Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset
Authors: Jones Lyn I. , Marshall Andrea , Elangovan Premkumar , Geach Rebecca , McKeown-Keegan Sadie , Vinnicombe Sarah , Harding Sam A. , Taylor-Phillips Sian , Halling-Brown Mark , Foy Christopher , O’Flynn Elizabeth , Ghiasvand Hesam , Hulme Claire , Dunn Janet A. ,   the FAST MRI Study Group, Kuhl Christiane , Wookey Jennifer , Rose Janice , Taylor Victoria , Gifford John , Gray Rosie , William-Jones Thomas , Litton Karen , Lloyd Simon , Steel Jim , Kutt Elisabeth , Valencia Alexandra , Pocklington Alice , Mahatma Anjum , Massey Helen , Clark Gillian , McLachlan Clare , Beckett Gemini , Alison Clare , Barta Miklos , Betancourt Claudia , Bramwell Julie , Bright Nichola , Burt Helen , Cann Louise , Ceney Jane , Cornford Eleanor , Dalgliesh Diana , Doyle Sarah , Fearn Sarah , Godden Dagmar , Goldthorpe Zoe , Hobson Lucinda , Hynam Paul , Jackson Emma , Jenkin Margaret , Kingsnorth Beckie , Klimczak Katherine , Moody Alice , Perrin Sarah , Peters Alison , Preston Elizabeth , Ratsey Anne , Sidebottom Richard , Stephenson Lesley , Taylor Michelle , Toth Erika , Vincent Frances , Watkin Sharon , Widdison Sue , Williams Jennifer , Wilmot Karen , Singamaneni Sravya , Friedrich Zsolt , Robson Joanne , Cullimore Elizabeth , Mankelow Anna 
Published: July 2022

Abstract
Background
Abbreviated breast MRI (abMRI) is being introduced in breast screening trials and clinical practice, particularly for women with dense breasts. Upscaling abMRI provision requires the workforce of mammogram readers to learn to effectively interpret abMRI.
The purpose of this study was to examine the diagnostic accuracy of mammogram readers to interpret abMRI after a single day of standardised small-group training and to compare diagnostic performance of mammogram readers experienced in full-protocol breast MRI (fpMRI) interpretation (Group 1) with that of those without fpMRI interpretation experience (Group 2).

Methods
Mammogram readers were recruited from six NHS Breast Screening Programme sites. Small-group hands-on workstation training was provided, with subsequent prospective, independent, blinded interpretation of an enriched dataset with known outcome. A simplified form of abMRI (first post-contrast subtracted images (FAST MRI), displayed as maximum-intensity projection (MIP) and subtracted slice stack) was used. Per-breast and per-lesion diagnostic accuracy analysis was undertaken, with comparison across groups, and double-reading simulation of a consecutive screening subset.

Results
37 readers (Group 1: 17, Group 2: 20) completed the reading task of 125 scans (250 breasts) (total = 9250 reads). Overall sensitivity was 86% (95% confidence interval (CI) 84–87%; 1776/2072) and specificity 86% (95%CI 85–86%; 6140/7178). Group 1 showed significantly higher sensitivity (843/952; 89%; 95%CI 86–91%) and higher specificity (2957/3298; 90%; 95%CI 89–91%) than Group 2 (sensitivity = 83%; 95%CI 81–85% (933/1120) p < 0.0001; specificity = 82%; 95%CI 81–83% (3183/3880) p < 0.0001). Inter-reader agreement was higher for Group 1 (kappa = 0.73; 95%CI 0.68–0.79) than for Group 2 (kappa = 0.51; 95%CI 0.45–0.56). Specificity improved for Group 2, from the first 55 cases (81%) to the remaining 70 (83%) (p = 0.02) but not for Group 1 (90–89% p = 0.44), whereas sensitivity remained consistent for both Group 1 (88–89%) and Group 2 (83–84%).

Conclusions
Single-day abMRI interpretation training for mammogram readers achieved an overall diagnostic performance within benchmarks published for fpMRI but was insufficient for diagnostic accuracy of mammogram readers new to breast MRI to match that of experienced fpMRI readers. Novice MRI reader performance improved during the reading task, suggesting that additional training could further narrow this performance gap.