Correlation of Radiologist Rank as a Measure of Skill in Screening and Diagnostic Interpretation of Mammograms

Abstract

To determine whether skill in the interpretation of screening mammograms is correlated with skill in the interpretation of diagnostic mammograms. The institutional review board of the University of South Florida approved this study. This study was determined to be exempt from informed consent requirements because of the retrospective use of images and was conducted before HIPPA requirements were implemented. A total of 59 radiologists interpreted screening and diagnostic performance test sets of mammograms with a 1-year interval. Interpretations were recorded with modifications of the Breast Imaging and Reporting Data System. Radiologist skill was measured as the radiologist's ranking among his or her cohort in each of several measures of performance (ie, performance test receiver operating characteristic curve area, performance test screening sensitivity, performance test diagnostic sensitivity, and associated specificities). Correlations between radiologist rank in screening and rank in the diagnostic performance test measures were analyzed with the Spearman rank correlation statistical test. Radiologist rank in screening interpretations and in diagnostic interpretations was found to be significantly correlated in all measurements (P < .05). However, only two measurments (ie, receiver operating characteristic curve area rank correlation of 0.327 and sensitivity rank correlation of 0.402) remained significant after adjusting for multiple testing. The correlation between ranked screening specificity and ranked diagnostic specificity (0.296) was significant at only the .05 level. The interpretive performance of radiologists among their peers is moderately correlated between screening and diagnostic interpretations. Thus, proficiency in one area does not guarantee proficiency in the other area for some radiologists.