Table 3.
Facility-reported practice procedures and unadjusted performance measurements at the level of the diagnostic mammogram (based on 32 facilities with 28 100 evaluations of a breast problem)*
| Procedures and performance measurements | No.† (%) | False-positive rate,‡ % (95% CI) | Sensitivity,§ % (95% CI) | PPV2, ‖ % (95% CI) |
| Overall mean at mammogram level¶ | 32 | 6.4 (5.5 to 7.4) | 82.1 (78.4 to 85.3) | 39.1 (35.3 to 43.0) |
| Facility structure and organization | ||||
| Associated with an academic medical center | ||||
| No | 27 (84) | 5.9 (5.0 to 7.0) | 81.0 (77.6 to 84.0) | 39.3 (35.1 to 43.7) |
| Yes | 5 (16) | 7.6 (6.2 to 9.2) | 84.8 (74.7 to 91.3) | 38.5 (30.9 to 46.7) |
| Volume | ||||
| Facility volume of all screening and diagnostic mammograms (average per year) from BCSC data# | ||||
| ≤1500 | 5 (16) | 8.5 (5.7 to 12.4) | 73.7 (58.5 to 84.7)* | 31.8 (20.9 to 45.2) |
| 1501–2500 | 7 (23) | 6.0 (5.1 to 7.0) | 70.0 (55.8 to 81.2)* | 32.6 (26.6 to 39.2) |
| 2501–6000 | 9 (29) | 6.2 (5.2 to 7.3) | 77.5 (72.3 to 81.9)* | 38.0 (32.2 to 44.1) |
| >6000 | 10 (32) | 6.3 (5.0 to 8.0) | 86.1 (83.4 to 88.4)* | 41.0 (36.0 to 46.1) |
| Facility volume of diagnostic evaluations for breast problems (average per year) from BCSC data# | ||||
| ≤100 | 13 (42) | 7.7 (6.3 to 9.3) | 71.8 (63.6 to 78.8)* | 31.5 (26.6 to 36.8)* |
| 101–400 | 9 (29) | 7.0 (5.2 to 9.5) | 83.6 (76.1 to 89.1)* | 36.3 (29.9 to 43.1)* |
| >400 | 9 (29) | 5.6 (4.6 to 6.8) | 83.8 (79.6 to 87.3)* | 43.2 (40.3 to 46.1)* |
| Clinical services | ||||
| Interventional services offered (FNA to core or vacuum-assisted biopsy, cyst aspirations, needle localization, or other procedures) | ||||
| No | 8 (25) | 4.1 (2.7 to 6.1) | 68.7 (51.5 to 81.9) | 34.7 (27.2 to 43.0) |
| Yes | 24 (75) | 6.7 (5.7 to 7.7) | 83.2 (79.7 to 86.2) | 39.4 (35.5 to 43.5) |
| Specialized imaging services offered (breast CT, breast MRI, breast nuclear medicine scans)** | ||||
| No | 13 (57) | 5.8 (4.1 to 8.2) | 81.3 (74.1 to 86.9) | 37.8 (29.3 to 47.2) |
| Yes | 10 (43) | 7.3 (6.2 to 8.6) | 84.6 (79.1 to 88.8) | 38.8 (34.0 to 43.8) |
| Facility is currently short staffed (ie, not enough radiologists) | ||||
| Strongly disagree/disagree/neutral | 17 (53) | 6.2 (5.2 to 7.5) | 79.0 (70.6 to 85.6) | 39.5 (33.9 to 45.4) |
| Agree/strongly agree | 15 (47) | 6.4 (5.1 to 8.0) | 84.5 (81.4 to 87.2) | 38.8 (33.9 to 43.9) |
| Financial and malpractice | ||||
| Profit status | ||||
| Nonprofit | 19 (59) | 6.4 (5.4 to 7.5) | 85.0 (82.1 to 87.6)* | 41.4 (37.9 to 45.0) |
| For profit | 13 (41) | 6.3 (4.5 to 8.8) | 73.4 (66.4 to 79.3)* | 32.8 (26.7 to 39.5) |
| What does your facility charge self-pay patients (uninsured) for diagnostic mammograms (facility and radiologist fees)? | ||||
| <$200 per examination | 17 (63) | 7.0 (5.4 to 8.9) | 78.9 (72.7 to 84.0) | 34.4 (29.5 to 39.7)* |
| ≥$200 per examination | 10 (37) | 6.0 (5.0 to 7.2) | 86.1 (83.3 to 88.5) | 43.3 (39.8 to 46.9)* |
| How have medical malpractice concerns influenced recommendations of diagnostic mammograms, ultrasounds, or breast biopsies at your facility following screening mammograms? | ||||
| Not changed | 11 (41) | 5.2 (4.2 to 6.5) | 74.8 (70.2 to 78.9)* | 39.0 (33.5 to 44.9) |
| Moderately increased/greatly increased | 16 (59) | 6.9 (5.7 to 8.4) | 85.0 (81.6 to 87.8)* | 39.5 (34.5 to 44.7) |
| Do you feel that your facility has fiscal market competition from other mammography facilities in the area? | ||||
| No competition | 7 (23) | 5.5 (4.8 to 6.4) | 85.5 (82.3 to 88.2) | 42.4 (36.5 to 48.6) |
| Some competition | 11 (37) | 6.9 (5.2 to 9.2) | 84.9 (80.1 to 88.7) | 39.1 (32.8 to 45.8) |
| Moderate to extreme competition | 12 (40) | 6.2 (5.3 to 7.2) | 76.3 (69.7 to 81.9) | 37.3 (32.0 to 42.9) |
| Scheduling process | ||||
| Average wait time to schedule diagnostic mammogram | ||||
| ≤3 d | 16 (52) | 5.4 (4.4 to 6.7) | 74.6 (67.2 to 80.7)* | 36.4 (31.5 to 41.7) |
