“Device expertise” rather than “organ expertise”: a major cause of breast cancer misdiagnosis

IMAGE AND EXAMINATION QUALITY in mammography has been held to high standards since 1996 in the USA and 2003 in the European Union countries and is guaranteed by accreditation. Every center that does mammography must be accredited. The continuity of the accreditation gained depends on the high standard of image and review quality. Despite this, misdiagnoses on mammography and marked discrepancies between radiologists’ diagnoses are common. In both the USA and Europe, 20% of early-stage breast cancers are missed each year on screening mammography..!

For example, in a study evaluating 36,000 screening mammograms at 72 centers in the USA between 1996 and 2003, the rate of correct diagnosis of cancer among 123 radiologists was found. 27-100%The rate of suggesting a biopsy unnecessarily (thinking it as cancer) was between 0-16%was found among On average 21% of cancers are missed, on average 4.3% of womenbiopsy was recommended unnecessarily ( Miglioretti D et al., Journal of National Cancer Institute, Vol 99(24):1854-1863, 2007).

Since it is not possible to talk about the QUALITY of mammography in the USA and Europe thanks to quality accreditation programs, what is the reason for the wide range of accurate diagnosis rates and the overlooked 20% of early-stage breast cancers?

The results of 484,463 diagnostic mammograms read in 44 mammography centers in the USA between 1996 and 2002 also showed significant differences between the correct diagnosis rates of radiologists ( Taplin S et al., Journal of National Cancer Institute, Vol 100(12):876-887, 2008), In this study, The common features of the centers with high accurate diagnosis rates were that they were centers where only mammography was performed and evaluations were made by a ‘breast radiologist’.

In fact, the situation is not different for other radiological examinations. For example, in a study by J Potchen in which he measured the ‘reading’ performance of more than 100 radiologists using 60 chest X-rays, it was shown that about 38 seconds after starting to look at the chest X-ray, the radiologists began to see ‘things that weren’t’, that is, they started describing normal anatomical structures as abnormal. .

Regardless of the type of radiological examination, an important reason for the differences between diagnoses and misdiagnoses is that radiologists do not have enough in-depth knowledge and experience of the subject they are observing, so they are not sure. So why?

Because, in hospitals, general radiologists usually work with rotation between different devices (3 months ultrasound, 3 months MR, 3 months mammography..). They are expected to know “good enough of everything” rather than “very well”. Naturally, the chances of misdiagnosis are remarkably high. In order to prevent this negativity, radiologists, like doctors in other branches, prefer to receive higher education in a subject. For nearly 20 years, there are radiology specialties such as “abdominal radiology”, “breast radiology”, “brain and nervous system radiology”, “musculoskeletal system radiology”, “pediatric radiology” all over the world.

general radiologistsIt is very easy to “see what you want to see” because it is almost inevitable to be conditioned to the request and question of the referring physician.

Organ specialist radiologists On the other hand, due to their extensive experience in the diseases, diagnosis, treatment and follow-up of the organ, they have become much more sensitive to keep their minds open, to see and interpret beyond their expectations. They are honed in how the clinical story is framed, clues in the clinician’s language, and skills in systematic evaluation of the organ.

at the Journal of National Cancer InstituteThe conclusion sentences of the published studies – mentioned above – are similar to those of previous similar scientific studies:

Women should only have their mammogram done by a breast radiologist; While it may not be easy, it is definitely worth it.”.

“This study has shown that the diagnoses of breast radiologists are definitely more reliable. Other doctors should make sure that the radiologist they refer their patients to for mammography is a “breast radiologist.”

This is true not only for mammography, but also for other breast examinations such as breast ultrasonography and breast MRI. All radiological examinations related to the breast should be planned and performed by the same radiologist with the understanding of “organ examination”. This can only be possible if the radiologist is a “breast radiologist”.

There are radiologists who specialize in organs in Turkey, but the weighted system is still the “device system” (such as ultrasound expertise, MR expertise, Computed tomography expertise). Undoubtedly, the increase in the number of organ specialist radiologists can only be possible if other specialties (such as General Surgery and Obstetrics) give the “organ radiology” and “organ radiologists” the importance they deserve. The second requirement is to increase the awareness of the society about the “quality of service”. We hope that one day, the quality demands of our society will reach dimensions that can affect the quality of service supply as in developed countries…

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