Screening mammography: benefit of double reading by breast density

My Von Euler-Chelpin,Ilse Vejborg,Mads Nielsen,Martin Lillholm,Elsebeth Lynge,George Napolitano

doi:10.1007/s10549-018-4864-1

My Von Euler-Chelpin, Ilse Vejborg + Show 4 more

Open Access

https://doi.org/10.1007/s10549-018-4864-1

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Abstract

PurposeThe currently recommended double reading of all screening mammography examinations is an economic burden for screening programs. The sensitivity of screening is higher for women with low breast density than for women with high density. One may therefore ask whether single reading could replace double reading at least for women with low density. We addressed this question using data from a screening program where the radiologists coded their readings independently.MethodsData include all screening mammography examinations in the Capital Region of Denmark from 1 November 2012 to 31 December 2013. Outcome of screening was assessed by linkage to the Danish Pathology Register. We calculated sensitivity, specificity, number of interval cancers, and false positive-tests per 1000 screened women by both single reader and consensus BI-RADS density code.ResultsIn total 54,808 women were included. The overall sensitivity of double reading was 72%, specificity was 97.6%, 3 women per 1000 screened experienced an interval cancer, and 24 a false-positive test. Across all BI-RADS density codes, single reading consistently decreased sensitivity as compared with consensus reading. The same was true for specificity, apart from results across BI-RADS density codes set by reader 2.ConclusionsSingle reading decreased sensitivity as compared with double reading across all BI-RADS density codes. This included results based on consensus BI-RADS density codes. This means that replacement of double with single reading would have negative consequences for the screened women, even if density could be assessed automatically calibrated to the usual consensus level.

Highlights

The European Guidelines for quality assurance in breast cancer screening and diagnosis [1] recommend that a mammogram is read independently by two radiologists; called double reading
The same was true for specificity, apart from results across Breast Imaging-Reporting andData System (BI-RADS) density codes set by reader 2
Single reading decreased sensitivity as compared with double reading across all BI-RADS density codes. This included results based on consensus BI-RADS density codes. This means that replacement of double with single reading would have negative consequences for the screened women, even if density could be assessed automatically calibrated to the usual consensus level

Summary

Introduction

The European Guidelines for quality assurance in breast cancer screening and diagnosis [1] recommend that a mammogram is read independently by two radiologists; called double reading. According to the Guidelines, double reading enhances the sensitivity of the screening test with 5–15%, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark. Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Data System (BI-RADS) [3]. Region of Denmark, data have been collected on the outcome of the mammogram reading for each radiologist separately. This included both the BI-RADS density code and the categorization of the screening mammogram as negative or positive of malignancy. Women with negative mammography examinations were returned to routine screening, and women with positive mammography examinations were followed up with triple diagnostics

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