| >3 d | 15 (48) | 7.0 (5.8 to 8.3) | 85.3 (82.3 to 87.9)* | 40.0 (35.1 to 45.1) |
| Do women wait for interpretation of diagnostic mammogram? | ||||
| No, never/yes, some of the time | 14 (44) | 6.1 (5.2 to 7.1) | 76.7 (70.2 to 82.1)* | 38.0 (34.1 to 42.0) |
| Yes, all of the time | 18 (56) | 6.5 (5.3 to 7.9) | 84.6 (81.2 to 87.5)* | 39.6 (34.5 to 44.8) |
| Interpretation and audit processes | ||||
| Interpretive processes | ||||
| Are clinical breast examinations done routinely for women getting a screening mammogram? | ||||
| No | 25 (78) | 6.5 (5.3 to 7.9) | 78.3 (73.6 to 82.3)* | 35.1 (30.9 to 39.5)* |
| Yes | 7 (22) | 6.1 (5.0 to 7.5) | 87.2 (85.7 to 88.6)* | 45.3 (43.5 to 47.1)* |
| What percentage of diagnostic mammograms are interpreted on-site? | ||||
| 0 | 3 (9) | 5.2 (4.2 to 6.5) | 53.6 (35.6 to 70.7) | 27.8 (22 to 34.4)* |
| 100 | 29 (91) | 6.4 (5.5 to 7.4) | 82.7 (79.2 to 85.7) | 39.3 (35.5 to 43.2) |
| How many radiologists interpret mammograms full time (ie, 40 h per week)? | ||||
| 0 | 26 (84) | 6.5 (5.5 to 7.6) | 82.5 (78.5 to 85.9) | 39.6 (35.5 to 43.9) |
| ≥1 | 5 (16) | 5.4 (3.8 to 7.8) | 80.4 (69.4 to 88.1) | 35.8 (28.1 to 44.3) |
| Are any diagnostic mammograms interpreted by more than one radiologist? | ||||
| No | 15 (50) | 5.3 (4.7 to 5.9) | 82.2 (77.8 to 85.9) | 40.1 (35.0 to 45.4) |
| Yes, 1%–5% of the time | 6 (20) | 5.7 (3.4 to 9.5) | 76.0 (59.4 to 87.2) | 33.3 (24.7 to 43.1) |
| Yes, 10%–25% or less of the time | 6 (20) | 7.2 (5.8 to 9.0) | 86.0 (82.8 to 88.7) | 42.3 (36.7 to 48.2) |
| Yes, ≥80% of the time | 3 (10) | 7.8 (6.3 to 9.6) | 73.3 (68.7 to 77.4) | 32.8 (29.2 to 36.6) |
| Audit processes | ||||
| Individual performance data reported back to radiologists | ||||
| Once a year | 13 (41) | 5.6 (4.8 to 6.5) | 80.3 (75.3 to 84.6) | 40.7 (37.1 to 44.5) |
| Twice or more per year | 15 (47) | 7.3 (5.9 to 9.1) | 83.2 (77.7 to 87.6) | 37.3 (30.8 to 44.3) |
| Unknown | 4 (13) | 4.8 (4.0 to 5.8) | 83.5 (77.9 to 87.9) | 42.8 (35.9 to 50.0) |
| Method of performance feedback information review | ||||
| Reviewed together in meeting | 18 (56) | 6.6 (5.5 to 8.0) | 81.2 (76.9 to 84.8) | 37.7 (33.2 to 42.4) |
| Reviewed by facility or department manager or lead radiologist alone | 5 (16) | 4.4 (3.1 to 6.2) | 80.6 (68.6 to 88.8) | 41.9 (31.3 to 53.4) |
| Reviewed by each radiologist alone | 4 (13) | 7.0 (6.0 to 8.0) | 73.7 (50.8 to 88.4) | 28.3 (15.4 to 46.1) |
| Unknown | 5 (16) | 6.9 (5.5 to 8.6) | 86.9 (82.8 to 90.2) | 44.3 (41.8 to 46.7) |
Values are statistically significantly different, that is, P < .05 (two-sided χ2 tests). PPV2 = positive predictive value of biopsy; CI = confidence interval; BCSC = Breast Cancer Surveillance Consortium; FNA = fine-needle aspiration; CT = computed tomography; MRI = magnetic resonance imaging.
Columns may not total 32 because of missing values.
False-positive rate is defined as the percentage of mammograms without a cancer diagnoses within 1 year that also have a BI-RADS assessment 4, 5, 0, or 3 with a recommendation for biopsy, surgical consultation, or FNA.
Sensitivity is defined as the percentage of mammograms with a cancer diagnoses within 1 year that also have a BI-RADS assessment 4, 5, 0 or 3 with a recommendation for biopsy, surgical consultation, or FNA.
PPV2 is defined as the percentage of mammograms with either a BI-RADS assessment 0 or 3 with a recommendation for biopsy, surgical consultation, or FNA or a BI-RADS assessment 4 or 5 that result in a cancer diagnosis within 1 year.
The overall mean at the mammogram level was computed by weighting each facility by the number of mammography screening examinations interpreted at that facility and included in this analysis (facilities with more mammography screening examinations would be given a higher weight in this calculation compared with the overall mean at the facility level shown in Figure 2).
Based on mammography registry data.
Does not include ultrasound or ductography.