Sprague BL, Arao RF, Miglioretti DL, Henderson LM, Buist DS, Onega T, Rauscher GH, Lee JM, Tosteson AN, Kerlikowske K, Lehman CD; Breast Cancer Surveillance Consortium. Radiology. 2017 Apr;283(1):59-69. doi: 10.1148/radiol.2017161519. Epub 2017 Feb 28.

Abstract

OBJECTIVE:

To establish contemporary performance benchmarks for diagnostic digital mammography with use of recent data from the Breast Cancer Surveillance Consortium (BCSC).

MATERIALS AND METHODS:

Institutional review board approval was obtained for active or passive consenting processes or to obtain a waiver of consent to enroll participants, link data, and perform analyses. Data were obtained from six BCSC registries (418 radiologists, 92 radiology facilities). Mammogram indication and assessments were prospectively collected for women undergoing diagnostic digital mammography and linked with cancer diagnoses from state cancer registries. The study included 401,548 examinations conducted from 2007 to 2013 in 265,360 women.

RESULTS:

Overall diagnostic performance measures were as follows: cancer detection rate, 34.7 per 1,000 (95% confidence interval [CI]: 34.1, 35.2); abnormal interpretation rate, 12.6% (95% CI: 12.5%, 12.7%); positive predictive value (PPV) of a biopsy recommendation (PPV2), 27.5% (95% CI: 27.1%, 27.9%); PPV of biopsies performed (PPV3), 30.4% (95% CI: 29.9%, 30.9%); false-negative rate, 4.8 per 1,000 (95% CI: 4.6, 5.0); sensitivity, 87.8% (95% CI: 87.3%, 88.4%); and specificity, 90.5% (95% CI: 90.4%, 90.6%). Among cancer detected, 63.4% were stage 0 or 1 cancers, 45.6% were minimal cancers, the mean size of invasive cancers was 21.2 mm, and 69.6% of invasive cancers were node negative. Performance metrics varied widely across diagnostic indications, with cancer detection rate (64.5 per 1,000) and abnormal interpretation rate (18.7%) highest for diagnostic mammograms obtained to evaluate a breast problem with a lump. Compared with performance during the screen-film mammography era, diagnostic digital performance showed increased abnormal interpretation and cancer detection rates and decreasing PPVs, with less than 70% of radiologists within acceptable ranges for PPV2 and PPV3.

CONCLUSIONS:

These performance measures can serve as national benchmarks that may help transform the marked variation in radiologists’ diagnostic performance into targeted quality improvement efforts.