support vector machine classifier and the test set to evaluate the classifier. The average A(z) value (area under the receiver operating characteristic curve) for classifying each lesion was 0.74 without temporal features and 0.77 with the use of temporal features. The improvement obtained by adding temporal features was statistically significant (P = 0.005). In particular, similarity features contributed to this improvement. Furthermore, we found that the improvement was comparable for masses that were visible and for masses that were not visible on the prior view. These results show that the use of temporal features is an effective approach to improve the characterization of masses.
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Roelofs AAJ, Karssemeijer N, Wedekind N, Beck C, van Woudenberg S, Snoeren PR, Hendriks JHCL, Rosselli del Turco M, Bjurstam N, Junkermann H, Beijerinck D, Séradour B, Evertsz CJG. Importance of Comparison of Current and Prior Mammograms in Breast Cancer Screening. Radiology 2007; 242:70-7. [PMID: 17185661 DOI: 10.1148/radiol.2421050684] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively determine the influence of comparing current mammograms with prior mammograms on breast cancer detection in screening and to investigate a protocol in which prior mammograms are viewed only when necessary. MATERIALS AND METHODS Institutional review board approval was not required. Participants gave written informed consent. Twelve experienced screening radiologists read 160 soft-copy screening mammograms twice, once with and once without prior mammograms. Eighty mammograms were obtained in women in whom breast cancer was diagnosed later; the other 80 mammograms had been reported as normal or benign. All cancers were visible in retrospect. Readers located potential abnormalities, estimated likelihood of malignancy for each finding, and indicated whether prior mammograms were considered necessary. The effect of prior mammograms on detection was determined by computing the mean lesion localized fraction in a range of low fractions of nonlesion locations corresponding to operating points in screening. Scores for both reading sessions were combined to assess the effect of making prior mammograms available only when requested. Data were analyzed by comparing the number of localized lesions between the two reading conditions with a paired two-tailed Student t test and applying a linear mixed model to test differences in average mean lesion localized fraction between reading conditions. P values less than .05 indicated statistical significance. RESULTS Without prior mammograms, significantly more annotations were made. When only positive cases were considered, no difference was observed. Reading performance was significantly better when prior screening mammograms were available. At fixed lesion localized fraction, nonlesion localized fraction was reduced by 44% (P<.001) on average when prior mammograms were read. Performance was also increased for combined reading mode (ie, when prior mammograms were available on request only). However, this increase was smaller than that when prior mammograms were always available. Prior mammograms were requested in 24%-33% of all cases and were requested more often in positive cases. CONCLUSION Comparison with prior mammograms significantly improves overall performance and can reduce referrals due to nonlesion locations. Limiting the availability of prior mammograms to cases selected by the reader reduces the beneficial effect of prior mammograms.
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Affiliation(s)
- Antonius A J Roelofs
- Department of Radiology, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 667 Radiology, 6500 HB Nijmegen, the Netherlands.
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Lakhani P, Menschik ED, Goldszal AF, Murray JP, Weiner MG, Langlotz CP. Development and validation of queries using structured query language (SQL) to determine the utilization of comparison imaging in radiology reports stored on PACS. J Digit Imaging 2006; 19:52-68. [PMID: 16132483 PMCID: PMC3043946 DOI: 10.1007/s10278-005-7667-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The purpose of this research was to develop queries that quantify the utilization of comparison imaging in free-text radiology reports. The queries searched for common phrases that indicate whether comparison imaging was utilized, not available, or not mentioned. The queries were iteratively refined and tested on random samples of 100 reports with human review as a reference standard until the precision and recall of the queries did not improve significantly between iterations. Then, query accuracy was assessed on a new random sample of 200 reports. Overall accuracy of the queries was 95.6%. The queries were then applied to a database of 1.8 million reports. Comparisons were made to prior images in 38.69% of the reports (693,955/1,793,754), were unavailable in 18.79% (337,028/1,793,754), and were not mentioned in 42.52% (762,771/1,793,754). The results show that queries of text reports can achieve greater than 95% accuracy in determining the utilization of prior images.
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Affiliation(s)
- Paras Lakhani
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | | | | | | | - Mark G. Weiner
- Department of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Curtis P. Langlotz
- Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
- 719 Iron Post Road, Moorestown, NJ 08057 USA
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Blanchard K, Colbert JA, Kopans DB, Moore R, Halpern EF, Hughes KS, Smith BL, Tanabe KK, Michaelson JS. Long-term risk of false-positive screening results and subsequent biopsy as a function of mammography use. Radiology 2006; 240:335-42. [PMID: 16864665 DOI: 10.1148/radiol.2402050107] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively determine the long-term risk of false-positive mammographic assessments and to evaluate the effect of screening regularity on the risk of false-positive events. MATERIALS AND METHODS Institutional review board approval was obtained, and informed consent was waived. Retrospective analysis was performed for the occurrence of false-positive assessments among 83,511 women who underwent 314,185 mammographic examinations from January 1, 1985, to February 19, 2002. Data were collected from a database that had been assembled prospectively. Two categories of false-positive events were examined: biopsies that did not reveal cancer and false-positive mammographic assessments. Rates of false-positive events were compared by using a chi2 analysis, and 95% confidence limits were calculated. Because comparisons of multiple pairs were considered, all P values that demonstrated statistical significance exceeded the requirement of the Bonferroni correction. RESULTS While the overall rates of biopsies that did not reveal cancer and of false-positive mammographic assessments were similar to those found in other studies, most of the burden of false-positive events was borne by women who underwent intermittent screening. Long-term rates of false-positive events were lower among women who underwent regular screening than among those who underwent intermittent screening. In the 5-year group, 2.9% of women who underwent five mammographic examinations over the next 5 years had biopsy results that did not reveal cancer, whereas 4.6% of women who underwent three mammographic examinations over the next 5 years had biopsy results that did not reveal cancer. For women who underwent regular screening, the risk of undergoing biopsies that did not reveal cancer declined over time to 0.25% per year after several years of screening, a value that is lower than the risk of these events among women who did not undergo screening. The rate of false-positive mammographic assessments was also lower for women who underwent regular screening than for those who underwent intermittent screening. CONCLUSION Prompt annual attendance for mammographic screening reduces the occurrence of false-positive mammographic results.
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Affiliation(s)
- Karen Blanchard
- Department of Surgery, Massachusetts General Hospital, Yawkey 7939, 55 Fruit St, Boston, MA 02114, USA
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Holt JJ. Evaluating Radiological Technologist's Ability to Detect Abnormalities in Film-Screen Mammographic Images: A Decision Analysis Pilot Project. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0820-5930(09)60133-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Yankaskas BC, Gill KS. Diagnostic mammography performance and race: outcomes in Black and White women. Cancer 2006; 104:2671-81. [PMID: 16288489 DOI: 10.1002/cncr.21550] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A previous study compared the performance (sensitivity, specificity, positive predictive value, and cancer detection rate) of screening mammography in Black and White women. No study, to the authors' knowledge, has evaluated the difference in the performance of diagnostic mammography between Black and White women. METHODS Univariate analysis was used to evaluate differences in characteristics and cancers between Black and White women. Stratified and adjusted logistic regression analyses were used to test the association of Black and White race with performance measures of diagnostic mammography. RESULTS The sensitivity of diagnostic mammography was higher (91% vs. 84%) and specificity was lower (86% vs. 90%) among Black women compared with White women. After controlling for age, density, self-reported breast problems, and previous mammography, sensitivity was significantly higher (odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.22-2.80) and specificity was significantly lower (OR = 0.75, 95% CI = 0.70-0.81) among Black women. The crude cancer detection rate of mammography was higher for Black women (42.6/1000) than for White women (31.0/1000) and Black women had a higher proportion of cancers that were > 2.0 cm (57.4% vs. 46.2%) that were more often poorly differentiated (61.7% vs. 49.3%) and were more often estrogen-receptor and progesterone-receptor negative. CONCLUSIONS Black women have lower specificity of diagnostic mammography and, consequently, more unnecessary workups than White women. Black women have higher sensitivity of diagnostic mammography, with cancers that are larger and more advanced than White women. Delay in responding to signs and symptoms would explain the size and later stage. However, more research is needed to understand the biologic differences of breast cancer characteristics between Black and White women.
