Standardized Abnormal Interpretation and Cancer Detection Ratios to Assess Reading Volume and Reader Performance in a Breast Screening Program

Purpose: Although some studies have shown increasing radiologists’ mammography volumes improves performance, there is a lack of evidence specific to digital mammography and breast screening program performance targets. This study evaluates the relationship between digital screening volume and meeting performance targets. Methods: This retrospective cohort study included 493 radiologists in the Ontario Breast Screening Program who interpreted 1,762,173 screening mammograms in participants ages 50-90 between 2014 and 2016. Associations between annual screening volume and meeting performance targets for abnormal call rate, positive predictive value (PPV), invasive cancer detection rate (CDR), sensitivity, and specificity were modeled using mixed-effects multivariate logistic regression. Results: Most radiologists read 500-999 (36.7%) or 1,000-1,999 (31.0%) screens annually, and 18.5% read ≥2,000. Radiologists who read ≥2,000 annually were more likely to meet abnormal call rate (OR = 3.85; 95% CI: 1.17-12.61), PPV (OR = 5.36; 95% CI: 2.53-11.34), invasive CDR (OR = 4.14; 95% CI: 1.50-11.46), and specificity (OR = 4.07; 95% CI: 1.89-8.79) targets versus those who read 100-499 screens. Radiologists reading 1,000-1,999 screens annually were more likely to meet PPV (OR = 2.32; 95% CI: 1.22-4.40), invasive CDR (OR = 3.36; 95% CI: 1.49-7.59) and specificity (OR = 2.00; 95% CI: 1.04-3.84) targets versus those who read 100-499 screens. No significant differences were observed for sensitivity. Conclusions: Annual reading volume requirements of 1,000 in Canada are supported as screening volume above 1,000 was strongly associated with achieving performance targets for nearly all measures. Increasing the minimum volume to 2,000 may further reduce the potential limitations of screening due to false positives, leading to improvements in overall breast screening program quality.

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Performance Measures of Magnetic Resonance Imaging Plus Mammography in the High Risk Ontario Breast Screening Program

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz079 ◽

2019 ◽

Vol 112 (2) ◽

pp. 136-144 ◽

Cited By ~ 11

Author(s):

Anna M Chiarelli ◽

Kristina M Blackmore ◽

Derek Muradali ◽

Susan J Done ◽

Vicky Majpruz ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

High Risk ◽

Magnetic Resonance ◽

Cancer Detection ◽

Breast Screening ◽

Screening Program ◽

Breast Cancers ◽

Resonance Imaging ◽

High Risk Women ◽

Mutation Carriers

Abstract Background The Ontario Breast Screening Program expanded in July 2011 to screen high-risk women age 30–69 years with annual magnetic resonance imaging (MRI) and digital mammography. This study examined the benefits of screening with mammography and MRI by age and risk criteria. Methods This prospective cohort study included 8782 women age 30–69 years referred to the High Risk Ontario Breast Screening Program from July 2011 to June 2015, with final results to December 2016. Cancer detection rates, sensitivity, and specificity of MRI and mammography combined were compared with each modality individually within risk groups stratified by age using generalized estimating equation models. Prognostic features of screen-detected breast cancers were compared by modality using Fisher exact test. All P values are two-sided. Results Among 20 053 screening episodes, there were 280 screen-detected breast cancers (cancer detection rate = 14.0 per 1000, 95% confidence interval [CI] = 12.4 to 15.7). The sensitivity of mammography was statistically significantly lower than that of MRI plus mammography (40.8%, 95% CI = 29.3% to 53.5% vs 96.0%, 95% CI = 92.2% to 98.0%, P < .001). In mutation carriers age 30–39 years, sensitivity of the combination was comparable with MRI alone (100.0% vs 96.8%, 95% CI = 79.2% to 100.0%, P = .99) but with statistically significantly decreased specificity (78.0%, 95% CI = 74.7% to 80.9% vs 86.2%, 95% CI = 83.5% to 88.5%, P < .001). In women age 50–69 years, combining MRI and mammography statistically significantly increased sensitivity compared with MRI alone (96.3%, 95% CI = 90.6% to 98.6% vs 90.9%, 95% CI = 83.6% to 95.1%, P = .02), with a small but statistically significant decrease in specificity (84.2%, 95% CI = 83.1% to 85.2% vs 90.0%, 95% CI = 89.2% to 90.9%, P < .001). Conclusions Screening high risk women age 30–39 years with annual MRI only may be sufficient for cancer detection and should be evaluated further, particularly for mutation carriers. Among women age 50–69 years, detection is most effective when mammography is included with annual MRI.

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Results from the Ontario breast screening program, 1990–1995

Journal of Medical Screening ◽

10.1136/jms.5.2.73 ◽

1998 ◽

Vol 5 (2) ◽

pp. 73-80 ◽

Cited By ~ 21

Author(s):

