Test-set training improves the detection rates of invasive cancer in screening mammography

B A Qenam; T Li; E Ekpo; H Frazer; P C Brennan

doi:10.1016/j.crad.2022.11.012

Test-set training improves the detection rates of invasive cancer in screening mammography

Clin Radiol. 2023 Mar;78(3):e260-e267. doi: 10.1016/j.crad.2022.11.012. Epub 2022 Dec 22.

Authors

B A Qenam¹, T Li², E Ekpo³, H Frazer⁴, P C Brennan⁵

Affiliations

¹ Medical Image Optimisation and Perception Research Group (MIOPeG), Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia. Electronic address: bqen8833@uni.sydney.edu.au.
² Medical Image Optimisation and Perception Research Group (MIOPeG), Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
³ Medical Image Optimisation and Perception Research Group (MIOPeG), Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Orange Radiology, Laboratories and Research Centre, Calabar 540281, Nigeria.
⁴ Screening and Assessment Service, St Vincent's BreastScreen, 1st Floor Healy Wing, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
⁵ Medical Image Optimisation and Perception Research Group (MIOPeG), Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.

PMID: 36646529
DOI: 10.1016/j.crad.2022.11.012

Abstract

Aim: To investigate if mammographic test-set participation affects routine breast cancer screening performance.

Materials and methods: Clinical audit data between 2008 and 2018 were collected for 35 breast screen readers who participated in the BreastScreen Reader Assessment Strategy (BREAST) and 22 readers with no history of test-set participation. For BREAST readers, the annual audit data were divided according to the year they completed their first test set, and the same years were used randomly to align and divide the data of non-BREAST readers into pre- and post-test set periods. Multiple audit parameters were inspected retrospectively for the two cohorts to identify how their reading performance has evolved in screening mammography.

Results: Investigating 2 calendar years before and after test-set participation, BREAST and non-BREAST readers recalled lower rates of women in the latter period (p=0.03 and p=0.02, respectively). They also improved their positive predictive value (PPV; p=0.01 and p=0.02, respectively). BREAST readers additionally improved their detection rates of invasive cancer (p=0.02) and all cancers (p=0.01). In an extended 3-year comparison, similar improvements occurred in the recall rate for BREAST (p=0.02) and non-BREAST readers (p=0.02) and in PPV (p=0.001, 0.01, respectively); however, improvements in detection rates also occurred exclusively in BREAST readers' performance for invasive cancer (p=0.04), DCIS (p=0.05), and all cancers (p=0.02); however, significant improvements in detection did not involve <15 mm invasive cancers in both periods. Meanwhile, non-BREAST readers demonstrated a decrease in sensitivity (p=0.02).

Conclusion: Participation in test sets is linked to over-time improvements in most audit-measured cancer detection rates.

MeSH terms

Breast Neoplasms* / diagnostic imaging
Early Detection of Cancer
Female
Humans
Mammography*
Mass Screening
Retrospective Studies