Published in:
01-10-2015 | Breast
Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome
Published in: European Radiology | Issue 10/2015
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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.