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2.Edward A. Sickles_Screening Mammography Interpretation at the Threshold for Recall
- 1. Screening Mammography Interpretation at the Threshold for Recall Edward A. Sickles, M.D.
- 2. Threshold Screening Mammo. Interpretation Easy vs. difficult screening interpretation
- 3. Threshold Screening Mammo. Interpretation Easy vs. difficult screening interpretation ↑ TP much more important than ↓ FP
- 4. Threshold Screening Mammo. Interpretation Easy vs. difficult screening interpretation ↑ TP much more important than ↓ FP First, learn the subtle signs of malignancy
- 5. Threshold Screening Mammo. Interpretation Easy vs. difficult screening interpretation ↑ TP much more important than ↓ FP First, learn the subtle signs of malignancy Then, learn the limits of normal variation
- 6. Threshold Screening Mammo. Interpretation Easy vs. difficult screening interpretation ↑ TP much more important than ↓ FP First, learn the subtle signs of malignancy Then, learn the limits of normal variation Detect ~ all detectable cancers at RR ≤ 12%
- 7. Threshold Screening Mammo. Interpretation Increase the cancer detection rate Decrease the recall rate
- 8. Increase the Cancer Detection Rate Learn the subtle signs of malignancy
- 9. Mammographic Features Prompting Biopsy Mass Calcifications Indirect signs 118 (39%) 125 (42%) 57 (19%) Am J Roentgenol 1986; 146:661-663
- 10. Mammographic Features Prompting Biopsy All indirect signs - Solitary dilated duct - Focal asymmetry - Developing asymmetry - Architectural distortion 57 (19%) 4 ( 1%) 8 ( 3%) 19 ( 6%) 26 ( 9%) Am J Roentgenol 1986; 146:661-663
- 11. General Principles (↑ CDR) Read the patient history questionnaire ● High-risk patient ● Archit. dist. not explained by trauma
- 12. General Principles (↑ CDR) Read the patient history questionnaire Read the previous mammography report(s) ● Recommended recall not done ● Recommended core biopsy not done
- 13. General Principles (↑ CDR) Read the patient history questionnaire Read the previous mammography report(s) Ensure proper viewing conditions
- 14. General Principles (↑ CDR) Read the patient history questionnaire Read the previous mammography report(s) Ensure proper viewing conditions Batch interpretation: employ a scribe
- 15. General Principles (↑ CDR) View R & L mammograms back-to-back
- 17. General Principles (↑ CDR) View R & L mammograms back-to-back Use overall and close-in visual search
- 21. MLO CC
- 22. CC Spot MagML Spot Mag
- 23. General Principles (↑ CDR) View R & L mammograms back-to-back Use overall and close-in visual search Beware the satisfaction of search
- 25. MLO
- 26. MLO Repeat MLO
- 27. General Principles (↑ CDR) View R & L mammograms back-to-back Use overall and close-in visual search Beware the satisfaction of search Concentrate on whitest areas on images
- 29. General Principles (↑ CDR) View R & L mammograms back-to-back Use overall and close-in visual search Beware the satisfaction of search Concentrate on whitest areas on images Search for one calcification / artifact
- 31. MLO CC
- 32. General Principles (↑ CDR) View R & L mammograms back-to-back Use overall and close-in visual search Beware the satisfaction of search Concentrate on whitest areas on images Search for one calcification / artifact Compare with two prior examinations
- 34. General Principles (↑ CDR) View R & L mammograms back-to-back Use overall and close-in visual search Beware the satisfaction of search Concentrate on whitest areas on images Search for one calcification / artifact Compare with two prior examinations Beware the seduction of stability
- 35. Current
- 36. Current CCMLO
- 37. Current
- 38. 7 yrs ago
- 39. General Principles (↑ CDR) Annotate peri-threshold findings
- 41. General Principles (↑ CDR) Annotate peri-threshold findings Follow-up not a substitute for full work-up
- 42. General Principles (↑ CDR) Annotate peri-threshold findings Follow-up not a substitute for full work-up Use CAD (as intended) or double reading
- 44. Radiologist alone CAD alone Radiologist + CAD Detected Marked Detected missed missed missed missed
- 45. General Principles (↑ CDR) Annotate peri-threshold findings Follow-up not a substitute for full work-up Use CAD (as intended) or double reading Review all known false-negative cases
- 46. Specific Approaches for Asymmetry (↑ CDR) Recall if a hint of any additional finding(s)
- 48. Specific Approaches for Asymmetry (↑ CDR) Recall if a hint of any additional finding(s) Assess lesion size versus palpability
- 51. Specific Approaches for Asymmetry (↑ CDR) Recall if a hint of any additional finding(s) Assess lesion size versus palpability Above two steps for focal asymmetries
- 52. Specific Approaches for Asymmetry (↑ CDR) Recall if a hint of any additional finding(s) Assess lesion size versus palpability Above two steps for focal asymmetries One extra step for one-view-only findings
- 53. • Recall if one-view-only finding may not be included in the image field on view-not-visible • Recall if one-view-only finding may be obscured by dense fibroglandular tissue on view-not-visible Specific Approaches for Asymmetry (↑ CDR)
- 54. Threshold Screening Mammo. Interpretation Increase the cancer detection rate Decrease the recall rate
- 55. ↓ Recall Rate: General Observations Lower RR at high cancer detection rate - Why strive for this?
