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Breast Imaging |
1 From the Departments of Radiology (S.P.P.), Community and Family Medicine (A.N.T., M.R.G., P.A.C.), Medicine (A.N.T.), and Pathology (W.A.W.), Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, HB 7999, Lebanon, NH 03756. From the 1999 RSNA scientific assembly. Received August 13, 1999; revision requested September 29; final revision received May 1, 2000; accepted May 22. Supported by grant DASD17-94-J-4109 from the United States Department of Defense and Cancer Center Support Grant 2P30 CA23108-22 from the National Cancer Institute. Address correspondence to S.P.P. (e-mail: steven.p.poplack@hitchcock.org).
PURPOSE: To describe measures of mammography performance in a geographically defined population and evaluate the interpreter’s use of the Breast Imaging Reporting and Data System (BI-RADS).
MATERIALS AND METHODS: Mammographic data from 47,651 screening and 6,152 diagnostic examinations from November 1, 1996, to October 31, 1997, were linked to 1,572 pathologic results. Mammographic outcomes were based on BI-RADS assessments and recommendations reported by the interpreting radiologist. The consistency of BI-RADS recommendations was evaluated.
RESULTS: Screening mammography had a sensitivity of 72.4% (95% CI: 66.4%, 78.4%), specificity of 97.3% (95% CI: 97.25%, 97.4%), and positive predictive value of 10.6% (95% CI: 9.1%, 12.2%). Diagnostic mammography had higher sensitivity, 78.1% (95% CI: 71.9%, 84.3%); lower specificity, 89.3% (95% CI: 88.5%, 90.1%); and better positive predictive value, 17.1% (95% CI: 14.5%, 19.8%). The cancer detection rate with screening mammography was 3.3 per 1,000 women, with a biopsy yield of 22.4%, whereas the interval cancer rate was 1.2 per 1,000. Nearly 80% of screening-detected invasive malignancies were node negative. The recall rate for screening mammography was 8.3%. Ultrasonography was used in 3.5% of screening and 17.5% of diagnostic examinations. BI-RADS recommendations were generally consistent, except for probably benign assessments.
CONCLUSION: The sensitivity of screening mammography in this population-based sample is lower than expected, although other performance indicators are commendable. BI-RADS "probably benign" assessments are commonly misused.
Index terms: Breast neoplasms, radiography, 00.11, 00.30 • Cancer screening, 00.11, 00.30 • Diagnostic radiology, observer performance, 00.11, 00.30
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