Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome.

Abstract

OBJECTIVES:

To determine the value of adding a third reader for arbitration of discrepant screening mammography assessments.

METHODS:

We included a consecutive series of 84,927 digital screening mammograms, double read in a blinded or non-blinded fashion. Arbitration was retrospectively performed by a third screening radiologist. Two years' follow-up was performed.

RESULTS:

Discrepant readings comprised 57.2% (830/1452) and 29.1% (346/1188) of recalls at blinded and non-blinded double readings, respectively. At blinded double reading, arbitration would have decreased recall rate (3.4 to 2.2%, p < 0.001) and programme sensitivity (83.2 to 76.0%, p = 0.013), would not have influenced the cancer detection rate (CDR; 7.5 to 6.8 per 1,000 screens, p = 0.258) and would have increased the positive predictive value of recall (PPV; 22.3 to 31.2%, p < 0.001). At non-blinded double reading, arbitration would have decreased recall rate (2.8 to 2.3%, p < 0.001) and increased PPV (23.2 to 27.5%, p = 0.021), but would not have affected CDR (6.6 to 6.3 per 1,000 screens, p = 0.604) and programme sensitivity (76.0 to 72.7%, p = 0.308).

CONCLUSION:

Arbitration of discrepant screening mammography assessments is a good tool to improve recall rate and PPV, but is not desirable as it reduces the programme sensitivity at blinded double reading.

KEY POINTS:

• Blinded double reading results in higher programme sensitivity than non-blinded reading. • Discrepant readings occur more often at blinded compared to non-blinded reading. • Arbitration of discrepant readings reduces the recall rate and PPV. • Arbitration would reduce the programme sensitivity at blinded double reading.

• Authors: Elisabeth G Klompenhouwer, Adri C Voogd, Gerard J den Heeten, Luc J A Strobbe, Vivianne C Tjan-Heijnen, Mireille J M Broeders, Lucien E M Duijm
• Journal: European radiology (Eur Radiol) Vol. 25 Issue 10 Pg. 2821-9 (Oct 2015) ISSN: 1432-1084 [Electronic] Germany
• PMID: 25894007 (Publication Type: Comparative Study, Journal Article, Multicenter Study)

Topics

• Aged
• Breast Neoplasms (diagnostic imaging)
• Delayed Diagnosis
• Double-Blind Method
• Early Detection of Cancer (methods, standards)
• Female
• Humans
• Mammography (methods, standards)
• Mass Screening (methods)
• Middle Aged
• Negotiating
• Observer Variation
• Retrospective Studies