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Performance Benchmarks for Diagnostic Mammography¹

¹ From the Departments of Radiology (E.A.S., J.W.T.L., R.S.B.) and Epidemiology/Biostatistics (R.S.B.), University of California San Francisco School of Medicine, 1600 Divisadero St, Rm H-2801, San Francisco, CA 94115; Center for Health Studies, Group Health Cooperative, Seattle, Wash (D.L.M.); Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (R.B.B.); Office of Health Promotion Research, University of Vermont, Burlington, Vt (B.M.G.); Department of Radiology, University of New Mexico-HSC, Albuquerque, NM (R.D.R.); and Department of Radiology, University of North Carolina, Chapel Hill, NC (B.C.Y.). Received April 23, 2004; revision requested July 2; revision received July 20; accepted August 18. Supported by grants U01CA63740 (E.A.S.), U01CA86076 (D.L.M.), U01CA70013 (B.M.G.), U0169976 (R.D.R.), U01CA70040 (B.C.Y.), U01CA63731 (Group Health Cooperative, Diana Buist principal investigator), and U01CA86082–01 (New Hampshire Mammography Network, Patricia Carney principal investigator) from the National Cancer Institute; K07CA86032 (R.S.B.) from the NIH. Address correspondence to E.A.S. (e-mail: edward.sickles@ucsfmedctr.org).

View larger version (36K): [in a new window]   Figure 1. Smoothed plots of frequency distributions of abnormal interpretation rates for 281 401 diagnostic mammography examinations (among radiologists with 10 or more examinations), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 332 926 examinations are listed in Table 3.

View larger version (38K): [in a new window]   Figure 2. Smoothed plots of frequency distributions of PPV1 for 21 336 diagnostic mammography examinations with abnormal findings (among radiologists with 10 or more examinations with abnormal findings), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 26 776 diagnostic examinations with abnormal results are listed in Table 3.

View larger version (38K): [in a new window]   Figure 3. Smoothed plots of frequency distributions of PPV2 for 18 140 diagnostic mammography examinations with abnormal results for which biopsy was recommended (among radiologists with 10 or more biopsies recommended), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 22 799 examinations for which biopsy was recommended are listed in Table 3.

View larger version (37K): [in a new window]   Figure 4. Smoothed plots of frequency distributions of PPV3 for 14 374 diagnostic mammography examinations with abnormal results for which biopsy was recommended and actually performed (among radiologists with 10 or more biopsies performed), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 18 076 examinations for which biopsy was performed are listed in Table 3.

View larger version (37K): [in a new window]   Figure 5. Smoothed plots of frequency distributions of cancer diagnosis rate for 274 946 diagnostic mammography examinations (among radiologists with 100 or more examinations), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, ahort-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 332 926 examinations are listed in Table 4.

View larger version (38K): [in a new window]   Figure 6. Smoothed plots of frequency distributions of invasive cancer size for 4733 invasive cancers of known size that were identified at diagnostic mammography (among radiologists finding five or more invasive cancers of known size), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 5998 invasive cancers of known size are listed in Table 4.

View larger version (36K): [in a new window]   Figure 7. Smoothed plots of frequency distributions of minimal cancer percentage for 6001 DCIS and invasive cancers of known size that were identified at diagnostic mammography (among radiologists finding five or more DCIS and invasive cancers of known size), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 7471 DCIS and invasive cancers of known size are listed in Table 4.

View larger version (36K): [in a new window]   Figure 8. Smoothed plots of frequency distributions of node-negative percentage for 5051 invasive cancers of known nodal status that were identified at diagnostic mammography (among radiologists finding five or more invasive cancers of known nodal status), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 6324 invasive cancers of known nodal status are listed in Table 4.

View larger version (35K): [in a new window]   Figure 9. Smoothed plots of frequency distributions of stage 0 or I percentage for 5910 cancers of known stage that were identified at diagnostic mammography (among radiologists finding five or more cancers of known stage), as a function of indication for examination. An overlaid solid line indicates the 50th percentile (median), paired dashed lines indicate the 25th and 75th percentiles, and paired dotted lines indicate the 10th and 90th percentiles. A, Work-up of abnormal results detected at screening examination; B, short-interval follow-up; C, evaluation of breast problem, no lump or lump unknown; D, evaluation of breast problem, palpable lump; E, all diagnostic examinations. Corresponding arithmetic mean values for all 7381 cancers of known stage are listed in Table 4.