Performance of Double Reading Mammography in an Iranian Population and Its Effect on Patient Outcome

BACKGROUND: Considering the importance and responsibility of reporting mammography and the necessity to notice details with a high degree of precision, double reading mammography has been introduced and recommended. OBJECTIVES: This study aimed to assess the performance of double reading of mammograms and its effect on patient outcomes. PATIENTS AND METHODS: Throughout this cross sectional study, 1284 digitized mammographic views of 642 breasts which belonged to 339 women (of which 303 were bilateral and 36 were unilateral mammographies) were enrolled. Two independent radiologists interpreted these mammograms and BI-RADS categories of both reports were compared. Discordant results were determined and assumed significant if they were in the positive (BI-RADS 0, 4, 5) versus negative (BI-RADS 1, 2, 3) groups and then significant discordant cases were followed up to determine benign versus malignant final diagnosis. The recall rate was calculated for each reader. Inter-observer agreement in breast density was determined by Kappa test. RESULTS: Readers had consensus on BI-RADS categories in 459 breasts (71%), but diverse categories were used for 183 breasts (29%), including 132 significant and 51 non-significant discrepancies. According to weighted Kappa test, agreement between two readers in positive or negative reports was 0.78 (95% CI=0.73-0.83) and in parenchymal density, it was 0.73 (95% CI=0.7-0.77). Most of the discrepancies were between category zero versus categories 1 and 2 (63.4%). The recall rate was 36% for the first and 44% for the second reader. Among 132 significant discordant results, one case had the final diagnosis of malignancy and the others had benign or negative diagnosis. There was 0.2% increase in cancer detection rate by double reading. CONCLUSION: This study shows no significant improvement in the cancer detection rate by double reading; however, a lower recall rate could be a more helpful consequence.