Breast imaging reader characteristics impact performance

2019 02 19 18 03 9526 Mammogram Breast 400

No single characteristic seems to be linked to the performance of breast imagers reading screening mammography exams, but some trends impact reading efficacy, a report published January 26 in Clinical Breast Cancer has found.

Researchers led by Dennis Jay Wong from the University of Sydney discovered that older readers tend to have lower false-positive rates, and high imaging reading volume is linked with higher sensitivity. However, overall, what influences screening interpretation performance remains somewhat unclear.

"The evidence... shows mixed findings for the association between reader characteristics and screening performance," Wong and colleagues wrote.

Despite mammography being the gold standard for breast cancer detection, it is not without its flaws, including interreader variability -- different readers may have different approaches to finding and diagnosing mammography findings, which can lead to wider variability.

Since breast imaging reading errors can lead to negative diagnosis and treatment outcomes for breast cancer, Wong's team sought to evaluate the characteristics of breast cancer screening exam readers and whether there are any associations with diagnostic efficacy. The group included 28 studies in their review, identifying trends for different reader characteristics.

  • Age and gender. Five studies explored the association between readers' age and performance, with four showing that older readers have lower false-positive rates or better specificity. But two studies reported a decrease in sensitivity with aging. As for gender, seven studies explored ties between gender and performance, with five reporting no associations between gender and either sensitivity, specificity, recall rate, or cancer detection rate.
  • Reading volume and performance. Eight out of 13 studies that assessed reading volume reported that higher volume was linked to better sensitivity, but four others showed no association between reading volume and sensitivity. The researchers found that, for eight studies, high-volume readers also showed better location sensitivity, diagnostic accuracy, lower recall rates, and lower false positive rates.
  • Fellowship, specialization in breast radiology, and academic affiliation. Seven studies examined the association between completing a breast imaging fellowship and screening mammography performance metrics. Completing a breast fellowship translated to lower abnormal interpretation and recall rates and increased positive predictive value, the group wrote.

Regarding specialization, four studies explored associations between it and performance; of these, three found that specialist readers had better cancer detection rates, sensitivity, and specificity, as well as higher positive predictive value of recall and lower abnormal interpretation rates. Finally, Wong and colleagues found no ties between affiliation with an academic medical center and reading performance metrics.

In the end, the investigators suggested that models considering interactions between reader characteristics and effects of patient and facility-level characteristics, as well as tailored feedback interventions, could help inform strategies to improve reader performance.

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