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. 2015 Apr;204(4):W486-91.
doi: 10.2214/AJR.13.12313.

Criteria for Identifying Radiologists With Acceptable Screening Mammography Interpretive Performance on Basis of Multiple Performance Measures

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Free PMC article

Criteria for Identifying Radiologists With Acceptable Screening Mammography Interpretive Performance on Basis of Multiple Performance Measures

Diana L Miglioretti et al. AJR Am J Roentgenol. .
Free PMC article

Abstract

Objective: Using a combination of performance measures, we updated previously proposed criteria for identifying physicians whose performance interpreting screening mammography may indicate suboptimal interpretation skills.

Materials and methods: In this study, six expert breast imagers used a method based on the Angoff approach to update criteria for acceptable mammography performance on the basis of two sets of combined performance measures: set 1, sensitivity and specificity for facilities with complete capture of false-negative cancers; and set 2, cancer detection rate (CDR), recall rate, and positive predictive value of a recall (PPV1) for facilities that cannot capture false-negative cancers but have reliable cancer follow-up information for positive mammography results. Decisions were informed by normative data from the Breast Cancer Surveillance Consortium (BCSC).

Results: Updated combined ranges for acceptable sensitivity and specificity of screening mammography are sensitivity≥80% and specificity≥85% or sensitivity 75-79% and specificity 88-97%. Updated ranges for CDR, recall rate, and PPV1 are: CDR≥6 per 1000, recall rate 3-20%, and any PPV1; CDR 4-6 per 1000, recall rate 3-15%, and PPV1≥3%; or CDR 2.5-4.0 per 1000, recall rate 5-12%, and PPV1 3-8%. Using the original criteria, 51% of BCSC radiologists had acceptable sensitivity and specificity; 40% had acceptable CDR, recall rate, and PPV1. Using the combined criteria, 69% had acceptable sensitivity and specificity and 62% had acceptable CDR, recall rate, and PPV1.

Conclusion: The combined criteria improve previous criteria by considering the interrelationships of multiple performance measures and broaden the acceptable performance ranges compared with previous criteria based on individual measures.

Keywords: Breast Cancer Surveillance Consortium (BCSC); audit; mammography; performance; screening.

Figures

Figure 1
Figure 1
Sensitivity versus false-positive rate for original criteria based on separate evaluation of these measures and for the updated criteria evaluating these measures in combination. Dots represent observed values for 350 BCSC radiologists with at least 1000 screening mammograms and at least 10 screening mammograms associated with cancer: black, acceptable under original and updated criteria; blue, acceptable under updated criteria but not original criteria; red, acceptable under neither. Zone A, original criteria for acceptable performance. Zones B, C, and D, areas of acceptable performance added with updated criteria. Zone B, upper specificity threshold increased to 97%. Zone C, upper specificity threshold increased to 100% for radiologists with at least 80% sensitivity. Zone D, lower specificity threshold decreased to 85% for radiologists with at least 80% sensitivity. Note: the y-axis (sensitivity) starts at 40% instead of 0%.
Figure 2
Figure 2
Cancer detection rate (CDR), recall rate, and positive predictive value of a recall (PPV1) for original criteria based on separate evaluation of these measures and for the updated criteria based on evaluating these measures in combination. Dots represent observed values for 486 BCSC radiologists with at least 1000 screening mammograms: black, acceptable under original and updated criteria; blue acceptable under updated criteria but not original criteria; red, acceptable under neither. Zone A, acceptable under original criteria. Zones B and C, areas of acceptable performance added with updated criteria. Zone B, 3–20% recall rate for radiologists with CDR at least 6/1000. Zone C, 3–15% recall rate and PPV1 of at least 3% for radiologists with CDR at least 4/1000 but less than 6/1000.

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