Impact of Telephone Communication on Patient Adherence With Follow-Up Recommendations After an Abnormal Screening Mammogram

ObjectiveThe Mammography Quality Standards Act requires written communication to every patient after an abnormal screening mammogram. Starting in 2013, our institution began telephoning all patients with a Breast Imaging Reporting and Data System (BI-RADS) assessment 0 on the next business day to schedule their diagnostic follow-up. Our aim is to analyze the changes in adherence and time to follow-up of patients recalled from screening mammography after the implementation of telephone communication.MethodsThis retrospective study reviewed data from screening mammograms at our institution with a BI-RADS 0 assessment excluding technical recalls between January 1, and December 31, 2011 (pre-intervention group), 2014 (early post-intervention group), and 2018 (later post-intervention group). We compared patient adherence with timely follow-up diagnostic mammography (within 60 days) in these three groups using univariate and multivariate logistic regression. Cox proportional hazards regression analysis was done to evaluate the impact of telephone communication on time to follow-up.ResultsThis study included 1899 women in 2011, 2829 women in 2014, and 1999 women in 2018. We found that 73.1% patients in 2011 returned for their diagnostic follow-up within 60 days compared to 87.6% in 2014 and 90.0% in 2018, P < 0.001. Median time to follow-up in 2011 was 28 days (IQR 17-76 days) compared to 15 days (IQR 9-28 days) in 2014 and 9 days (IQR 5-18) in 2018, P < 0.001.ConclusionA higher percentage of women were adherent with a timely diagnostic follow-up examination after an abnormal screening mammogram with the addition of telephone communication.     

Impact of Electronic Procedural Protocoling on the Timeliness of Pre-operative Breast Localization Procedures

ObjectiveTo evaluate the impact of a new electronic procedural protocol on start times of pre-operative breast localization procedures.MethodsThis HIPAA-compliant, Institutional Review Board-exempted, quality improvement initiative was performed at a large tertiary academic center. In May 2018, an electronic version of the pre-procedure protocol for breast localizations was created within the electronic health record; prior to this time, the protocol was completed manually on a paper form. Mean time between: (1) appointment time and procedure start time, (2) procedure begin-to-end time, and (3) arrival to appointment time were compared for all female patients undergoing pre-operative breast localization procedures during 4-month periods pre-implementation of the electronic procedural protocol (January-April 2018), and post-implementation (June-September 2018), excluding the May 2018 implementation month. Statistical analysis was done by two tailed t-test and statistical process control charting.ResultsPre-implementation, 427 procedures were performed, and post-implementation 409 procedures were performed. Three pre-implementation cases performed more than 3 hours prior to appointment time were excluded (presumed to be rescheduled cases). Mean time between appointment time and procedure start time decreased from 2.7 minutes after to 5.6 minutes before appointment start time, an 8.3-minute improvement (P = 0.0001), with sustained improvement by statistical process control analysis. Mean time for procedure length increased by 4.7 minutes (P = 0.001). There was no significant difference in mean time of patient arrival to appointment time pre- and post-implementation.ConclusionImplementation of an electronic protocol process for pre-operative breast localizations was associated with a significant and sustained reduction in time between appointment time and procedure start time.     

Influences of Radiology Trainees on Screening Mammography Interpretation

PurposeParticipation of radiology trainees in screening mammographic interpretation is a critical component of radiology residency and fellowship training. The aim of this study was to investigate and quantify the effects of trainee involvement on screening mammographic interpretation and diagnostic outcomes.MethodsScreening mammograms interpreted at an academic medical center by six dedicated breast imagers over a three-year period were identified, with cases interpreted by an attending radiologist alone or in conjunction with a trainee. Trainees included radiology residents, breast imaging fellows, and fellows from other radiology subspecialties during breast imaging rotations. Trainee participation, patient variables, results of diagnostic evaluations, and pathology were recorded.ResultsA total of 47,914 mammograms from 34,867 patients were included, with an overall recall rate for attending radiologists reading alone of 14.7% compared with 18.0% when involving a trainee (P < .0001). Overall cancer detection rate for attending radiologists reading alone was 5.7 per 1,000 compared with 5.2 per 1,000 when reading with a trainee (P = .517). When reading with a trainee, dense breasts represented a greater portion of recalls (P = .0001), and more frequently, greater than one abnormality was described in the breast (P = .013). Detection of ductal carcinoma in situ versus invasive carcinoma or invasive cancer type was not significantly different. The mean size of cancers in patients recalled by attending radiologists alone was smaller, and nodal involvement was less frequent, though not statistically significantly.ConclusionsThese results demonstrate a significant overall increase in recall rate when interpreting screening mammograms with radiology trainees, with no change in cancer detection rate. Radiology faculty members should be aware of this potentiality and mitigate tendencies toward greater false positives.     

Patient Navigation to Improve Cancer Screening in Underserved Populations: Reported Experiences,Opportunities, and Challenges

Our goal is to define patient navigation for an imaging audience, present a focused selection of published experiences with navigation programs for breast and colorectal cancer screening, and expose principal barriers to the success of such programs. Despite numerous advances in the early detection of cancers, many patients still present with advanced disease. A disproportionate number are low-income minority patients who experience worse health outcomes than their white or more financially stable counterparts. Patient navigation, which aims to assist the medically underserved by overcoming specific barriers to care, may represent one solution to narrowing disparities. Related research suggests that in general, patient navigation programs that have addressed breast or colorectal cancer screening have been successful in improving screening rates and timeliness of follow-up care. However, although beneficial, navigation is expensive and may present an unmanageable financial burden for many health care centers. To overcome this challenge, navigation efforts will likely need to target those patients that are most likely to benefit. Further research to identify such patients will be critically important for improving the sustainability of navigation programs, and, in turn, for realizing the benefits of such programs in reducing cancer disparities.     

