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Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome

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Abstract

Objectives

To determine the value of adding a third reader for arbitration of discrepant screening mammography assessments.

Methods

We included a consecutive series of 84,927 digital screening mammograms, double read in a blinded or non-blinded fashion. Arbitration was retrospectively performed by a third screening radiologist. Two years’ follow-up was performed.

Results

Discrepant readings comprised 57.2 % (830/1452) and 29.1 % (346/1188) of recalls at blinded and non-blinded double readings, respectively. At blinded double reading, arbitration would have decreased recall rate (3.4 to 2.2 %, p < 0.001) and programme sensitivity (83.2 to 76.0 %, p = 0.013), would not have influenced the cancer detection rate (CDR; 7.5 to 6.8 per 1,000 screens, p = 0.258) and would have increased the positive predictive value of recall (PPV; 22.3 to 31.2 %, p < 0.001). At non-blinded double reading, arbitration would have decreased recall rate (2.8 to 2.3 %, p < 0.001) and increased PPV (23.2 to 27.5 %, p = 0.021), but would not have affected CDR (6.6 to 6.3 per 1,000 screens, p = 0.604) and programme sensitivity (76.0 to 72.7 %, p = 0.308).

Conclusion

Arbitration of discrepant screening mammography assessments is a good tool to improve recall rate and PPV, but is not desirable as it reduces the programme sensitivity at blinded double reading.

Key points

• Blinded double reading results in higher programme sensitivity than non-blinded reading.

• Discrepant readings occur more often at blinded compared to non-blinded reading.

• Arbitration of discrepant readings reduces the recall rate and PPV.

• Arbitration would reduce the programme sensitivity at blinded double reading.

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Acknowledgments

The authors thank all screening radiologists, screening technologists and associates of the BOZ and participating hospitals for their voluntary contributions to the study.

The scientific guarantor of this publication is L.E.M Duijm. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this study was performed within the national permit for breast cancer screening, which is issued by the Ministry of Health, Welfare and Sports after advice of the Dutch Health Council. This study did not require a special permit according to the Dutch law on population-based screening as both blinded and non-blinded double reading were considered ‘standard of care’ at the time of the study. Written informed consent was waived by the Institutional Review Board. Some study subjects or cohorts have been previously reported in Klompenhouwer EG, Voogd AC, den Heeten GJ, Strobbe LJ, de Haan AFJ, Wauters CA, et al. Blinded double reading yields a higher programme sensitivity than non-blinded double reading at digital screening mammography: a prospective population based study in the south of the Netherlands. Eur J Cancer 2014; DOI: 10.1016/j.ejca.2014.12.008. Methodology: Prospective study, arbitration retrospectively performed, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands

    Elisabeth G. Klompenhouwer

  2. Department of Research, Comprehensive Cancer Centre the Netherlands (IKNL), PO Box 231, 5600 AE, Eindhoven, The Netherlands

    Adri C. Voogd

  3. Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands

    Adri C. Voogd

  4. Dutch Reference Centre for Screening, PO Box 231, 5600 AE, Nijmegen, The Netherlands

    Gerard J. den Heeten & Mireille J. M. Broeders

  5. Department of Radiology, Biomechanical Engineering and Physics, Academic Medical Centre Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands

    Gerard J. den Heeten

  6. Department of Surgical Oncology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands

    Luc J. A. Strobbe

  7. Department of Medical Oncology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Vivianne C. Tjan-Heijnen

  8. Department for Health Evidence, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Mireille J. M. Broeders

  9. Department of Radiology, Canisius Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands

    Lucien E. M. Duijm

Authors
  1. Elisabeth G. Klompenhouwer
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  2. Adri C. Voogd
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  3. Gerard J. den Heeten
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  4. Luc J. A. Strobbe
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  5. Vivianne C. Tjan-Heijnen
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  6. Mireille J. M. Broeders
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  7. Lucien E. M. Duijm
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Corresponding author

Correspondence to Elisabeth G. Klompenhouwer.

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Klompenhouwer, E.G., Voogd, A.C., den Heeten, G.J. et al. Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome. Eur Radiol 25, 2821–2829 (2015). https://doi.org/10.1007/s00330-015-3711-6

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  • DOI: https://doi.org/10.1007/s00330-015-3711-6

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