Characteristics of screen-detected cancers following concordant or discordant recalls at blinded double reading in biennial digital screening mammography

Angela M. P. Coolen*, Joost R. C. Lameijer, Adri C. Voogd, Marieke W. J. Louwman, Luc J. Strobbe, Vivianne C. G. Tjan-Heijnen, Lucien E. M. Duijm

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

ObjectivesTo analyse which mammographic and tumour characteristics led to concordant versus discordant recalls at blinded double reading to further optimise our breast cancer screening programme.MethodsWe included a consecutive series of 99,013 screening mammograms obtained between July 2013 and January 2015. All mammograms were double read in a blinded fashion. Discordant readings were routinely recalled without consensus or arbitration. During the 2-year follow-up, relevant data of the recalled women were collected. We compared mammographic characteristics, screening outcome and tumour characteristics between concordant and discordant recalls.ResultsThere were 2,543 concordant recalls (71.4%) and 997 discordant recalls (28.0%). The positive predictive value of a concordant recall was significantly higher (23.5% vs. 10.0%, p <0.001). The proportion of BI-RADS 0 was significantly higher in the discordant recall group (75.7% vs. 56.3%, p <0.001). Discordant recalls were more often an asymmetry or architectural distortion (21.8% vs. 13.2% and 9.3% vs. 6.5%, respectively, p <0.001). There were no differences in the distribution of DCIS and invasive cancers and tumour characteristics were comparable for the two groups, except for a more favourable tumour grade in the discordant recall group (54.7% vs. 39.9% grade I tumours, p = 0.022).ConclusionsScreen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall. The higher proportion of asymmetries and architectural distortions in this group provide a possible target for improving screening programmes by additional training of screening radiologists and the implementation of digital breast tomosynthesis.Key Points center dot With blinded double reading of screening mammograms, screen-detected cancers detected by a discordant reading show a more favourable tumour grade than cancers diagnosed after a concordant recall.center dot The proportions of asymmetries and architectural distortions are higher in case of a discordant reading.center dot Possible improvement strategies could target additional training of screening radiologists and the implementation of digital breast tomosynthesis in breast cancer screening programmes.

Original languageEnglish
Pages (from-to)337-344
Number of pages8
JournalEuropean Radiology
Volume29
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Mass screening
  • Early detection of cancer
  • Breast neoplasms
  • Mammography
  • Follow-up studies
  • BREAST-CANCER
  • CLINICAL-EXPERIENCE
  • READER VARIABILITY
  • 3RD READER
  • TOMOSYNTHESIS
  • ARBITRATION
  • PROGRAM
  • SENSITIVITY
  • CATEGORIES

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