Quadruple screening best for mammogram review

The following report appears in British Journal of Cancer and provides more evidence of the important role of Specialist Breast Centres.

Radiographers can help examine screening mammograms, say Dutch researchers who believe their study may help hospitals with a shortage of screening radiologists.  

Although quadruple reading – where each mammogram is examined by two radiologists and two radiographers – gave the best sensitivity, the team says a strategy of a single radiologist and double radiographer review is acceptable.  

As reported in the British Journal of Cancer, a team of 21 screening mammography radiographers and eight screening radiologists reviewed 106,093 screening mammograms, with each film examined by two radiographers followed by two radiologists.  

Women were referred for further investigation where positive findings were agreed on by both radiologists, or where the radiologist agreed on radiographer-referred findings.  

Analysis of findings after single radiologist review showed that an average of 4.64 cancers were detected per 1000 mammograms, but that this rate varied between individuals significantly, from 4.64 to 5.04 cases. Similarly, the sensitivity was an average of 63.9% but varied from 51.5% to 75.0% between individual radiologists.  

However, sensitivity increased to an average of 68.6% when mammograms were screened in a non-blinded fashion by two radiologists, and to 73.2% when mammograms were screened by two radiographers followed by a radiologist review of positive cases.  

Furthermore, the sensitivity increased to 75.2% when triple read by one radiologist and two radiographers referring all positive readings, and to 76.9% when quadruple screened with referral of all findings.  

The referral rate was highest with the quadruple reading strategy, at 2.04, as was the cancer detection rate, at 5.58 cases per 1000 women. In comparison, the triple reading strategy gave referral and cancer detection rates of 1.48 and 5.32, respectively.  

Recognizing that many countries, including the UK and USA, have a shortage of screening radiologists, L Duijm (Catharina Hospital, Eindhoven) and colleagues say “it would be of practical value if dedicated radiographers can replace a screening radiologist as the second reader.”  

They conclude: “Triple reading by one radiologist and two radiographers may be an alternative to radiologist double-reading in programs with a shortage of radiologists.”

Source: MedWire News
Br J Cancer 2009; 100: 901–907