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

transcript

Edward A. Sickles, M.D.

Clinical Diagnostic

Mammography Benchmarks

Importance of Diagnostic Mammography

Screening: recall versus no recall

Diagnostic: biopsy versus no biopsy

Screening: recall versus no recall

Diagnostic: biopsy versus no biopsy

Screening: who gets diagnostic

Dxic: “where the rubber meets the road”

Benefits: screening ≈ diagnostic

Harms: screening << diagnostic

Harms of Mammography

Screening

AnxietyInconvenienceResourcesCost

Screening Diagnostic

AnxietyInconvenienceResourcesCost

Anxiety More anxietyInconvenienceResourcesCost

Anxiety More anxietyInconvenience More inconvenienceResourcesCost

Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost

Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost More 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.

Harms: screening << diagnostic

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; 176:729-733

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; 235:775-790

Abnormal Interpretation Rate: 1996-2002

112,917 Exams 97,123 Exams

99,737 Exams 72,307 Exams

http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

PPV2 (Biopsy Recommended): 1996-2002

112,917 Exams 97,123 Exams

PPV3 (Biopsy Performed): 1996-2002

112,917 Exams 97,123 Exams

Cancer Diagnosis Rate: 1996-2002

105,378 Exams 88,750 Exams

Mean Invasive Cancer Size: 1996-2002

105,378 Exams 88,750 Exams

Percent Minimal Cancer: 1996-2002

105,378 Exams 88,750 Exams

Percent Node Negative: 1996-2002

88,750 Exams

88,750 Exams105,378 Exams

Percent Stage 0 or I: 1996-2002

105,378 Exams 88,750 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

105,378 Exams 88,750 Exams

176,943 Exams 137,639 Exams

160,189 Exams 92,764 Exams

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

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