Breast Cancer Research and Treatment

, Volume 85, Issue 3, pp 223–228 | Cite as

The influence of clinical information on the accuracy of diagnostic mammography

  • Nehmat HoussamiEmail author
  • Les Irwig
  • Judy M Simpson
  • Merran McKessar
  • Steven Blome
  • Jennie Noakes


Objective. This study examined the influence of knowledge of clinical information on the accuracy of mammography in women referred for investigation of breast symptoms.

Methods. Subjects were sampled from all women consecutively attending a symptomatic breast clinic and aged 25–55 years. This included all 240 women shown to have breast cancer and 240 age-matched women shown not to have cancer. Mammography films were prospectively reported by two radiologists independently of each other in a blinded manner and without knowledge of any clinical information. The films were then re-read with information about the type and site of symptoms (and without knowledge of the level of suspicion of cancer on clinical examination). The accuracy of reading with and without information on symptoms was compared using sensitivity and specificity and receiver operating characteristic (ROC) curves. The effect of age on changes in test accuracy was examined.

Results. Reporting the mammogram with knowledge of clinical information (compared to without any information) significantly improved sensitivity (75.8 vs. 71.3%, P= 0.003) for one radiologist, with a non-significant reduction in specificity (85.4 vs. 87.1%, P= 0.22). For the other radiologist, it resulted in non-significant improvement in both sensitivity (75.4 vs. 73.8%, P= 0.13) and specificity (89.2 vs. 87.9%, P= 0.25). Age did not have a statistically significant effect on changes in test accuracy in our data. ROC curves for both radiologists showed that reporting mammography with knowledge of clinical information resulted in small (about 2%) but significant improvement in overall test accuracy.

Conclusion. Our findings support the provision of clinical information relating to patients' presentation to radiologists reporting diagnostic mammography.

Breast neoplasms clinical information mammography sensitivity specificity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Elmore JG, Wells CK, Howard DH, Feinstein AR: The impact of clinical history on mammographic interpretations. JAMA 277: 49–52, 1997Google Scholar
  2. 2.
    Houssami N, Irwig L, Simpson JM, McKessar M, Blome S, Noakes J: Sydney breast imaging accuracy study: comparative sensitivity and specificity of mammography and sonography in young women with symptoms. Am J Roentgenol 180: 935–940, 2003Google Scholar
  3. 3.
    Jaeschke R, Guyatt G, Sackett DL: Users' guide to the medical literature. How to use an article about a diagnostic test. Are the results of the study valid? JAMA 271: 389–391, 1994Google Scholar
  4. 4.
    Houssami N, Irwig L: Likelihood ratios for clinical examination, mammography, ultrasound and fine needle biopsy in women with breast problems. Breast 7: 85–89, 1998Google Scholar
  5. 5.
    Altman DG, Gardner MJ: Statistics With Confidence-Confidence Intervals and Statistical Guidelines. BMJ, London, 1989, pp 31-33Google Scholar
  6. 6.
    De Long ER, De Long DM, Clarke-Pearson DL: Comparing the areas under 2 or more correlated Receiver Operating Characteristics curves: a non-parametric approach. Biometrics 44: 837–845, 1988Google Scholar
  7. 7.
    Zeger SL, Liang K-Y, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics 44: 1049–1060, 1988Google Scholar
  8. 8.
    Houssami N, Ciatto S, Irwig L, Simpson JM, Macaskill P: The comparative sensitivity of mammography and ultrasound in women with breast symptoms: an age-specific analysis. Breast 11: 125–130, 2002Google Scholar
  9. 9.
    Dixon JM, Anderson TJ, Lamb J, Nixon SJ, Forrest APM: Fine needle aspiration cytology, in relationships to clinical examination and mammography in the diagnosis of a solid breast mass. Br J Surg 71: 593–596, 1984Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Nehmat Houssami
    • 1
    Email author
  • Les Irwig
    • 1
  • Judy M Simpson
    • 1
  • Merran McKessar
    • 2
  • Steven Blome
    • 3
  • Jennie Noakes
    • 2
  1. 1.Screening and Test Evaluation Program (STEP), School of Public Health, A27University of SydneyAustralia
  2. 2.Northern Sydney and Central Coast BreastScreenThe CottageAustralia
  3. 3.Department of Diagnostic RadiologyRoyal North Shore HospitalSt. LeonardsAustralia

Personalised recommendations