Radiologist Agreement for Mammographic Recall by Case Difficulty and Finding Type

Area of Science:

• Radiology
• Medical Imaging
• Breast Cancer Screening

Background:

• Mammography is crucial for early breast cancer detection.
• Variability in interpretation can affect screening outcomes.
• Improving radiologist agreement is key to enhancing mammographic performance.

Purpose of the Study:

• To evaluate the agreement between community radiologists' mammographic interpretations and expert panel consensus.
• To identify specific findings and lesion types with low agreement.
• To inform strategies for improving mammographic accuracy and reducing unnecessary recalls.

Main Methods:

• 119 community radiologists interpreted screening mammograms from 6 registries.
• Interpretations were compared against an expert panel's consensus.
• Agreement was assessed for recall decisions, finding types (mass, calcifications, asymmetric density, architectural distortion), and subtlety levels.
• Unnecessary recall rates were calculated for each finding type.

Main Results:

• High agreement (100%) was observed for obvious findings like masses.
• Lower agreement was found for subtle or asymmetric lesions, especially in cancer cases (50-60%).
• Agreement was particularly low for architectural distortions (43%) and asymmetric densities (40%).
• Asymmetric densities accounted for the majority (51%) of unnecessary recalls.

Conclusions:

• Mammographic interpretation agreement is suboptimal for specific findings, including asymmetric densities and architectural distortions.
• Targeted training on these challenging interpretations is recommended.
• Improving radiologist consensus can enhance mammography accuracy and decrease patient recall rates.