- 56. ↓ Recall Rate: General Observations Lower RR at high cancer detection rate - Less patient anxiety
- 57. ↓ Recall Rate: General Observations Lower RR at high cancer detection rate - Less patient anxiety - Fewer benign biopsies
- 58. ↓ Recall Rate: General Observations Lower RR at high cancer detection rate - Less patient anxiety - Fewer benign biopsies - Reduced societal cost
- 59. ↓ Recall Rate: General Observations Several-year “learning curve”
- 61. ↓ Recall Rate: General Observations Several-year “learning curve” New-technology “learning curve”
- 62. ↓ Recall Rate: General Observations Several-year “learning curve” New-technology “learning curve” Feedback from auditing may ↓ RR
- 63. ↓ Recall Rate: General Observations Lower RR at high cancer detection rate - How low is low enough?
- 64. Decrease the Recall Rate AHCPR “desirable goal”1: < 10% BCSC median recall rate2 ≈ 10% BCSC (NC) “sweet spot”3: 4.9% - 8.8% BCSC “sweet spot”4: 6.7%, 10.0% Angoff consensus meeting5: 5% - 12% 1 AHCPR 1994; Quality Determinants of Mammography:82-85 2 Radiology 2006; 241:55-67; 3 AJR 2001; 177:543-549 4 Radiology 2007; 243:681-689; 5 Radiology 2010; 255:354-361.
- 65. General Principles (Decrease Recall Rate) Read the patient history questionnaire ● Archit. distortion explained by trauma
- 66. General Principles (Decrease Recall Rate) Read the patient history questionnaire Read the previous mammography report(s) ● Benign diagnostic imaging assessment ● Concordant benign core biopsy
- 67. General Principles (Decrease Recall Rate) Read the patient history questionnaire Read the previous mammography report(s) Utilize uninterrupted batch interpretation
- 69. General Principles (Decrease Recall Rate) Read the patient history questionnaire Read the previous mammography report(s) Utilize uninterrupted batch interpretation Assess past compliance with screening
- 70. Decrease the Recall Rate Compare with prior mammograms
- 71. Recall Rate (224,039 Exams) Priors Exams Pct. 8.7% 3.8% 6,057 5,858 Recalls 69,929 154,110 No Yes UCSF Mammography Screening Practice, 1985-2008
- 74. Threshold Screening Mammo. Interpretation Length of stability PPV Threshold for recall
- 75. Maximizing Availability of Prior Exams How to accomplish this laudable goal ?
- 76. Maximizing Availability of Prior Exams • Do not permit screening exams on a walk-in basis
- 77. Maximizing Availability of Prior Exams • Do not permit screening exams on a walk-in basis • Schedule screening exams sufficiently in advance to obtain prior exams
- 78. Compare with > 1 prior exam, to increase the likelihood of showing stability due to similar positioning and compression. Decrease the Recall Rate
- 79. CurrentPrevious
- 81. MLO CC
- 82. MLO MLO
- 84. MLO Current2 yrs ago
- 85. MLO Current5 yrs ago
- 87. Decrease the Recall Rate Compare with prior mammograms Identify summation artifacts
- 88. Decrease the Recall Rate Compare with prior mammograms Identify summation artifacts Ignore if multiplicity and bilaterality