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Summary: The inter- and intraobserver agreement (K statistic) in reporting according to BI-RADS assessment categories was tested on 12 dedicated breast radiologists, with little prior working knowledge of BI-RADS, reading a set of 50 lesions (29 malignant, 21 benign). Intraobserver agreement (four categories: R2, R3, R4, R5) was fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80) or almost perfect (>0.80) for one, two, five or four radiologists, or (six categories: R2, R3, R4a, R4b, R4c, R5) fair, moderate, substantial or almost perfect for three, three, three or three radiologists, respectively. Interobserver agreement (four categories) was fair, moderate or substantial for three, six, or three radiologists, or (six categories) slight, fair or moderate for one, six, or five radiologists. Major disagreement occurred for intermediate categories (R3=0.12, R4=0.25, R4a=0.08, R4b=0.07, R4c=0.10). We found insufficient intra- and interobserver consistency of breast radiologists in reporting BI-RADS assessment categories. Although training may improve these results, simpler alternative reporting methods (systems), focused on clinical decision-making, should be explored. [Copyright &y& Elsevier]

Objective: To assess double reading effectiveness in mammography screening. Design: Retrospective study of 177,631 consecutive mammograms double read during 1998–2003. Setting: The Florence screening programme, involving 11 trained radiologists. Abnormalities reported by at least one reader prompted assessment. Results: The referral rate was 2.89% for the first reader, 3.15% for the second reader, and 3.59% for either reader. Of 713 total cancers detected, 43 were suspected only by the second reader (6.4% relative, 0.024% increase in absolute detection rate) and had a lower stage compared to the first reader (pTis–pT1b = 65.7 versus 52.0%): 41 were reviewed and classified (error type) as 'minimal sign' in six, and 'screening error' in 35 cases, or as BI-RADS 3 in one, 4a in 20, 4b in 13, and 4c in three cases. The second reading cost was €2.70 per woman examined, or €11,168 per additional cancer detected (versus €11,585 at a single reading). Discussion: Second reading is effective in detecting a limited number of additional cancer cases. Tumour stage (one-third over 1 cm in diameter) and review findings (high rate of 'screening errors' and BI-RADS R4b-c categories) suggest that second reading detects small 'difficult cases' as well as larger cancers missed due to fatigue or loss of attention. Second reading reduces screening specificity to a minor extent, and since cancer detection at second reading seems cost-effective the procedure is recommendable in routine practice. [ABSTRACT FROM AUTHOR]

Objective: To asses the effectiveness of arbitration of discordant double readings in mammography screening. Design: A retrospective study of 1217 consecutive arbitrations. Setting: A subset of discordant double readings from the Florence screening programme underwent arbitration by a third reader. Results: Positive arbitration of 1217 discordant double readings prompted assessment in 476 cases (39.2%), detecting 30 cancers (6.3%). Of 741 negative arbitrations (60.8%), 311 have been followed up thus far, and two cancers (0.64%) occurred in the site previously suspected at one of the two independent readings. Arbitration had a sensitivity of 86.3% and a negative predictive value of 99.3%. Arbitration reduced the overall referral rates from 3.82% to 2.59% (relative decrease 32.1%). Due to false-negative arbitration, cancers detected per 1000 women screened would decrease from 4.58 to 4.50 (relative decrease 1.7%). For every cancer missed due to false-negative arbitration, 151 unnecessary recalls and €21,248 would have been saved, whereas the saved cost per screened woman due to arbitration was €1.72. Discussion: Arbitration of discordant double reading would substantially reduce referral rates with a limited reduction in cancer detection rate, and may be recommended as a routine procedure. Greater benefit from arbitration might be expected in the presence of high referral rates at independent double reading, a common scenario in a newly implemented service screening. [ABSTRACT FROM AUTHOR]