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Open Access 01-12-2022 | Magnetic Resonance Imaging | Research

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset

Authors: Lyn I. Jones, Andrea Marshall, Premkumar Elangovan, Rebecca Geach, Sadie McKeown-Keegan, Sarah Vinnicombe, Sam A. Harding, Sian Taylor-Phillips, Mark Halling-Brown, Christopher Foy, Elizabeth O’Flynn, Hesam Ghiasvand, Claire Hulme, Janet A. Dunn, the FAST MRI Study Group

Published in: Breast Cancer Research | Issue 1/2022

Abstract

Background

Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI.

The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2).

Methods

Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset.

Results

37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84–87%; 1776/2072) and specificity 86% (95%CI 85–86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86–91%) and higher specificity (2957/3298; 90%; 95%CI 89–91%) than Group 2 (sensitivity = 83%; 95%CI 81–85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81–83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68–0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45–0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90–89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88–89%) and Group 2 (83–84%).

Conclusions

Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.

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Title: Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset
Authors: Lyn I. Jones
Andrea Marshall
Premkumar Elangovan
Rebecca Geach
Sadie McKeown-Keegan
Sarah Vinnicombe
Sam A. Harding
Sian Taylor-Phillips
Mark Halling-Brown
Christopher Foy
Elizabeth O’Flynn
Hesam Ghiasvand
Claire Hulme
Janet A. Dunn
the FAST MRI Study Group
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Breast Cancer
Breast Cancer
Breast MRI
Published in: Breast Cancer Research / Issue 1/2022
Electronic ISSN: 1465-542X
DOI: https://doi.org/10.1186/s13058-022-01549-5

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