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Affiliation(s)
- Bonnie C Yankaskas
- Department of Radiology, University of North Carolina, Chapel Hill, 27599, USA.
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21
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Varela C, Karssemeijer N, Hendriks JHCL, Holland R. Use of prior mammograms in the classification of benign and malignant masses. Eur J Radiol 2005; 56:248-55. [PMID: 15890483 DOI: 10.1016/j.ejrad.2005.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 04/08/2005] [Accepted: 04/11/2005] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine the importance of using prior mammograms for classification of benign and malignant masses. Five radiologists and one resident classified mass lesions in 198 mammograms obtained from a population-based screening program. Cases were interpreted twice, once without and once with comparison of previous mammograms, in a sequential reading order using soft copy image display. The radiologists' performances in classifying benign and malignant masses without and with previous mammograms were evaluated with receiver operating characteristic (ROC) analysis. The statistical significance of the difference in performances was calculated using analysis of variance. The use of prior mammograms improved the classification performance of all participants in the study. The mean area under the ROC curve of the readers increased from 0.763 to 0.796. This difference in performance was statistically significant (P = 0.008).
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Affiliation(s)
- Celia Varela
- Radboud University Medical Centre Nijmegen, Department of Radiology, Geert Grooteplein 18, 6525 GA Nijmegen, The Netherlands
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22
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Timp S, van Engeland S, Karssemeijer N. A regional registration method to find corresponding mass lesions in temporal mammogram pairs. Med Phys 2005; 32:2629-38. [PMID: 16193793 DOI: 10.1118/1.1984323] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this paper we develop an automatic regional registration method to find corresponding masses on prior and current mammograms. The method contains three steps. In the first, we globally align both images. Then, for each mass lesion on the current view, we define a search area on the prior view, which is likely to contain the same mass lesion. Third, at each location in this search area we calculate a registration measure to quantify how well this location matches the mass lesion on the current view. Finally we select the best location. To determine the performance of our method we compare it to several other registration methods. On a dataset of 389 temporal mass pairs our method correctly links 82% of prior and current mass lesions, whereas other methods achieve at most 72%.
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Affiliation(s)
- Sheila Timp
- Department of Radiology, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands.
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Burnside ES, Park JM, Fine JP, Sisney GA. The Use of Batch Reading to Improve the Performance of Screening Mammography. AJR Am J Roentgenol 2005; 185:790-6. [PMID: 16120936 DOI: 10.2214/ajr.185.3.01850790] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of our study was to prove that batch reading of screening mammograms can reduce recall rates without sacrificing cancer detection. MATERIALS AND METHODS We analyzed recall rate, cancer detection, minimal cancer detection, detection of low-stage cancer, and tumor size from consecutive screening mammography examinations from October 2001 to July 2003. The initial 7,984 mammograms were interpreted in the midst of a busy breast imaging practice. Although these studies were not read online, the interpretations were often interrupted for telephone calls, procedures, and diagnostic mammograms. The remaining 1,538 studies were interpreted after the institution of dedicated uninterrupted batch reading. RESULTS Recall rates were 20.1% before and 16.2% after the introduction of batch reading (p < 0.001). Cancer detection rates were not significantly different: 5.6 cancers were detected per 1,000 examinations without and 7.2 were detected per 1,000 with batch reading. Prognostic factors for breast cancers diagnosed between these groups also were not significantly different. Of the screening-detected cancers diagnosed before batch reading, minimal cancers comprised 67% and low-stage cancers accounted for 76%. Of the cancers diagnosed using batch reading, 73% were minimal and 91% were low stage. The mean size of cancers, 11.7 mm without batch reading and 9.1 mm with batch reading, also showed no statistically significant difference. CONCLUSION Our experience shows that batch reading can significantly reduce screening mammography recall rates without affecting the cancer detection rate or the proportion of cancers diagnosed with favorable prognostic indicators.
