PURPOSE: To evaluate the characteristics of low suspicion lesions (BI-RADS 0) at blinded and non-blinded double reading of screening mammograms and to determine the potential effect of arbitration of discrepant BI-RADS 0 recalls by a third reader on screening outcome. METHODS: We included a series of 84,927 consecutive digital screening mammograms, double read in a blinded (43,184 screens) or non-blinded (41,743 screens) fashion, between July 2009 and July 2011. Discrepant readings were routinely recalled for further evaluation. During 2 years of follow-up, radiology, surgical and pathology reports were collected of all recalled @entity1 . Arbitration of discrepant BI-RADS 0 recalls (only one radiologist assigning a BI-RADS 0 score) was retrospectively performed by a third screening radiologist. RESULTS: At blinded and non-blinded double reading, 32.0% and 32.5% of recalls were assigned BI-RADS 0 with a positive predictive value ( @entity2286 ) of 7.2% and 6.8%, respectively. Compared to non-blinded double reading, BI-RADS 0 recalls at blinded double reading showed a higher discrepancy rate (9.0 versus 4.3 per 1000 screens, p  <  0.001) and false positive recall rate (10.1 versus 8.4 per 1000 screens, p  =  0.012). Arbitration of discrepant BI-RADS 0 recalls would have significantly lowered recall rate (from 3.4% to 2.8% at blinded double reading, p  <  0.001, and from 2.8% to 2.5% at non-blinded double reading, p  =  0.008), without a decrease in @entity5 detection rate (from 7.5    to 7.3   , p  =  0.751, and from 6.6    to 6.5   , p  =  0.832, respectively) and program sensitivity (from 83.2% to 81.2%, p  =  0.453, and from 76.0% to 74.6%, p  =  0.667, respectively). Arbitration would have significantly increased the @entity2286 at blinded double reading (from 22.3% to 26.3%, p  =  0.015). CONCLUSION: We advise arbitration of discrepant BI-RADS 0 recalls, at (non-)blinded double reading of screening mammograms, to reduce recall rates and improve the @entity2286 of recall at blinded double reading.

Arbitration of discrepant BI-RADS 0 recalls by a third reader at screening mammography lowers recall rate but not the XXXX detection rate and sensitivity at blinded and non-blinded double reading.

@entity1 :: ('9606', 'Species') :: ['women'] @entity2286 :: ('12211', 'Species') :: ['PPV'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer']
@entity5 :: (MESH:D009369,Disease) :: ['cancer']
