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Rates and Causes of Disagreement in Interpretation of Full-Field Digital Mammography and Film-Screen Mammography in a Diagnostic Setting

¹ Radiology Department, Lynn Sage Comprehensive Breast Center, Northwestern University Medical School, Galter Pavilion, 13th Floor, 251 E. Huron St., Chicago, IL 60611-2923.
² Present Address: Baylor Methodist Breast Care Center, 6550 Fannin St., 7th Floor, Ste. 701, Houston, TX 77030.
³ Present Address: West Suburban Hospital, Three Erie Ct., Oak Park, IL 60302.
⁴ AMC Cancer Research Center, 1600 Pierce St., Denver, CO 80214.

OBJECTIVE. This study was performed to determine the rates and causes of disagreements in interpretation between full-field digital mammography and film-screen mammography in a diagnostic setting.

SUBJECTS AND METHODS. Patients undergoing diagnostic mammography were invited to participate in the digital mammography study. Three views, selected by the radiologist interpreting the film-screen mammography, were obtained in both film-screen mammography and digital mammography. Radiologists independently assigned a Breast Imaging Reporting and Data System (BI-RADS) category to the film-screen mammography and the digital mammography images. The BI-RADS categories were grouped into the general categories of agreement, partial agreement, or disagreement. A third and different radiologist reviewed all cases of disagreement, reached a decision as to management, and determined the primary cause of disagreement.

RESULTS. Six radiologists reviewed digital mammography and film-screen mammography diagnostic images in a total of 1147 breasts in 692 patients. Agreement between digital mammography and final film-screen mammography assessment was present in 937 breasts (82%), partial agreement in 159 (14%), and disagreement in 51 (4%), for a kappa value of 0.29. The primary causes of disagreement were differences in management approach of the radiologists (52%), information derived from sonography or additional film-screen mammograms (34%), and technical differences between the two mammographic techniques (10%).

CONCLUSION. Significant disagreement between film-screen mammography and digital mammography affecting follow-up management was present in only 4% of breasts. The most frequent cause of disagreement in interpretation was a difference in management approach between radiologists (interobserver variability). This source of variability was larger than that due to differences in lesion visibility between film-screen mammography and digital mammography.

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