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Affiliation(s)
- Elizabeth S Burnside
- Breast Care Center, University of Wisconsin Medical School, Madison, WI 53792-1804, USA
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24
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Abstract
A successful screening mammography practice has three directives. The first directive is quality mammography interpretation, which results in detection of a high percentage of early stage breast cancers, an acceptable recall rate, and an acceptable biopsy rate and yield. The second directive is providing a cost-efficient service. The third directive is access for as many eligible women as possible. Strategies that have helped improve screening mammography access for underserved women are discussed in this article.
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Affiliation(s)
- Dione M Farria
- Breast Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St. Louis, MO 63110, USA.
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Skaane P, Skjennald A. Screen-film mammography versus full-field digital mammography with soft-copy reading: randomized trial in a population-based screening program--the Oslo II Study. Radiology 2004; 232:197-204. [PMID: 15155893 DOI: 10.1148/radiol.2321031624] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare cancer detection rates, recall rates, and positive predictive values at screen-film mammography (SFM) with those at full-field digital mammography (FFDM) with soft-copy reading in a population-based screening program in Norway. MATERIALS AND METHODS Of 43,429 women invited, 25,263 women aged 45-69 years attended the screening program and were randomized, with adjustments for age and area of residence, to undergo SFM or FFDM. Two standard views of each breast were acquired. Independent double reading was performed with use of a five-point rating scale for probability of cancer. Recall rates, positive predictive values, and cancer detection rates were compared for two age groups (45-49 and 50-69 years) by using the chi(2) test. RESULTS Overall, 73 cancers in 17,911 women were detected at SFM (detection rate, 0.41%), compared with 41 cancers in 6,997 women at FFDM (detection rate, 0.59%; P =.06). In the group aged 50-69 years, 56 cancers in 10,304 women were detected at SFM (detection rate, 0.54%), compared with 33 cancers in 3,985 at FFDM (detection rate, 0.83%); the difference in cancer detection rates approached significance (P =.053). In the group aged 45-49 years, 17 cancers in 7,607 women were detected at SFM (detection rate, 0.22%), compared with eight cancers in 3,012 at FFDM (detection rate, 0.27%). Recall rates in both age groups were significantly higher at FFDM than at SFM (P <.05), but positive predictive value was not significantly different. CONCLUSION FFDM allowed a higher cancer detection rate than did SFM in the group aged 50-69, although the difference did not reach statistical significance. The detection rate was nearly equal for the two modalities in the group aged 45-49. SFM and FFDM with soft-copy reading are comparable techniques for population-based screening mammography programs.
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Affiliation(s)
- Per Skaane
- Department of Radiology, Breast Imaging Center, Ullevaal University Hospital, Kirkeveien 166, N-0407 Oslo, Norway.
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Abstract
OBJECTIVE To investigate the causes of false positive in mammograms. DATA SOURCES Secondary data collected from extracts from computerized medical records from 1999 from five thousand patients at a single hospital in a medium-sized Southern city. STUDY DESIGN Retrospective analysis of electronic medical data on screening and diagnostic mammograms. Detection-controlled estimation (DCE) was used to compare the efficacy of alternative readers of mammogram films. Analysis was also conducted on follow-up exams of women who tested positive in the first stage of investigation. Key variables included whether the patient had had a prior mammogram, age of the patient, and identifiers for the individual physicians. DATA COLLECTION/EXTRACTION METHODS Hospital maintains electronic medical records (EMR) on all patients. Extracts were performed on this EMR system under the guidance of clinical expertise. Data were collected for all women who had mammograms in 1999. Random samples were employed for screening mammograms, and all data was used for diagnostic mammograms. PRINCIPAL FINDINGS Study results imply that access to a previous mammogram greatly reduces the incidence of false positives readings. This has important consequences for benefit-cost, and cost-effectiveness analysis of mammography. Were previous mammograms always available, the results imply the number of false positives would decrease by at least half. The results here also indicate that there is no reason to believe this decrease in false positive would be accompanied by an increase in the number of false negatives. Other attributes also affected the number of false positives. Mondays and Wednesdays appear to be more prone to false positives than the other days in the week. There is also some disparity in false positive outcomes among the five physicians studied. With respect to detection-controlled estimation, the results are mixed. With follow-up data, the DCE estimator appears to generate reasonable, robust results. Without follow-up data, however, the DCE estimator is far less precise. CONCLUSIONS Study results imply that access to a previous mammogram reduces by at least half the incidence of false positives readings. This has important consequences for benefit-cost, and cost-effectiveness analysis of mammography.
