11 March 2014 Does sensitivity measured from screening test-sets predict clinical performance?
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Abstract
Aim: To examine the relationship between sensitivity measured from the BREAST test-set and clinical performance.

Background: Although the UK and Australia national breast screening programs have regarded PERFORMS and BREAST test-set strategies as possible methods of estimating readers' clinical efficacy, the relationship between test-set and real life performance results has never been satisfactorily understood.

Methods: Forty-one radiologists from BreastScreen New South Wales participated in this study. Each reader interpreted a BREAST test-set which comprised sixty de-identified mammographic examinations sourced from the BreastScreen Digital Imaging Library. Spearman's rank correlation coefficient was used to compare the sensitivity measured from the BREAST test-set with screen readers' clinical audit data.

Results: Results shown statistically significant positive moderate correlations between test-set sensitivity and each of the following metrics: rate of invasive cancer per 10 000 reads (r=0.495; p < 0.01); rate of small invasive cancer per 10 000 reads (r=0.546; p < 0.001); detection rate of all invasive cancers and DCIS per 10 000 reads (r=0.444; p < 0.01).

Conclusion: Comparison between sensitivity measured from the BREAST test-set and real life detection rate demonstrated statistically significant positive moderate correlations which validated that such test-set strategies can reflect readers' clinical performance and be used as a quality assurance tool. The strength of correlation demonstrated in this study was higher than previously found by others.
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BaoLin P. Soh, Warwick B. Lee, Claudia R. Mello-Thoms, Kriscia A. Tapia, John Ryan, Wai Tak Hung, Graham J. Thompson, Rob Heard, Patrick C. Brennan, "Does sensitivity measured from screening test-sets predict clinical performance?", Proc. SPIE 9037, Medical Imaging 2014: Image Perception, Observer Performance, and Technology Assessment, 90370R (11 March 2014); doi: 10.1117/12.2035111; https://doi.org/10.1117/12.2035111
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