Clinically relevant summary performance measure needed for breast cancer screening

The creation of a simple, computable summary performance measure for estimation of marginal values of new or supplementary imaging-based procedures is needed for the rapidly changing clinical environment, according to an article published in the March issue of Academic Radiology.

The advent of numerous supplemental screening methods to mammography has led to increasing costs and complexity in clinical practice. “Clinicians and investigators should focus on assessing the marginal value of these additional procedures, regardless of any other performance measure considerations, such as cost, professional resources, recall rate, and participants’ anxiety,” wrote author David Gur, ScD, of the University of Pittsburgh.

Gur believes that positive predictive values are the closest summary measure to a clinically relevant outcome measure that is related to marginal value. “If one agrees with this general concept,” wrote Gur, “the issue becomes simply an assessment of the difference in the agreed upon summary measure with and without the use of the modality in question on the entire population or subsets of the population in question.”

Although a significant portion of data needed from large field trials is unavailable due to the contemporary nature of these supplemental screening modalities, Gur suggests data can be derived from the Mammography Quality Standards Act to estimate the proposed summary measure. Any technology or practice that has been shown to improve sensitivity and specificity would improve the marginal values. Therefore, the decision regarding adoption of the practice should be based on operational and cost concerns instead of clinical outcomes, noted Gur.

“In summary, I propose that clinicians and investigators consider, discuss, argue, and hopefully agree on a relatively simple computable summary performance measure that could be used for estimating marginal values of new and/or supplementary imaging-based procedures,” he wrote.