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Affiliation(s)
- Andrew N Kleit
- Center for Health Care Policy and Research, The Pennsylvania State University, University Park, PA 16803, USA
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Zheng B, Good WF, Armfield DR, Cohen C, Hertzberg T, Sumkin JH, Gur D. Performance change of mammographic CAD schemes optimized with most-recent and prior image databases. Acad Radiol 2003; 10:283-8. [PMID: 12643555 DOI: 10.1016/s1076-6332(03)80102-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES The authors evaluated performance changes in the detection of masses on "current" (latest) and "prior" images by computer-aided diagnosis (CAD) schemes that had been optimized with databases of current and prior mammograms. MATERIALS AND METHODS The authors selected 260 pairs of matched consecutive mammograms. Each current image depicted one or two verified masses. All prior images had been interpreted originally as negative or probably benign. A CAD scheme initially detected 261 mass regions and 465 false-positive regions on the current images, and 252 corresponding mass regions (early signs) and 471 false-positive regions on prior images. These regions were divided into two training and two testing databases. The current and prior training databases were used to optimize two CAD schemes with a genetic algorithm. These schemes were evaluated with two independent testing databases. RESULTS The scheme optimized with current images produced areas under the receiver operating characteristic curve of (0.89 +/- 0.01 and 0.65 +/- 0.02 when tested with current images and prior images, respectively. The scheme optimized with prior images produced areas under the receiver operating characteristic curve of 0.81 +/- 0.02 and 0.71 +/- 0.02 when tested with current images and prior images, respectively. Performance changes for both current and prior testing databases were significant (P < .01) for the two schemes. CONCLUSION CAD schemes trained with current images do not perform optimally in detecting masses depicted on prior images. To optimize CAD schemes for early detection, it may be important to include in the training database a large fraction of prior images originally reported as negative and later proven to be positive.
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Affiliation(s)
- Bin Zheng
- Department of Radiology, University of Pittsburgh and Magee-Womens Hospital, 300 Halket St, Suite 4200, Pittsburgh, PA 15213-3180, USA
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Sumkin JH, Holbert BL, Herrmann JS, Hakim CA, Ganott MA, Poller WR, Shah R, Hardesty LA, Gur D. Optimal reference mammography: a comparison of mammograms obtained 1 and 2 years before the present examination. AJR Am J Roentgenol 2003; 180:343-6. [PMID: 12540430 DOI: 10.2214/ajr.180.2.1800343] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We assessed and compared the benefit of using images acquired 1 year or 2 years previously during mammography interpretations. MATERIALS AND METHODS Eleven radiologists and one resident reviewed 128 cases three times: once without prior mammograms for comparison, once with mammograms from the most recent (1 year) examination, and once with mammograms acquired 2 years previously. They were asked to determine whether the patient should be recalled for additional procedures. Performances under the three conditions were compared. RESULTS Radiologists were significantly more accurate (p < 0.001) when comparison mammograms (obtained 1 or 2 years previously) were available. Although sensitivity was not significantly affected between the availability of mammograms from 1 or 2 years earlier (p > 0.10), the specificity was. Specificity using mammograms from the latest examination (obtained 1 year previously) as a reference was significantly better (p = 0.03) than specificity using mammograms obtained 2 years previously. CONCLUSION Comparison mammograms are important for accurate diagnosis-in particular, for increasing specificity. The latest prior examination seems to be the optimal one for this purpose.
