Radiologists perform better at screening if they follow up with diagnostic mammograms

Buist et al in their Radiology article analyzed the performance of 96 radiologists at screening mammograms (651 671).  They looked at the effect the number of diagnostic work-ups performed after abnormal findings were found at screening had if the same or a different radiologist interpreted them.

Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% for 0–50, and 39% for more than 50. For the work-up of recalled screening mammograms from other radiologists, 24% of radiologists performed the work-up for 0–50 mammograms, 32% performed the work-up for 51–125, and 44% performed the work-up for more than 125.

With increasing numbers of radiologist work-ups for their own recalled mammograms, the sensitivity of screening mammography increased, yielding a stepped increase in women recalled per cancer detected from 17.4 for 25 or fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant increases in false positive rate and cancer detection rate and a non-significant increase in sensitivity. Radiologists with a lower annual volume of any work-ups had consistently lower false positive rate, sensitivity, and cancer detection rate at all annual interpretive volumes.

They conclude that radiologists may improve their screening accuracy by performing diagnostic work-up for their own recalled screening mammograms.  They recommend arranging for radiologists to work up a minimum number of their own recalled cases in order to improve their accuracy in screening.