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Performance Parameters for Mammography Screening

Norma J. Vinger Center for Breast Care Gundersen Lutheran Health System La Crosse, WI 54601

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I read with great interest the recent article by Gromet [1], "Comparison of Computer-Aided Detection to Double Reading of Screening Mammograms: Review of 231,221 Mammograms," in the April 2008 issue of the AJR. As we are all well aware, the main purpose of mammography screening is to detect breast cancer in an early, nonpalpable phase to reduce morbidity and mortality from the disease.

The impact of mammography service screening on mortality from breast cancer in women who attend screening can be predicted by thorough analysis of the reliable surrogate measures, such as tumor size and node status [2]. These parameters will enable us to estimate whether a significant decrease in the advanced breast cancer rate has been achieved, a prerequisite for the subsequent, significant mortality reduction in women who attend screening regularly.

Although recall rate, sensitivity, cancer detection rate, positive predictive value, and false-negative rate are additional important performance measures when evaluating mam mography service screening, without reporting the tumor size and node status of all screening-detected and interval cancers, we will not have an accurate metric for predicting the effect on patient morbidity and mortality. At a minimum, the following performance parameters will be required to assess the long-term effect of the mammography screening: cancer detection rate in screening according to 10-year age subgroups, invasive-to-noninvasive cancer ratio, mean and median size of invasive cancers, node positivity rate, recall rate, sensitivity, and specificity.

In addition, it is extremely important to perform a similar audit on the cancers de tected in the interscreening interval (i.e., cancers detected within 11 months of a BI-RADS assessment category 1 or 2 [3] screening mammography finding): invasive-to-noninvasive cancer ratio, mean and median size of invasive cancers, and node positivity rate. These parameters will be vital for comparing the performance of different screening inter pre tation methods (single reader, double reader, and single reader with CAD).

Second, experience alone does not provide an objective measure of performance. Therefore, it is necessary to list the objective screening mammography performance parameters for each interpreting radiologist involved in mammography service screening.

Lastly, the potential value of CAD is inversely proportional to the expertise of the radiologist performing mammography screening.

References

1. Gromet M. Comparison of computer-aided detection to double reading of screening mammograms: review of 231,221 mammograms. AJR 2008; 190:854 –859[Abstract/Free Full Text]
2. Tabàr L, Fagerberg G, Duffy SW, Day NE, Gad A, Gröntoft O. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 1992;30 : 187–210[Medline]
3. American College of Radiology. Breast imaging reporting and data system: breast imaging atlas, 4th ed. Reston, VA: American College of Radiology, 2003

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				M. Gromet Reply Am. J. Roentgenol., November 1, 2008; 191(5): W205 - W205. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ellis, R. L. Search for Related Content PubMed PubMed Citation Articles by Ellis, R. L. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?