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Affiliation(s)
- Jules H Sumkin
- Department of Radiology, Imaging Research, Ste. 4200, University of Pittsburgh and Magee-Womens Hospital, 300 Halket St., Pittsburgh, PA 15213, USA
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Burnside ES, Sickles EA, Sohlich RE, Dee KE. Differential value of comparison with previous examinations in diagnostic versus screening mammography. AJR Am J Roentgenol 2002; 179:1173-7. [PMID: 12388494 DOI: 10.2214/ajr.179.5.1791173] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to analyze the differences in clinical outcomes of diagnostic and screening mammography depending on whether comparison is made with previous examinations. MATERIALS AND METHODS We analyzed 48,281 consecutive mammography examinations for which previous mammography (9825 diagnostic, 38,456 screening) had been performed between 1997 and 2001, collecting data on demographics, whether comparison actually was made with previous examinations, abnormal findings (recall for screening mammography or biopsy recommendation for diagnostic mammography), biopsy yield of cancer, cancer detection rate, size of invasive cancers, axillary nodal status, and cancer stage. RESULTS Comparison with previous examinations in the incidence screening setting decreases the recall rate from 4.9% to 3.8% (p < 0.0001) but does not significantly affect the biopsy yield (40-44%, p = 0.56) or the cancer detection rate (5.5-5.2/1000, p = 0.87). In the diagnostic setting, comparison with previous examinations increases the biopsy-recommended rate from 4.3% to 9.4% (p < 0.0001), the biopsy yield from 38% to 51% (p = 0.12), and the overall cancer detection rate from 11/1000 to 39/1000 (p < 0.0001). Comparison with previous examinations is not associated with a significant difference in mean tumor size. However, it is associated with a significant decrease in the frequency of axillary node metastasis and the cancer stage for screening mammography, but not for diagnostic mammography. CONCLUSION For screening mammography, comparison with previous examinations significantly decreases false-positive but not true-positive findings and permits detection of cancers at an earlier stage. For diagnostic mammography, comparison with previous examinations increases true-positive findings.
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Affiliation(s)
- Elizabeth S Burnside
- Department of Radiology, Box 1667, University of California School of Medicine, San Francisco, CA 94143-1667, USA
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Sickles EA, Wolverton DE, Dee KE. Performance parameters for screening and diagnostic mammography: specialist and general radiologists. Radiology 2002; 224:861-9. [PMID: 12202726 DOI: 10.1148/radiol.2243011482] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate performance parameters for radiologists in a practice of breast imaging specialists and general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic mammographic studies. MATERIALS AND METHODS Data (ie, patient age; family history of breast cancer; availability of previous mammograms for comparison; and abnormal interpretation, cancer detection, and stage 0-I cancer detection rates) were derived from review of mammographic studies obtained from January 1997 through August 2001. The breast imaging specialists have substantially more initial training in mammography and at least six times more continuing education in mammography, and they interpret 10 times more mammographic studies per year than the general radiologists. Differences between specialist and general radiologist performances at both screening and diagnostic examinations were assessed for significance by using Student t and chi(2) tests. RESULTS The study involved 47,798 screening and 13,286 diagnostic mammographic examinations. Abnormal interpretation rates for screening mammography (ie, recall rate) were 4.9% for specialists and 7.1% for generalists (P <.001); and for diagnostic mammography (ie, recommended biopsy rate), 15.8% and 9.9%, respectively (P <.001). Cancer detection rates at screening mammography were 6.0 cancer cases per 1,000 examinations for specialists and 3.4 per 1,000 for generalists (P =.007); and at diagnostic mammography, 59.0 per 1,000 and 36.6 per 1,000, respectively (P <.001). Stage 0-I cancer detection rates at screening mammography were 5.3 cancer cases per 1,000 examinations for specialists and 3.0 per 1,000 for generalists (P =.012); and at diagnostic mammography, 43.9 per 1,000 and 27.0 per 1,000, respectively (P <.001). CONCLUSION Specialist radiologists detect more cancers and more early-stage cancers, recommend more biopsies, and have lower recall rates than general radiologists.
