Table 4.
Associations between individual facility characteristics and false-positive rate, sensitivity, and positive predictive value of biopsy, adjusted for patient characteristics, radiologist characteristics, and a facility random effect (based on 32 facilities with 21 653 evaluations of a breast problem)*
| Facility characteristic | Odds of having a positive mammogram given no cancer diagnosis (false-positive rate),† OR (95% CI) | Odds of having a positive mammogram given a cancer diagnosis (sensitivity),‡ OR (95% CI) | Odds of having a cancer diagnosis given a positive mammogram (PPV2),§ OR (95% CI) |
| Facility structure and organization | |||
| Associated with an academic medical center | |||
| No | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Yes | 1.1 (0.75 to 1.68) | 1.1 (0.67 to 1.65) | 1 (0.77 to 1.32) |
| Volume | |||
| Facility volume of all screening and diagnostic mammograms (average per year) from BCSC data‖ | |||
| ≤1500 | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| 1501–2500 | 0.6 (0.36 to 1.14) | 0.5 (0.19 to 1.37) | 0.9 (0.46 to 1.65) |
| 2501–6000 | 0.7 (0.39 to 1.15) | 1.1 (0.43 to 2.6) | 1.0 (0.58 to 1.69) |
| >6000 | 0.7 (0.42 to 1.23) | 1.3 (0.56 to 3.2) | 0.9 (0.56 to 1.56) |
| Facility volume of diagnostic evaluations for breast problems (average per year) from BCSC data‖ | |||
| ≤100 | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| 101–400 | 0.9 (0.61 to 1.41) | 1.6 (0.90 to 2.82) | 0.9 (0.60 to 1.21) |
| >400 | 0.8 (0.46 to 1.23) | 1.3 (0.72 to 2.51) | 1.1 (0.75 to 1.63) |
| Clinical services | |||
| Interventional services offered (FNA, core or vacuum-assisted biopsy, cyst aspirations, needle localization, or other procedures) | |||
| No | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Yes | 1.6 (1.08 to 2.28)* | 2.4 (1.30 to 4.31)* | 1.3 (0.86 to 2.00) |
| Specialized imaging services offered (breast CT, breast MRI, breast nuclear medicine scans)¶ | |||
| No | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Yes | 1.6 (1.11 to 2.18)* | 1.1 (0.69 to 1.76) | 1.1 (0.84 to 1.42) |
| Facility is currently short staffed (ie, not enough radiologists) | |||
| Strongly disagree/disagree/neutral | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Agree/strongly agree | 1.3 (0.96 to 1.81) | 1.6 (1.05 to 2.50)* | 0.8 (0.61 to 0.97)* |
| Financial and malpractice | |||
| Profit status | |||
| Nonprofit | 1 | 1 | 1 |
| For profit | 0.7 (0.51 to 1.02) | 0.7 (0.45 to 1.20) | 0.9 (0.69 to 1.22) |
| What does your facility charge self-pay patients (uninsured) for diagnostic mammograms (facility and radiologist fees)? | |||
| <$200 per examination | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| ≥$200 per examination | 1.1 (0.68 to 1.77) | 1.5 (0.52 to 4.13) | 0.8 (0.45 to 1.33) |
| How have medical malpractice concerns influenced recommendations of diagnostic mammograms, ultrasounds, or breast biopsies at your facility following screening mammograms? | |||
| Not changed | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Moderately increased/greatly increased | 1.6 (1.13 to 2.15)* | 1.5 (0.92 to 2.45) | 0.7 (0.55 to 0.98)* |
| Do you feel that your facility has fiscal market competition from other mammography facilities in the area? | |||
| No competition | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Some competition | 1.1 (0.70 to 1.78) | 1.0 (0.54 to 1.73) | 1.1 (0.79 to 1.52) |
| Moderate to extreme competition | 1.0 (0.61 to 1.59) | 0.8 (0.43 to 1.52) | 1.0 (0.73 to 1.48) |
| Scheduling process | |||
| Average wait time to schedule diagnostic mammogram | |||
| ≤3 d | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| >3 d | 1.4 (1.00 to 2.08)* | 1.6 (0.93 to 2.69) | 0.8 (0.59 to 1.06) |
| Do women wait for interpretation of diagnostic mammogram? | |||
| No, never/yes, some of the time | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Yes, all of the time | 1.2 (0.85 to 1.74) | 1.7 (1.07 to 2.80)* | 0.8 (0.64 to 1.08) |
| Interpretation and audit processes | |||
| Interpretive process | |||
| Are clinical breast examinations done routinely for women getting a screening mammogram? | |||
| No | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Yes | 2.3 (0.67 to 7.91) | 0.5 (0.04 to 5.77) | 2.0 (0.36 to 10.53) |
| What percentage of diagnostic mammograms are interpreted on-site? | |||
| 0 | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| 100 | 1.2 (0.65 to 2.31) | 4.3 (1.66 to 11.10)* | 1.1 (0.50 to 2.40) |
| How many radiologists interpret mammograms full time (ie, 40 h per week)? | |||
| 0 | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| ≥1 | 1.1 (0.66 to 1.87) | 1.3 (0.60 to 2.64) | 0.8 (0.49 to 1.20) |
| Are any diagnostic mammograms interpreted by more than one radiologist? | |||
| No | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Yes, 1%–5% of the time | 0.7 (0.48 to 1.10) | 0.6 (0.33 to 1.26) | 0.9 (0.58 to 1.52) |
| Yes, 10%–25% or less of the time | 1.2 (0.85 to 1.81) | 1.1 (0.65 to 1.84) | 1.0 (0.71 to 1.33) |
| Yes, ≥80% of the time | 1.2 (0.68 to 1.99) | 0.8 (0.37 to 1.78) | 0.9 (0.53 to 1.59) |
| Audit processes | |||
| Individual performance data reported back to radiologists | |||
| Once a year | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Twice or more per year | 1.0 (0.72 to 1.42) | 1.1 (0.74 to 1.72) | 0.9 (0.71 to 1.16) |
| Unknown | 1.1 (0.63 to 1.87) | 1.0 (0.48 to 2.12) | 0.8 (0.57 to 1.27) |
| Method of performance feedback information review | |||
| Reviewed together in meeting | 1.0 (referent) | 1.0 (referent) | 1.0 (referent) |
| Reviewed by facility/department manager or lead radiologist alone | 0.7 (0.40 to 1.31) | 1.4 (0.65 to 3.01) | 1.1 (0.66 to 1.68) |
| Reviewed by each radiologist alone | 1.1 (0.62 to 2.12) | 1.9 (0.49 to 7.56) | 0.9 (0.44 to 1.70) |
| Unknown | 1.2 (0.73 to 1.99) | 0.7 (0.40 to 1.24) | 1 (0.73 to 1.42) |
Values are statistically significantly different, that is, P < .05 (two-sided F tests). PPV2 = positive predictive value of biopsy; OR = odds ratio; CI = confidence interval; BCSC = Breast Cancer Surveillance Consortium; FNA = fine-needle aspiration; CT = computed tomography; MRI = magnetic resonance imaging.
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 4, 5, 0 or 3 with a recommendation for biopsy, surgical consultation, or FNA that result in a cancer diagnosis within 1 year.
Based on mammography registry data.
Does not include ultrasound or ductography.