Test-set results can predict participants' development in breast-screen cancer detection: An observational cohort study.

BACKGROUND AND AIM

Test-sets are standardized assessments used to evaluate reader performance in breast screening. Understanding how test-set results affect real-world performance can help refine their use as a quality improvement tool. The aim of this study is to explore if mammographic test-set results could identify breast-screening readers who improved their cancer detection in association with test-set training.

METHODS

Test-set results of 41 participants were linked to their annual cancer detection rate change in two periods oriented around their first test-set participation year. Correlation tests and a multiple linear regression model investigated the relationship between each metric in the test-set results and the change in detection rates. Additionally, participants were divided based on their improvement status between the two periods, and Mann-Whitney test was used to determine if the subgroups differed in their test-set metrics.

RESULTS

Test-set records indicated multiple significant correlations with the change in breast cancer detection rate: a moderate positive correlation with sensitivity (0.688,  < 0.001), a moderate negative correlation with specificity (-0.528,  < 0.001), and a low to moderate positive correlation with lesion sensitivity (0.469,  = 0.002), and the number of years screen-reading mammograms (0.365,  = 0.02). In addition, the overall regression was statistically significant ( (2,38) = 18.456  < 0.001), with an ² of 0.493 (adjusted ² = 0.466) based on sensitivity ( = 27.132,  < 0.001) and specificity ( = 9.78,  = 0.003). Subgrouping the cohort based on the change in cancer detection indicated that the improved group is significantly higher in sensitivity ( < 0.001) and lesion sensitivity ( = 0.02) but lower in specificity ( = 0.003).

CONCLUSION

Sensitivity and specificity are the strongest test-set performance measures to predict the change in breast cancer detection in real-world breast screening settings following test-set participation.