Variations in screening outcome among pairs of screening radiologists at non-blinded double reading of screening mammograms: a population-based study

Objectives

Substantial inter-observer variability in screening mammography interpretation has been reported at single reading. However, screening results of pairs of screening radiologists have not yet been published. We determined variations in screening performances among pairs of screening radiologists at non-blinded double reading.

Methods

We included pairs of screening radiologists with at least 7,500 screening examinations per pair, obtained between 1997 and 2011. During 2-year follow-up, breast imaging reports, surgical reports and pathology results were collected of all referred women and interval cancers. Referral rate, cancer detection rate, positive predictive value and sensitivity were calculated for each pair.

Results

A total of 310,906 screening mammograms, read by 26 pairs of screening radiologists, were included for analysis. The referral rate ranged from 1.0 % (95 % CI 0.8 %–1.2 %) to 1.5 % (95 % CI 1.3 %–1.8 %), the cancer detection rate from 4.0 (95 % CI 2.8–5.2) to 6.3 (95 % CI 4.5–8.0) per 1,000 screens. The programme sensitivity and positive predictive value of referral ranged from 55.1 % (95 % CI 45.1 %–65.1 %) to 81.5 % (95 % CI 73.4 %–89.6 %) and from 28.7 % (95 % CI 20.8 %–36.6 %) to 49.5 % (95 % CI 39.7 %–59.3 %), respectively.

Conclusion

We found significant variations in screening outcomes among pairs of screening radiologists at non-blinded double reading. This stresses the importance of monitoring screening results on a local scale.

Key Points

? Substantial inter-observer variability in screening mammography interpretation is known at single reading ? Population-based study showed significant variations in outcomes among pairs of screening radiologists ? Local monitoring and regular feedback are important to optimise screening outcome