The Relationship between Mammography Readers' Real-Life Performance and Performance in a Test Set-based Assessment Scheme in a National Breast Screening Program

Purpose: To compare an individual's Personal Performance in Mammographic Screening (PERFORMS) score with their Breast Screening Information System (BSIS) real-life performance data and determine which parameters in the PERFORMS scheme offer the best reflection of BSIS real-life performance metrics. Materials and Methods: In this retrospective study, the BSIS real-life performance metrics of individual readers (n = 452) in the National Health Service Breast Screening Program (NHSBSP) in England were compared with performance in the test set-based assessment scheme over a 3-year period from 2013 to 2016. Cancer detection rate (CDR), recall rate, and positive predictive value (PPV) were calculated for each reader, for both real-life screening and the PERFORMS test. For each metric, real-life and test set versions were compared using a Pearson correlation. The real-life CDR, recall rate, and PPV of outliers were compared against other readers (non-outliers) using analysis of variance. Results: BSIS real-life CDRs, recall rates, and PPVs showed positive correlations with the equivalent PERFORMS measures (P<.001, P=.002, and P<.001, respectively). The mean real-life CDR of PERFORMS outliers was 7.2 per 1000 women screened and was significantly lower than other readers (nonoutliers) where the real-life CDR was 7.9 (P=.002). The mean real-life screening PPV of PERFORMS outliers was 0.14% and was significantly lower than the nonoutlier group who had a mean PPV of 0.17% (P=.006). Conclusion: The use of test set-based assessment schemes in a breast screening program has the potential to predict and identify poor performance in real life. (C) RSNA, 2020