Edward A. Sickles, M.D. Clinical Diagnostic Mammography Benchmarks.

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Presentation transcript:

Edward A. Sickles, M.D. Clinical Diagnostic Mammography Benchmarks

Importance of Diagnostic Mammography Screening:recall versus no recall Diagnostic:biopsy versus no biopsy

Importance of Diagnostic Mammography Screening:recall versus no recall Diagnostic:biopsy versus no biopsy Screening:who gets diagnostic Dxic: “where the rubber meets the road”

Importance of Diagnostic Mammography Benefits: screening ≈ diagnostic

Importance of Diagnostic Mammography Benefits: screening ≈ diagnostic Harms: screening << diagnostic

Harms of Mammography Screening Anxiety Inconvenience Resources Cost

Harms of Mammography ScreeningDiagnostic Anxiety Inconvenience Resources Cost

Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety Inconvenience Resources Cost

Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience Resources Cost

Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience ResourcesMore resources Cost

Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience ResourcesMore resources CostMore costs

Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience ResourcesMore resources CostMore costs “Overdiagnosis”

In the USA, mammography practice is opportunistic not organized, delivered locally not regionally or nationally.

In the USA, mammography practice is opportunistic not organized, delivered locally not regionally or nationally. The same physicians interpret both screening & diagnostic mammography.

The same physicians interpret both screening & diagnostic mammography.

Dxic: “where the rubber meets the road” The same physicians interpret both screening & diagnostic mammography.

Dxic: “where the rubber meets the road” Harms: screening << diagnostic The same physicians interpret both screening & diagnostic mammography.

Hence the crucial importance in monitoring and assessing not only screening but also diagnostic mammography performance

How to Assess Mammo Performance Observed performance outcomes are compared to standard performance parameters that have been designated as acceptable.

AJR 2001; 176:

Diagnostic Examinations Additional work-up of abnormal screening Short-interval (6-month) follow-up Evaluation of a breast problem - Palpable mass - Other breast problem

Performance benchmarks derived from audits of very large numbers of exams interpreted by a “population-based sample” of U.S. radiologists

Radiology 2005; 235:

Abnormal Interpretation Rate: ,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams

PPV 2 (Biopsy Recommended): ,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams

PPV 3 (Biopsy Performed): ,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams

Cancer Diagnosis Rate: ,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams

Mean Invasive Cancer Size: ,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams

Percent Minimal Cancer: ,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams

Percent Node Negative: ,750 Exams 90,318 Exams 62,793 Exams 88,750 Exams105,378 Exams

Percent Stage 0 or I: ,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams

5th Edition

BI-RADS 5th Edition: BCSC Contributions Separate screening / diagnostic audits 6 of 15 “see more” reference citations Elimination of percent density guidance Revised definition for cat. 3 at screening Angoff-consensus screening cut points Updated plots of all measured outcomes

Cancer Diagnosis Rate: ,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams

176,943 Exams 137,639 Exams 160,189 Exams 92,764 Exams Cancer Diagnosis Rate: