Performance benchmarks for screening mammography

Purpose: To retrospectively evaluate the range of performance outcomes of the radiologist in an audit of screening mammography by using a representative sample of U.S. radiologists to allow development of performance benchmarks for screening mammography. Materials and Methods: Institutional review board approval was obtained, and study was HIPAA compliant. Informed consent was or was not obtained according to institutional review board guidelines. Data from 188 mammographic facilities and 807 radiologists obtained between 1996 and 2002 were analyzed from six registries from the Breast Cancer Surveillance Consortium (BCSC). Contributed data included demographic information, clinical findings, mammographic interpretation, and biopsy results. Measurements calculated were positive predictive values (PPVs) from screening mammography (PPV₁), biopsy recommendation (PPV₂), biopsy performed (PPV₃), recall rate, cancer detection rate, mean cancer size, and cancer stage. Radiologist performance data are presented as 50th (median), 10th, 25th, 75th, and 90th percentiles and as graphic presentations by using smoothed curves. Results: There were 2 580 151 screening mammographic studies from 1 117 390 women (age range, <30 to ≥80 years). The respective means and ranges of performance outcomes for the middle 50% of radiologists were as follows: recall rate, 9.8% and 6.4%-13.3%; PPV₁, 4.8% and 3.4%-6.2%; and PPV ₂, 24.6% and 18.8%-32.0%. Mean cancer detection rate was 4.7 per 1000, and the mean size of invasive cancers was 13 mm. The range of performance outcomes for the middle 80% of radiologists also was presented. Conclusion: Community screening mammographic performance measurements of cancer outcomes for the majority of radiologists in the BCSC surpass performance recommendations. Recall rate for almost half of radiologists, however, is higher than the recommended rate.