A R Libstug ◽

V Moravan ◽

S E Aitken

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Screening Programme ◽

Screening Program ◽

Tumour Size ◽

Clinical Breast Examination ◽

Nodal Status ◽

Detection Rates ◽

Intermediate Outcomes ◽

Clinical Breast

Objective The Ontario breast screening program (OBSP) is a provincial breast screening programme offering two view mammography, clinical breast examination, instruction in breast self examination, and systematic two year recall to Ontario women 50 years and older. This paper presents the results of the programme's intermediate outcomes from 1990 to 1995 and compares them with recommended standards and other published programmes. Methods Programme data from a provincial screening programme in a large Canadian province were collated from 18 sites in operation between July 1990 and December 1995. Results In its first five years of operation, 215 738 screens were performed on 142 173 women. The referral rates for initial and rescreens are 13.8% and 8.6% respectively. A total of 1718 women were diagnosed with cancer, 1325 at initial screens and 393 at rescreens, resulting in cancer detection rates of 9.3 and 5.3/1000. The cancer detection rates for invasive cancers were 8.3/1000 at initial screens and 4.5/1000 at rescreens. The benign to malignant biopsy ratio was 1.5:1 at initial screens and 1.3:1 at rescreens. Of the 1358 cancers diagnosed at initial screens, 11.6% were in situ and 50.3% of invasive cancers of known size were <15 mm. For women with invasive cancer where nodal status was known, 71.3% were node negative. The proportions at rescreens were 15.7%, 60.0%, and 76.0% respectively. Conclusions While the OBSP has achieved the standards suggested by other studies and programmes during its first five years of operation, there is work to be done to increase participation and obtain more complete data on tumour size and nodal status.

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Consensus Review of Discordant Findings Maximizes Cancer Detection Rate in Double-Reader Screening Mammography: Irish National Breast Screening Program Experience

Radiology ◽

10.1148/radiol.2502080224 ◽

2009 ◽

Vol 250 (2) ◽

pp. 354-362 ◽

Cited By ~ 32

Author(s):

Colette M. Shaw ◽

Fidema L. Flanagan ◽

Helen M. Fenlon ◽

Michelle M. McNicholas

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Detection Rate ◽

Screening Program ◽

Screening Mammography ◽

Cancer Detection Rate ◽

National Breast

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Digital Compared with Screen-Film Mammography: Measures of Diagnostic Accuracy among Women Screened in the Ontario Breast Screening Program—Evidence that Direct Radiography Is Superior to Computed Radiography for Cancer Detection

Radiology ◽

10.1148/radiol.2015152344 ◽

2016 ◽

Vol 278 (2) ◽

pp. 311-312 ◽

Cited By ~ 3

Author(s):

Etta D. Pisano

Keyword(s):

Diagnostic Accuracy ◽

Cancer Detection ◽

Breast Screening ◽

Screening Program ◽

Computed Radiography ◽

Direct Radiography

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Automated Breast Ultrasound: Technical Aspects, Impact on Breast Screening, and Future Perspectives

Current Breast Cancer Reports ◽

10.1007/s12609-021-00423-1 ◽

2021 ◽

Author(s):

Iris Allajbeu ◽

Sarah E Hickman ◽

Nicholas Payne ◽

Penelope Moyle ◽

Kathryn Taylor ◽

...

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Screening Tool ◽

Imaging Technique ◽

Breast Ultrasound ◽

Computer Aided Detection ◽

Future Perspectives ◽

Technical Aspects ◽

Dense Breasts ◽

Automated Breast Ultrasound

Abstract Purpose of Review Automated breast ultrasound (ABUS) is a three-dimensional imaging technique, used as a supplemental screening tool in women with dense breasts. This review considers the technical aspects, pitfalls, and the use of ABUS in screening and clinical practice, together with new developments and future perspectives. Recent Findings ABUS has been approved in the USA and Europe as a screening tool for asymptomatic women with dense breasts in addition to mammography. Supplemental US screening has high sensitivity for cancer detection, especially early-stage invasive cancers, and reduces the frequency of interval cancers. ABUS has similar diagnostic performance to handheld ultrasound (HHUS) and is designed to overcome the drawbacks of operator dependence and poor reproducibility. Concerns with ABUS, like HHUS, include relatively high recall rates and lengthy reading time when compared to mammography. ABUS is a new technique with unique features; therefore, adequate training is required to improve detection and reduce false positives. Computer-aided detection may reduce reading times and improve cancer detection. Other potential applications of ABUS include local staging, treatment response evaluation, breast density assessment, and integration of radiomics. Summary ABUS provides an efficient, reproducible, and comprehensive supplemental imaging technique in breast screening. Developments with computer-aided detection may improve the sensitivity and specificity as well as radiologist confidence and reduce reading times, making this modality acceptable in large volume screening centers.

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Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Göteborg prostate cancer screening 2 trial

European Radiology ◽

10.1007/s00330-021-07907-9 ◽

2021 ◽

Author(s):

Jonas Wallström ◽

Kjell Geterud ◽

Kimia Kohestani ◽

Stephan E. Maier ◽

Marianne Månsson ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Screening Program ◽

Prostate Cancer Screening ◽

High Sensitivity ◽

Multiparametric Mri ◽

False Positives ◽

Quality Data ◽

Gadolinium Contrast ◽

Sequential Screening

Abstract Objectives The PIRADS Steering Committee has called for “higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up,” however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa). Methods Within the ongoing Göteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3–5 with bpMRI and/or mpMRI. Results Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4–18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3–18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84–0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01–1.10. Conclusions In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives. Key Points • In screening for prostate cancer with PSA followed by MRI, biparametric MRI allows radiologists to detect an almost similar number of prostate cancers and score fewer false positive lesions compared to multiparametric MRI. • In a screening program, high sensitivity should be weighed against cost and risks for healthy men; a large number of men can be saved the exposure of gadolinium contrast medium by adopting biparametric MRI and at the same time allowing for a higher turnover in the MRI room.

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