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Affiliation(s)
- Edward A Sickles
- Department of Radiology, University of California (UCSF) Medical Center, Box 1667, San Francisco 94143-1667, USA
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31
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O’driscoll D, Wallis M, Duncan A. Current practice regarding reading previous films in the NHS Breast Screening Programme. Radiography (Lond) 2002. [DOI: 10.1053/radi.2001.0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Quekel LG, Goei R, Kessels AG, van Engelshoven JM. Detection of lung cancer on the chest radiograph: impact of previous films, clinical information, double reading, and dual reading. J Clin Epidemiol 2001; 54:1146-50. [PMID: 11675166 DOI: 10.1016/s0895-4356(01)00382-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To study the impact of clinical information, previous chest radiographs, double reading (one pair of observers read the films independently) and dual reading (one pair of observers read the films simultaneously) on the sensitivity, specificity and odds ratios of observers in the detection of early lung cancer on the chest radiograph. The study was performed in 3 sessions. In the first session, 14 observers reviewed the chest radiographs of 100 cases (30 with early lung cancer, 35 with no abnormalities, 35 with other cardiopulmonary diseases). Sensitivity, specificity, odds ratios and the effect of double reading were calculated. After 4 months, a second session was held in which 7 observers reviewed all cases with the provision of all information. The other 7 observers reviewed all cases without information again. To determine the effect of dual reading, in the third session, 4 pairs of observers reviewed all cases in which they disagreed in the first independent reading session. The effects of information, double reading and dual reading on sensitivity, specificity and odds ratio were calculated. The sensitivity of the observers in the first session ranged from 0.20 to 0.60 and the specificity from 0.87 to 0.95. In the second session, these parameters changed only slightly, independent from the availability of clinical information and previous films. With double reading the sensitivity increased and specificity decreased. With dual reading sensitivity increased and specificity remained unchanged. The odds ratios were improved with double reading by 4% and with the dual reading by 14%. Additional clinical information, previous chest radiographs, double reading and dual reading have little impact on the detection of early lung cancer on the chest radiograph.
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Affiliation(s)
- L G Quekel
- Department of Radiology, Atrium Medical Centre, Heerlen, The Netherlands
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Abstract
Several approaches to mammographic interpretation and breast imaging management have been developed that substantially reduce the frequency of false-positive cases, involving both recall examinations and biopsies, without meaningfully reducing the detection of nonpalpable favorable-prognosis cancers. By applying these approaches successfully, on a nationwide scale, radiologists should be able to demonstrate convincingly that the benefits of mammography far outweigh the risks of false-positive interpretations. The challenge we face is to learn to use the approaches effectively, thereby achieving widespread use.
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Affiliation(s)
- E A Sickles
- Department of Radiology, University of California Medical Center, San Francisco, USA
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34
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Abstract
Breast cancer is the most common malignancy among women in the United States; however, recent data demonstrates a decline in the mortality rate, which may be attributed to early detection from screening programs combined with effective therapies for early stage disease. As a result of the prevalence of breast cancer and its association with highly emotional issues, screening recommendations have aroused debate in the scientific, public, and legislative domains. A general consensus supports breast cancer screening among women between the ages of 50 and 70; however, much controversy exists regarding screening for women age 40 to 49 or above age 70. This article explores the issues involved in determining breast cancer screening recommendations among asymptomatic women with average risk in the United States.
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Affiliation(s)
- B Overmoyer
- Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve School of Medicine, Ohio, USA
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35
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Leichter I, Lederman R, Bamberger P, Novak B, Fields S, Buchbinder SS. The use of an interactive software program for quantitative characterization of microcalcifications on digitized film-screen mammograms. Invest Radiol 1999; 34:394-400. [PMID: 10353031 DOI: 10.1097/00004424-199906000-00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Mammography is relatively nonspecific for the early detection of breast cancer. This study evaluates the accuracy of mammographic interpretation using quantitative features characterizing microcalcifications, which are extracted by a computerized system. METHODS A computer-aided diagnosis (CAD) system enabling digitization of film-screen mammograms and automatic feature extraction was developed. A classification scheme (discriminant analysis) based on these features was constructed and trained on 217 cases with known pathology. The diagnostic performance of the classification scheme was tested against the radiologist's conventional interpretation on 45 additional cases of microcalcifications, each analyzed independently by four radiologists. RESULTS The sensitivity of the CAD system analysis (95.7%) was significantly better than that of conventional interpretation (84.8%). The positive predictive value of interpretation increased significantly, as did the area under the receiver operating characteristic curve. CONCLUSIONS This classification scheme for microcalcifications, based on quantitative features characterizing the lesion, significantly improved the accuracy of mammographic interpretation.
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Affiliation(s)
- I Leichter
- Department of Electro-Optics, Jerusalem College of Technology, Israel
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