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Published on: August 30, 2013
Second reading of screening mammograms increases cancer detection and recall rates. Results in the Florence screening
S Ciatto1, D Ambrogetti, R Bonardi
1Department of Diagnostic Imaging, Centro per lo Studio e la Prevenzione Oncologica, viale A. Volta 171, 50131 Florence, Italy. s.ciatto@cspo.it
Objective:
To assess double reading effectiveness in mammography screening.
Design:
Retrospective study of 177,631 consecutive mammograms double read during 1998-2003.
Setting:
The Florence screening programme, involving 11 trained radiologists. Abnormalities reported by at least one reader prompted assessment.
Results:
The referral rate was 2.89% for the first reader, 3.15% for the second reader, and 3.59% for either reader. Of 713 total cancers detected, 43 were suspected only by the second reader (6.4% relative, 0.024% increase in absolute detection rate) and had a lower stage compared to the first reader (pTis-pT1b = 65.7 versus 52.0%): 41 were reviewed and classified (error type) as "minimal sign" in six, and "screening error" in 35 cases, or as BI-RADS 3 in one, 4a in 20, 4b in 13, and 4c in three cases. The second reading cost was 2.70 per woman examined, or 11,168 per additional cancer detected (versus 11,585 at a single reading).
Discussion:
Second reading is effective in detecting a limited number of additional cancer cases. Tumour stage (one-third over 1 cm in diameter) and review findings (high rate of "screening errors" and BI-RADS R4b-c categories) suggest that second reading detects small "difficult cases" as well as larger cancers missed due to fatigue or loss of attention. Second reading reduces screening specificity to a minor extent, and since cancer detection at second reading seems cost-effective the procedure is recommendable in routine practice.
