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2–12 Performance Benchmarks for Screening Mammography
2–12
Performance Benchmarks for Screening Mammography Rosenberg RD, Yankaskas BC, Abraham LA, et al (Univ of New Mexico, Albuquerque; Univ of North Carolina, Chapel Hill; Group Health Ctr for Health Studies, Seattle; et al) Radiology 241:55-66, 2006
Purpose.—To retrospectively evaluate the range of performance outcomes of the radiologist in an audit of screening mammography by using a representative sample of U.S. radiologists to allow development of performance benchmarks for screening mammography. Materials and Methods.—Institutional review board approval was obtained, and study was HIPAA compliant. Informed consent was or was not obtained according to institutional review board guidelines. Data from 188 mammographic facilities and 807 radiologists obtained between 1996 and 2002 were analyzed from six registries from the Breast Cancer Surveillance Consortium (BCSC). Contributed data included demographic information, clinical findings, mammographic interpretation, and biopsy results. Measurements calculated were positive predictive values (PPVs) from screening mammography (PPV1), biopsy recommendation (PPV2), biopsy performed (PPV3), recall rate, cancer detection rate, mean cancer size, and cancer stage. Radiologist performance data are presented as 50th (median), 10th, 25th,
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75th, and 90th percentiles and as graphic presentations by using smoothed curves. Results.—There were 2 580 151 screening mammographic studies from 1 117 390 women (age range, <30 to ≥80 years). The respective means and ranges of performance outcomes for the middle 50% of radiologists were as follows: recall rate, 9.8% and 6.4%–13.3%; PPV1, 4.8% and 3.4%–6.2%; and PPV2, 24.6% and 18.8%–32.0%. Mean cancer detection rate was 4.7 per 1000, and the mean size of invasive cancers was 13 mm. The range of performance outcomes for the middle 80% of radiologists also was presented. Conclusion.—Community screening mammographic performance measurements of cancer outcomes for the majority of radiologists in the BCSC surpass performance recommendations. Recall rate for almost half of radiologists, however, is higher than the recommended rate. Rosenberg and colleagues outline and clearly define performance benchmarks for U.S. community radiologists in screening mammography. This article is a wonderful framework for radiologists to review and adapt as they go forward in their individual and facility audits and their outcome measurements. The ability of a radiologist to compare their outcome measurements with those of a group of radiologists in any practice is a powerful teaching tool. It enables each radiologist to recognize their ar-
Breast Diseases: A Year Book Quarterly Vol 18 No 2 2007
eas of strength as well as areas that may need improvement. I was impressed by the authors’ reassignment of the American College of Radiology Breast Imaging Reporting and Data Systems (BI-RADS) category 3 mammograms (negative assessment) into a BI-RADS category 0 (positive assessment). In our practice at the Elizabeth Wende Breast Clinic, we frequently use the same nonstandard approach of assigning BI-RADS category 3 (probably benign) while recommending additional imaging. This is one of the stumbling blocks that different practices and their radiologists will have to modify in order to have comparison benchmarks across multiple sites. The study indicates that while most performance measurements for the radiologists are similar to previously published ones, the recall rate is higher and the PPV1 is lower. I agree with the authors that the more favorable cancer detection rate, the ductal carcinoma in situ rate, along with the lower percentage of lymph node involvement may very well be due to the higher recall rate and the shorter screening interval in the United States in comparison to Europe. I look forward to reading the followup articles suggested by the authors and reviewing how double reading may influence the recall rate, the cancer detection rate and the outcome parameters, and the overall current guidelines. S. Destounis, MD
Performance Benchmarks for Screening Mammography Rosenberg RD, Yankaskas BC, Abraham LA, et al (Univ of New Mexico, Albuquerque; Univ of North Carolina, Chapel Hill; Group Health Ctr for Health Studies, Seattle; et al) Radiology 241:55-66, 2006
Purpose.—To retrospectively evaluate the range of performance outcomes of the radiologist in an audit of screening mammography by using a representative sample of U.S. radiologists to allow development of performance benchmarks for screening mammography. Materials and Methods.—Institutional review board approval was obtained, and study was HIPAA compliant. Informed consent was or was not obtained according to institutional review board guidelines. Data from 188 mammographic facilities and 807 radiologists obtained between 1996 and 2002 were analyzed from six registries from the Breast Cancer Surveillance Consortium (BCSC). Contributed data included demographic information, clinical findings, mammographic interpretation, and biopsy results. Measurements calculated were positive predictive values (PPVs) from screening mammography (PPV1), biopsy recommendation (PPV2), biopsy performed (PPV3), recall rate, cancer detection rate, mean cancer size, and cancer stage. Radiologist performance data are presented as 50th (median), 10th, 25th,
148 148
®
75th, and 90th percentiles and as graphic presentations by using smoothed curves. Results.—There were 2 580 151 screening mammographic studies from 1 117 390 women (age range, <30 to ≥80 years). The respective means and ranges of performance outcomes for the middle 50% of radiologists were as follows: recall rate, 9.8% and 6.4%–13.3%; PPV1, 4.8% and 3.4%–6.2%; and PPV2, 24.6% and 18.8%–32.0%. Mean cancer detection rate was 4.7 per 1000, and the mean size of invasive cancers was 13 mm. The range of performance outcomes for the middle 80% of radiologists also was presented. Conclusion.—Community screening mammographic performance measurements of cancer outcomes for the majority of radiologists in the BCSC surpass performance recommendations. Recall rate for almost half of radiologists, however, is higher than the recommended rate. Rosenberg and colleagues outline and clearly define performance benchmarks for U.S. community radiologists in screening mammography. This article is a wonderful framework for radiologists to review and adapt as they go forward in their individual and facility audits and their outcome measurements. The ability of a radiologist to compare their outcome measurements with those of a group of radiologists in any practice is a powerful teaching tool. It enables each radiologist to recognize their ar-
Breast Diseases: A Year Book Quarterly Vol 18 No 2 2007
eas of strength as well as areas that may need improvement. I was impressed by the authors’ reassignment of the American College of Radiology Breast Imaging Reporting and Data Systems (BI-RADS) category 3 mammograms (negative assessment) into a BI-RADS category 0 (positive assessment). In our practice at the Elizabeth Wende Breast Clinic, we frequently use the same nonstandard approach of assigning BI-RADS category 3 (probably benign) while recommending additional imaging. This is one of the stumbling blocks that different practices and their radiologists will have to modify in order to have comparison benchmarks across multiple sites. The study indicates that while most performance measurements for the radiologists are similar to previously published ones, the recall rate is higher and the PPV1 is lower. I agree with the authors that the more favorable cancer detection rate, the ductal carcinoma in situ rate, along with the lower percentage of lymph node involvement may very well be due to the higher recall rate and the shorter screening interval in the United States in comparison to Europe. I look forward to reading the followup articles suggested by the authors and reviewing how double reading may influence the recall rate, the cancer detection rate and the outcome parameters, and the overall current guidelines. S. Destounis, MD