Secondary Interpretation of CT Examinations: Frequency and Payment in the Medicare Fee-for-Service Population

PurposeSecondary interpretation of diagnostic imaging examinations (providing a second formal interpretation for imaging performed at another institution) may reduce repeat imaging after transfer of care. Recently, CMS requested information to guide payment policy. We aimed to study historic trends in submitted claims and payments for secondary interpretation services in the Medicare fee-for-service population.MethodsApplying current procedural terminology codes by body part to Medicare Part B aggregate claims files, we identified all CT interpretation services rendered between 1999 and 2012. Secondary interpretation services were identified using combined code modifiers 26 and 77, in accordance with CMS billing guidelines. The frequencies of billed and denied services were extracted for primary and secondary CT interpretation services. Primary versus secondary interpretation denial rates were calculated and compared.ResultsOf all 227 million Medicare Part B claims for CT services, 299,468 (0.13%) were for secondary interpretation services. From 1999 to 2012, growth in secondary interpretation claims outpaced that in primary interpretation claims (+811% versus +56%; compound annual growth rate 17% versus 3.2%). As a percentage of all services, secondary interpretations increased from 0.05% in 1999 to 0.30% in 2012. Denial rates for second interpretations decreased from 1999 to 2012 (12.7% to 7.0%), and now approach those for primary interpretations (5.4% in 2012).ConclusionsMedicare claims for secondary interpretation of CT examinations are growing but account for less than 1% of all billed CT interpretation services. Denial rates are similar to those of primary interpretation services.     

Breast Density Knowledge in a Screening Mammography Population Exposed to Density Notification

ObjectiveWomen are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear. We compared self-reported with clinically assessed breast density and assessed knowledge of density implications and feelings about future screening.MethodsFrom December 2017 to January 2020, we surveyed women aged 40 to 74 years without prior breast cancer, with a normal screening mammogram in the prior year, and ≥1 recorded breast density measures in four Breast Cancer Surveillance Consortium registries with density reporting laws. We measured agreement between self-reported and BI-RADS breast density categorized as “ever-dense” if heterogeneously or extremely dense within the past 5 years or “never-dense” otherwise, knowledge of dense breast implications, and feelings about future screening.ResultsSurvey participation was 28% (1,528 of 5,408), and 59% (896 of 1,528) of participants had ever-dense breasts. Concordance between self-report versus clinical density was 76% (677 of 896) among women with ever-dense breasts and 14% (89 of 632) among women with never-dense breasts, and 34% (217 of 632) with never-dense breasts reported being told they had dense breasts. Desire for supplemental screening was more frequent among those who reported having dense breasts 29% (256 of 893) or asked to imagine having dense breasts 30% (152 of 513) versus those reporting nondense breasts 15% (15 of 102) (P = .003, P = .002, respectively). Women with never-dense breasts had 6.3-fold higher odds (95% confidence interval:3.39-11.80) of accurate knowledge in states reporting density to all compared to states reporting only to women with dense breasts.DiscussionStandardized communications of breast density results to all women may increase density knowledge and are needed to support informed screening decisions.     

Batch Reading and Interrupted Interpretation of Digital Screening Mammograms Without and With Tomosynthesis

ObjectiveTo compare batch reading and interrupted interpretation for modern screening mammography.MethodsWe retrospectively reviewed digital mammograms without and with tomosynthesis that were originally interpreted with batch reading or interrupted interpretation between January 2015 and June 2017. The following performance metrics were compared: recall rate (per 100 examinations), cancer detection rate (per 1,000 examinations), and positive predictive values for recall and biopsy.ResultsIn all, 9,832 digital mammograms were batch read, yielding a recall rate of 9.98%, cancer detection rate of 4.27, and positive predictive values for recall and biopsy of 4.40% and 35.5%, respectively. There were 49,496 digital mammograms that were read with interrupted interpretation, yielding a recall rate of 11.3%, cancer detection rate of 4.44, and positive predictive values for recall and biopsy of 3.92% and 30.1%, respectively. Of the digital mammograms with tomosynthesis, 7,075 were batch read, yielding a recall rate of 6.98%, cancer detection rate of 5.37, and positive predictive values for recall and biopsy of 7.69% and 38.0%, respectively. Of the digital mammograms with tomosynthesis, 24,380 were read with interrupted interpretation, yielding a recall rate of 8.30%, cancer detection rate of 5.41, and positive predictive values for recall and biopsy of 6.52% and 33.3%, respectively. For both digital mammograms without and with tomosynthesis, recall rates improved with batch reading compared with interrupted interpretation (P < .001), but no significant differences were seen for other metrics.DiscussionBatch reading digital mammograms without and with tomosynthesis improves recall rates while maintaining cancer detection rates and positive predictive values compared with interrupted interpretation.     

软X线显示乳腺钙化灶的形态与临床意义

目的：研究在高清晰度的软Ｘ线摄影中,乳腺钙化灶的形态与临床意义。材料和方法：回顾性分析１９６例乳腺钙化灶在普通及高清晰度Ｘ线摄片中的形态,并与自动三维定位穿刺和活检的病理结论对照。结果：各种形态的钙化灶与良、恶性病变间有密切关系。结论：特定形态的钙化灶是乳腺癌早期诊断,尤其是Ｔ０级乳腺癌诊断的有力依据。改善软Ｘ线摄影机的性能,提高摄片清晰度,推广乳腺高频摄片和三维定位活检技术,对微小乳腺癌的早期检出有重要意义。