Updated audit database for breast imaging/histopathology correlation

To develop, test and validate an audit database, evolved from a prior, peer-reviewed, audit tool for symptomatic multi-modality breast imaging services.

The database is to cover all aspects of non-invasive breast imaging and recognize subspeciality inputs. When more than one imaging investigation is used for diagnosis, an overall breast imaging audit grade is to be introduced. Data derived from clinical studies has been input into the new database.

Results for mammography alone are virtually identical to those of the previous program. A slight increase in accuracy is suggested by using more investigations if the first investigation is not conclusive. More comprehensive reports can be issued.

The audit program can be used in the same context as the old audit. If mammography is the sole investigation, there is no change from the previous standards of a minimum mammography (ultrasound)/histopathology agreement of 70%, an equivocal rate of less than 15%, a false-positive rate of less than 7.5% and a false-negative rate of less than 6.5%. Although there is no statistical difference when more than one imaging investigation is used, there is some marginal improvement. It is suggested that initial audit standards for multi-imaging should be 75% for minimum agreement, a 10% maximum for an equivocal rate, a 5% maximum for false negative and an unchanged false positive rate of 7.5% maximum. These standards will be refined with experience. Due to the nature of the database, complex queries can be made including those about histopathological data. If widely used, the database will be a useful tool to audit the accuracy of symptomatic breast imaging services and types and frequencies of symptomatic breast disease, as seen in routine settings.