How radiologists interpret diagnostic mammograms varies widely and could affect clinical decisions in large numbers of women, according to a study published in the Journal of the National Cancer Institute. Past studies have demonstrated extensive variability in the interpretation of screening mammograms, but less is known about interpretations of diagnostic mammograms. Diagnostic mammograms are used to explore suspicious findings from either physical exams or screening mammograms.
Diana Miglioretti, from the Group Health Center for Health Studies in Seattle and leader of the study, evaluated the extent to which radiologists' characteristics, such as experience and affiliation, influenced the accuracy of their mammography reading. About three quarters of the radiologists had been interpreting mammograms for at least 10 years. The median age of the radiologists was 49 years and three quarters of them were male.
Miglioretti found considerable variation in the radiologists' performance. About 80 percent of breast cancers were correctly diagnosed, but more than 4 percent of women without cancer were given a tentative cancer diagnosis based on their mammogram. Radiologists who were affiliated with an academic institution were more likely to correctly diagnose a cancer and were less likely to diagnose a cancer that didn't exist. Radiologists with more experience were likely to have a higher threshold for recommending a biopsy, while those who spent more time interpreting mammograms were more likely to have a lower threshold for biopsy recommendations.
"Because the rate of breast cancer is 10-fold higher among diagnostic mammograms than among screening mammograms and the majority of women with breast cancer have a physical sign or symptom at the time of diagnosis, this variability in interpretive performance is concerning and likely affects many women both with and without breast cancer," Miglioretti noted. "We need to identify ways to improve accuracy and reduce variability among all radiologists who interpret mammography."
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Source: Journal of the National Cancer Institute
