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National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance
Constance D Lehman1, Robert F Arao1, Brian L Sprague1
1From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WAC 240, Boston, MA 02114 (C.D.L.); Group Health Research Institute, Group Health Cooperative, Seattle, Wash (R.F.A., D.S.M.B.); Department of Surgery, University of Vermont College of Medicine, Burlington, Vt (B.L.S.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); Department of Medicine, Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (K.K.); Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (L.M.H.); Norris Cotton Cancer Center and Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.O., A.N.A.T.); Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Ill (G.H.R.); and Department of Public Health Sciences, School of Medicine, University of California-Davis, Davis, Calif (D.L.M.).
Abstract:
Purpose To establish performance benchmarks for modern screening digital mammography and assess performance trends over time in U.S. community practice. Materials and Methods This HIPAA-compliant, institutional review board-approved study measured the performance of digital screening mammography interpreted by 359 radiologists across 95 facilities in six Breast Cancer Surveillance Consortium (BCSC) registries. The study included 1 682 504 digital screening mammograms performed between 2007 and 2013 in 792 808 women. Performance measures were calculated according to the American College of Radiology Breast Imaging Reporting and Data System, 5th edition, and were compared with published benchmarks by the BCSC, the National Mammography Database, and performance recommendations by expert opinion. Benchmarks were derived from the distribution of performance metrics across radiologists and were presented as 50th (median), 10th, 25th, 75th, and 90th percentiles, with graphic presentations using smoothed curves. Results Mean screening performance measures were as follows: abnormal interpretation rate (AIR), 11.6 (95% confidence interval [CI]: 11.5, 11.6); cancers detected per 1000 screens, or cancer detection rate (CDR), 5.1 (95% CI: 5.0, 5.2); sensitivity, 86.9% (95% CI: 86.3%, 87.6%); specificity, 88.9% (95% CI: 88.8%, 88.9%); false-negative rate per 1000 screens, 0.8 (95% CI: 0.7, 0.8); positive predictive value (PPV) 1, 4.4% (95% CI: 4.3%, 4.5%); PPV2, 25.6% (95% CI: 25.1%, 26.1%); PPV3, 28.6% (95% CI: 28.0%, 29.3%); cancers stage 0 or 1, 76.9%; minimal cancers, 57.7%; and node-negative invasive cancers, 79.4%. Recommended CDRs were achieved by 92.1% of radiologists in community practice, and 97.1% achieved recommended ranges for sensitivity. Only 59.0% of radiologists achieved recommended AIRs, and only 63.0% achieved recommended levels of specificity. Conclusion The majority of radiologists in the BCSC surpass cancer detection recommendations for screening mammography; however, AIRs continue to be higher than the recommended rate for almost half of radiologists interpreting screening mammograms. © RSNA, 2016 Online supplemental material is available for this article.
