Independent Double Reading of Screening Mammograms in the Netherlands: Effect of Arbitration Following Reader Disagreements
Radiology , Volume 231 - Issue 2 p. 564- 570
PURPOSE: To prospectively determine the value of arbitration by a panel of radiologists when two radiologists performing independent readings of screening mammograms do not reach a consensus about referral. MATERIALS AND METHODS: The study population consisted of women who participated in the Dutch Nationwide Breast Cancer Screening Program, in which biennial screening is offered to women aged 50-75 years. An arbitration panel of three radiologists assessed those screening mammograms for which two screening radiologists did not reach a consensus about referral necessity. Women were referred for further analysis if at least one arbitration panel radiologist considered referral to be necessary. RESULTS: The two screening radiologists agreed on the recommendation for referral of 498 (0.8%) of 65,779 screened women and on the recommendation for no referral of 64,949 (98.7%) women. They initially disagreed about the referral in 332 (0.5%) cases. After a mutual consultation, disagreement persisted regarding 183 (0.3%) mammograms. The arbitration panel referred 89 of these cases for further analysis, which revealed cancer in 20 (22%) cases. In three (3%) of the 94 cases that were not referred by the panel, breast cancer was detected at the site of previously discrepant mammographic findings seen at subsequent screening performed 2 years later. If all 183 discrepant cases had been referred, the referral rate would have increased from 0.8% to 0.9% at subsequent (incident) screenings and from 1.5% to 1.7% at initial screenings. In addition, at subsequent screenings, the number of cancers detected per 1,000 women screened would have increased from 4.4 to 4.5. CONCLUSION: Mammograms with discrepant findings constitute a very important subset of screening mammograms. All lesions that are subsequently proved to be malignant may not be detected with panel arbitration.
|Breast neoplasms, Breast raciography, Breast raciography, quality assurance, Cancer screening, Diagnostic radiology, observer performance|
|Organisation||Erasmus MC: University Medical Center Rotterdam|
Duijm, L.E.M, Groenewoud, J.H, Hendriks, J.C.M, & de Koning, H.J. (2004). Independent Double Reading of Screening Mammograms in the Netherlands: Effect of Arbitration Following Reader Disagreements. Radiology, 231(2), 564–570. doi:10.1148/radiol.2312030665