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Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice.

Abstract：

RATIONALE AND OBJECTIVES:Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set. MATERIALS AND METHODS:This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test set and clinical performance with 95% confidence intervals (CI) were estimated. RESULTS:For test sets with fewer cancers (N = 15) that were more difficult to detect, correlations were weak to moderate for sensitivity (woman level = 0.46, 95% CI = 0.16, 0.69; breast level = 0.35, 95% CI = 0.03, 0.61) and weak for specificity (0.24, 95% CI = 0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N = 30) were close to 0 and not statistically significant. CONCLUSIONS:Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect.

journal_name

Acad Radiol

journal_title

Academic radiology

authors

Miglioretti DL,Ichikawa L,Smith RA,Buist DSM,Carney PA,Geller B,Monsees B,Onega T,Rosenberg R,Sickles EA,Yankaskas BC,Kerlikowske K

doi

10.1016/j.acra.2017.03.016

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

1256-1264

issue

eissn

1076-6332

issn

1878-4046

pii

S1076-6332(17)30187-3

journal_volume

pub_type

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Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice.