Screening mammograms by community radiologists: Variability in false-positive rates

Joann G. Elmore, Diana L Miglioretti, Lisa M. Reisch, Mary B. Barton, William Kreuter, Cindy L. Christiansen, Suzanne W. Fletcher

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Background: Previous studies have shown that the agreement among radiologists interpreting a test set of mammograms is relatively low. However, data available from real-world settings are sparse. We studied mammographic examination interpretations by radiologists practicing in a community setting and evaluated whether the variability in false-positive rates could be explained by patient, radiologist, and/or testing characteristics. Methods: We used medical records on randomly selected women aged 40-69 years who had had at least one screening mammographic examination in a community setting between January 1, 1985, and June 30, 1993. Twenty-four radiologists interpreted 8734 screening mammograms from 2169 women. Hierarchical logistic regression models were used to examine the impact of patient, radiologist, and testing characteristics. All statistical tests were two-sided. Results: Radiologists varied widely in mammographic examination interpretations, with a mass noted in 0%-7.9%, calcification in 0%-21.3%, and fibrocystic changes in 1.6%-27.8% of mammograms read. False-positive rates ranged from 2.6% to 15.9%. Younger and more recently trained radiologists had higher false-positive rates. Adjustment for patient, radiologist, and testing characteristics narrowed the range of false-positive rates to 3.5%-7.9%. If a woman went to two randomly selected radiologists, her odds, after adjustment, of having a false-positive reading would be 1.5 times greater for the radiologist at higher risk of a false-positive reading, compared with the radiologist at lowest risk (95% highest posterior density interval [similar to a confidence interval] = 1.17 to 2.08). Conclusion: Community radiologists varied widely in their false-positive rates in screening mammograms; this variability range was reduced by half, but not eliminated, after statistical adjustment for patient, radiologist, and testing characteristics. These characteristics need to be considered when evaluating false-positive rates in community mammographic examination screening.

Original languageEnglish (US)
Pages (from-to)1373-1380
Number of pages8
JournalJournal of the National Cancer Institute
Volume94
Issue number18
StatePublished - Sep 18 2002
Externally publishedYes

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Radiologists
Reading
Logistic Models
Medical Records
Confidence Intervals

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Elmore, J. G., Miglioretti, D. L., Reisch, L. M., Barton, M. B., Kreuter, W., Christiansen, C. L., & Fletcher, S. W. (2002). Screening mammograms by community radiologists: Variability in false-positive rates. Journal of the National Cancer Institute, 94(18), 1373-1380.

Screening mammograms by community radiologists : Variability in false-positive rates. / Elmore, Joann G.; Miglioretti, Diana L; Reisch, Lisa M.; Barton, Mary B.; Kreuter, William; Christiansen, Cindy L.; Fletcher, Suzanne W.

In: Journal of the National Cancer Institute, Vol. 94, No. 18, 18.09.2002, p. 1373-1380.

Research output: Contribution to journalArticle

Elmore, JG, Miglioretti, DL, Reisch, LM, Barton, MB, Kreuter, W, Christiansen, CL & Fletcher, SW 2002, 'Screening mammograms by community radiologists: Variability in false-positive rates', Journal of the National Cancer Institute, vol. 94, no. 18, pp. 1373-1380.
Elmore JG, Miglioretti DL, Reisch LM, Barton MB, Kreuter W, Christiansen CL et al. Screening mammograms by community radiologists: Variability in false-positive rates. Journal of the National Cancer Institute. 2002 Sep 18;94(18):1373-1380.
Elmore, Joann G. ; Miglioretti, Diana L ; Reisch, Lisa M. ; Barton, Mary B. ; Kreuter, William ; Christiansen, Cindy L. ; Fletcher, Suzanne W. / Screening mammograms by community radiologists : Variability in false-positive rates. In: Journal of the National Cancer Institute. 2002 ; Vol. 94, No. 18. pp. 1373-1380.
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abstract = "Background: Previous studies have shown that the agreement among radiologists interpreting a test set of mammograms is relatively low. However, data available from real-world settings are sparse. We studied mammographic examination interpretations by radiologists practicing in a community setting and evaluated whether the variability in false-positive rates could be explained by patient, radiologist, and/or testing characteristics. Methods: We used medical records on randomly selected women aged 40-69 years who had had at least one screening mammographic examination in a community setting between January 1, 1985, and June 30, 1993. Twenty-four radiologists interpreted 8734 screening mammograms from 2169 women. Hierarchical logistic regression models were used to examine the impact of patient, radiologist, and testing characteristics. All statistical tests were two-sided. Results: Radiologists varied widely in mammographic examination interpretations, with a mass noted in 0{\%}-7.9{\%}, calcification in 0{\%}-21.3{\%}, and fibrocystic changes in 1.6{\%}-27.8{\%} of mammograms read. False-positive rates ranged from 2.6{\%} to 15.9{\%}. Younger and more recently trained radiologists had higher false-positive rates. Adjustment for patient, radiologist, and testing characteristics narrowed the range of false-positive rates to 3.5{\%}-7.9{\%}. If a woman went to two randomly selected radiologists, her odds, after adjustment, of having a false-positive reading would be 1.5 times greater for the radiologist at higher risk of a false-positive reading, compared with the radiologist at lowest risk (95{\%} highest posterior density interval [similar to a confidence interval] = 1.17 to 2.08). Conclusion: Community radiologists varied widely in their false-positive rates in screening mammograms; this variability range was reduced by half, but not eliminated, after statistical adjustment for patient, radiologist, and testing characteristics. These characteristics need to be considered when evaluating false-positive rates in community mammographic examination screening.",
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AU - Christiansen, Cindy L.

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N2 - Background: Previous studies have shown that the agreement among radiologists interpreting a test set of mammograms is relatively low. However, data available from real-world settings are sparse. We studied mammographic examination interpretations by radiologists practicing in a community setting and evaluated whether the variability in false-positive rates could be explained by patient, radiologist, and/or testing characteristics. Methods: We used medical records on randomly selected women aged 40-69 years who had had at least one screening mammographic examination in a community setting between January 1, 1985, and June 30, 1993. Twenty-four radiologists interpreted 8734 screening mammograms from 2169 women. Hierarchical logistic regression models were used to examine the impact of patient, radiologist, and testing characteristics. All statistical tests were two-sided. Results: Radiologists varied widely in mammographic examination interpretations, with a mass noted in 0%-7.9%, calcification in 0%-21.3%, and fibrocystic changes in 1.6%-27.8% of mammograms read. False-positive rates ranged from 2.6% to 15.9%. Younger and more recently trained radiologists had higher false-positive rates. Adjustment for patient, radiologist, and testing characteristics narrowed the range of false-positive rates to 3.5%-7.9%. If a woman went to two randomly selected radiologists, her odds, after adjustment, of having a false-positive reading would be 1.5 times greater for the radiologist at higher risk of a false-positive reading, compared with the radiologist at lowest risk (95% highest posterior density interval [similar to a confidence interval] = 1.17 to 2.08). Conclusion: Community radiologists varied widely in their false-positive rates in screening mammograms; this variability range was reduced by half, but not eliminated, after statistical adjustment for patient, radiologist, and testing characteristics. These characteristics need to be considered when evaluating false-positive rates in community mammographic examination screening.

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