Variability in the Interpretation of Screening Mammograms by US Radiologists
- 22 January 1996
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 156 (2), 209-213
- https://doi.org/10.1001/archinte.1996.00440020119016
Abstract
Objective: To evaluate the effectiveness of screening mammography by estimating the variability in radiologists' ability to detect breast cancer within the US population of radiologists at mammography centers accredited by the American College of Radiology. Methods: A two-way sample survey design was used as follows. Fifty mammography centers having an American College of Radiology—accredited unit were randomly sampled from across the United States. One hundred eight radiologists from these centers gave blinded interpretation to the same set of 79 randomly selected screening mammograms. The mammograms were from women who had been screened at a large screening center. Before their sampling, these women had been stratified by their breast disease status, established either by biopsy or by 2-year follow-up. Rates of biopsy recommendations were summarized by the mean, median, minimum, maximum, and range of sensitivity and specificity. Overall cancer detection ability was summarized by similar statistics for receiver operating characteristic curve areas. Ninety-five percent lower confidence bounds on the ranges in accuracy measures were established by bootstrapping. Results: There is a range of at least 40% among US radiologists in their screening sensitivity. There is a range of at least 45% in the rates at which women without breast cancer are recommended for biopsy. As indicated by receiver operating characteristic curve areas, the ability of radiologists to detect cancer mammograms varies by as much as 11%. Conclusions: Our findings indicate that there is wide variability in the accuracy of mammogram interpretation in the population of US radiologists. Current accreditation programs that certify the technical quality of radiographic equipment and images but not the accuracy of the interpretation given to mammograms may not be sufficient to help mammography fully realize its potential to reduce breast cancer mortality. (Arch Intern Med. 1996;156:209-213)Keywords
This publication has 8 references indexed in Scilit:
- Screening for Breast CancerMultidisciplinary Cancer Investigation, 2017
- Variability in Radiologists' Interpretations of MammogramsNew England Journal of Medicine, 1994
- Screening for Cancer of the BreastEpidemiologic Reviews, 1993
- Nonpalpable, probably benign lesions: role of follow-up mammography.Radiology, 1992
- Nonparametric Estimation of Degenerate ROC Data Sets Used for Comparison of Imaging SystemsInvestigative Radiology, 1990
- The meaning and use of the area under a receiver operating characteristic (ROC) curve.Radiology, 1982
- Nonpalpable mammographic abnormalities: timing the follow-up studiesAmerican Journal of Roentgenology, 1981
- Bootstrap Methods: Another Look at the JackknifeThe Annals of Statistics, 1979