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Is Radiologists’ Performance Affected by Previous Knowledge of Presence of Cancer on Mammograms?

December 30, 2007
Written by: , Filed in: Breast Imaging
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A recent study was conducted to perform retrospective comparison of uninformed and informed review to identify interval breast cancers.

Two different settings of batch reading of screening mammograms, which included biopsy-proven interval breast cancers, was performed to compare radiologists’ ability to detect interval cancers. One setup (informed review) consisted of 17-20 images showing interval cancers that were mixed with 80 normal mammograms. These were reviewed by 2-3 radiologists who were aware of the study design. The second setup (uninformed review) consisted of 30-60 typical daily workload images mixed with one interval cancer per daily workload. These were reviewed by 3 radiologists who were blind to the study design.

The study included 21 mammograms showing interval breast cancers. Fifty percent of the mammograms with interval breast cancers were dismissed by all radiologists in the study. For 67% of cancers in the study, there was no difference in cancer detection rate between the informed and uninformed group. However, 29% of interval cancers were detected by only the radiologists in the informed group.

There is a bias in detecting breast cancers in radiologists’ performance when the radiologists are informed of presence of cancers on the mammograms.

Reviewer’s Comments
Mammography remains the only effective screening tool for breast cancers. Failure to diagnose breast cancers on mammograms may include failure to recognize lesions, incorrect conclusion and recommendation of a lesion after diagnostic workup, or truly mammographically inapparent cancers. Studies have shown that many breast cancers initially missed on the mammograms can be identified retrospectively with knowledge of their presence. The Results of this study also suggests presence of bias and improved performance of radiologists when those radiologists are informed of the presence of breast cancers on the mammograms.

Author: Bokran Won, MD

A True Screening Environment for Review of Interval Breast Cancers: Pilot Study to Reduce Bias.


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