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European Radiology
Published in: European Radiology 1/2019

01-01-2019 | Breast

Characteristics of screen-detected cancers following concordant or discordant recalls at blinded double reading in biennial digital screening mammography

Authors: Angela M. P. Coolen, Joost R. C. Lameijer, Adri C. Voogd, Marieke W. J. Louwman, Luc J. Strobbe, Vivianne C. G. Tjan-Heijnen, Lucien E. M. Duijm

Published in: European Radiology | Issue 1/2019

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Abstract

Objectives

To analyse which mammographic and tumour characteristics led to concordant versus discordant recalls at blinded double reading to further optimise our breast cancer screening programme.

Methods

We included a consecutive series of 99,013 screening mammograms obtained between July 2013 and January 2015. All mammograms were double read in a blinded fashion. Discordant readings were routinely recalled without consensus or arbitration. During the 2-year follow-up, relevant data of the recalled women were collected. We compared mammographic characteristics, screening outcome and tumour characteristics between concordant and discordant recalls.

Results

There were 2,543 concordant recalls (71.4%) and 997 discordant recalls (28.0%). The positive predictive value of a concordant recall was significantly higher (23.5% vs. 10.0%, p < 0.001). The proportion of BI-RADS 0 was significantly higher in the discordant recall group (75.7% vs. 56.3%, p < 0.001). Discordant recalls were more often an asymmetry or architectural distortion (21.8% vs. 13.2% and 9.3% vs. 6.5%, respectively, p < 0.001). There were no differences in the distribution of DCIS and invasive cancers and tumour characteristics were comparable for the two groups, except for a more favourable tumour grade in the discordant recall group (54.7% vs. 39.9% grade I tumours, p = 0.022).

Conclusions

Screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall. The higher proportion of asymmetries and architectural distortions in this group provide a possible target for improving screening programmes by additional training of screening radiologists and the implementation of digital breast tomosynthesis.

Key Points

• With blinded double reading of screening mammograms, screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall.
• The proportions of asymmetries and architectural distortions are higher in case of a discordant reading.
• Possible improvement strategies could target additional training of screening radiologists and the implementation of digital breast tomosynthesis in breast cancer screening programmes.
Literature
1.
Duijm LEM, Groenewoud JH, Fracheboud J, van Ineveld BM, Roumen RMH, de Koning HJ (2008) Introduction of additional double reading of mammograms by radiographers: Effects on a biennial screening programme outcome. Eur J Cancer 44(9):1223–1228CrossRef
2.
Caumo F, Brunelli S, Tosi E et al (2011) On the role of arbitration of discordant double readings of screening mammography: experience from two Italian programmes. Radiol Med 116(1):84–91CrossRef
3.
Azavedo E, Zackrisson S, Mejàre I, Heibert Arnlind M (2012) Is single reading with computer-aided detection (CAD) as good as double reading in mammography screening? A systematic review. BMC Med Imaging 12(1):22CrossRef
4.
Klompenhouwer EG, Voogd AC, Den Heeten GJ et al (2015) Blinded double reading yields a higher programme sensitivity than non-blinded double reading at digital screening mammography: A prospected population based study in the south of the Netherlands. Eur J Cancer 51(3):391–399CrossRef
5.
Posso MC, Puig T, Quintana MJ, Solá-Roca J, Bonfill X (2016) Double versus single reading of mammograms in a breast cancer screening programme: a cost-consequence analysis. Eur Radiol 26(9):3262–3271CrossRef
6.
Duijm LEM, Louwman MWJ, Groenewoud JH, van de Poll-Franse LV, Fracheboud J, Coebergh JW (2009) Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome. Br J Cancer 100(6):901–907CrossRef
7.
European Commission (2013) European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition. Office for Official Publications of the European Communities. 138 p.
8.
Gur D, Sumkin JH, Hardesty LA et al (2004) Recall and detection rates in screening mammography: a review of clinical experience - implications for practice guidelines. Cancer 100(8):1590–1594CrossRef
9.
Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19(5):403–410CrossRef
10.
Ciatto S, Ambrogetti D, Risso G et al (2005) The role of arbitration of discordant reports at double reading of screening mammograms. J Med Screen 12(3):125–127CrossRef
11.
Klompenhouwer EG, Voogd AC, den Heeten GJ et al (2015) Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome. Eur Radiol 25(10):2821–2829CrossRef
12.
Klompenhouwer EG, Weber RJP, Voogd AC et al (2015) Arbitration of discrepant BI-RADS 0 recalls by a third reader at screening mammography lowers recall rate but not the cancer detection rate and sensitivity at blinded and non-blinded double reading. Breast 24(5):601–607CrossRef
13.
Bluekens AMJ, Holland R, Karssemeijer N, Broeders MJM, den Heeten GJ (2012) Comparison of Digital Screening Mammography and Screen-Film Mammography in the Early Detection of Clinically Relevant Cancers: A Multicenter Study. Radiology 265(3):707–714CrossRef
14.
van Luijt PA, Heijnsdijk EAM, Fracheboud J et al (2016) The distribution of ductal carcinoma in situ (DCIS) grade in 4232 women and its impact on overdiagnosis in breast cancer screening. Breast Cancer Res 18(1):47CrossRef
15.
Welch HG, Prorok PC, O’Malley AJ, Kramer BS (2016) Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med 375(15):1438–1447CrossRef
16.
Lannin DR, Wang S (2017) Are small breast cancers good because they are small or small because they are good? N Engl J Med 376(23):2286–2291CrossRef
17.
Riihimäki M, Thomsen H, Brandt A, Sundquist J, Hemminki K (2012) Death causes in breast cancer patients. Ann Oncol 23(3):604–610CrossRef
18.
Lee AY, Wisner DJ, Aminololama-Shakeri S J et al (2017) Inter-reader variability in the use of BI-RADS descriptors for suspicious findings on diagnostic mammography: a multi-institution study of 10 academic radiologists. Acad Radiol 24(1):60–66
19.
Ciatto S, Houssami N, Apruzzese A et al (2006) Reader variability in reporting breast imaging according to BI-RADS® assessment categories (the Florence experience). Breast 15(1):44–51CrossRef
20.
Redondo A, Comas M, Macià F et al (2012) Inter- and intraradiologist variability in the BI-RADS assessment and breast density categories for screening mammograms. Br J Radiol 85:1465–1470CrossRef
21.
Houssami N, Bernardi D, Pellegrini M et al (2017) Breast cancer detection using single-reading of breast tomosynthesis (3D-mammography) compared to double-reading of 2D-mammography: Evidence from a population-based trial. Cancer Epidemiol 47:94–99CrossRef
22.
Dibble EH, Lourenco AP, Baird GL, Ward RC, Maynard AS, Mainiero MB (2018) Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion. Eur Radiol 28(1):3–10
23.
Durand MA, Haas BM, Yao X et al (2015) Early clinical experience with digital breast tomosynthesis for screening mammography. Radiology 274(1):85–92CrossRef
24.
Kooi T, Litjens G, van Ginneken B, Gubern-Mérida A et al (2017) Large scale deep learning for computer aided detection of mammographic lesions. Med Image Anal 35:303–312CrossRef
Metadata
Title
Characteristics of screen-detected cancers following concordant or discordant recalls at blinded double reading in biennial digital screening mammography
Authors
Angela M. P. Coolen
Joost R. C. Lameijer
Adri C. Voogd
Marieke W. J. Louwman
Luc J. Strobbe
Vivianne C. G. Tjan-Heijnen
Lucien E. M. Duijm
Publication date
01-01-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5586-9

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