Can mammogram readers swiftly and effectively learn to interpret first post-contrast acquisition subtracted (FAST) MRI, a type of abbreviated breast MRI?: A single centre data-interpretation study

Abstract

Objectives: To assess whether NHS breast screening programme (NHSBSP) mammogram readers could effectively interpret first post-contrast acquisition subtracted (FAST) MRI, for intended use in screening for breast cancer. Methods: Eight NHSBSP mammogram readers from a single centre (four who also read breast MRI (Group 1) and four who do not (Group 2)) were given structured FAST MRI reader training (median 4 h: 32 min). They then prospectively interpreted 125 FAST MRIs (250 breasts: 194 normal and 56 cancer) comprising a consecutive series of screening MRIs enriched with additional cancer cases from 2015, providing 2000 interpretations. Readers were blinded to other readers' opinions and to clinical information. Categorisation followed the NHSBSP MRI reporting categorisation, with categories 4 and 5 considered indicative of cancer. Diagnostic accuracy (reference standard: histology or 2 years' follow-up) and agreement between readers were determined. Results: The accuracy achieved by Group 2 (847/1000 (85%; 95% confidence interval (CI) 82-87%)) was 5% less than that of Group 1 (898/1000 (90%; 95% CI 88-92)). Good inter-reader agreement was seen between both Group 1 readers (κ = 0.66; 95% CI 0.61-0.71) and Group 2 readers (κ = 0.63; 95% CI 0.58-0.68). The median time taken to interpret each FAST MRI was Group 1: 34 s (range 3-351) and Group 2: 77 s (range 11-321). Conclusion: Brief structured training enabled multiprofessional mammogram readers to achieve similar accuracy at FAST MRI interpretation to consultant radiologists experienced at breast MRI interpretation. Advances in knowledge: FAST MRI could be feasible from a training-the-workforce perspective for screening within NHSBSP.