Timeliness of an Expedited Diagnostic Pathway for Screening Mammography Recalls.
Oct 23, 2026DOI: 10.1016/j.jacr.2026.10.019Journal ArticleJACR
Written by: Babita PanigrahiSwathi RamanLisa A MullenKelly S MyersKatharine YaoEmily B Ambinder
OBJECTIVE: To compare diagnostic and biopsy timeliness, malignancy yield, and cancer characteristics between expedited and standard screening mammography recall pathways.METHODS: An expedited recall workflow implemented in Epic enabled radiologists to flag highly suspicious BI-RADS 0 findings for telephone scheduling into reserved appointments, targeting diagnostic evaluation within one week. We retrospectively reviewed recalls from 11/1/2024-1/31/2026. Primary outcomes were time from screening to diagnostic evaluation and malignancy yield (PPV1 and PPV3). Secondary outcomes included diagnostic-to-biopsy and screening-to-biopsy intervals, delayed diagnostic imaging (≥30 days from screening), delayed biopsy (≥30 days from diagnostic), and malignancy characteristics. Intervals were measured in calendar days.RESULTS: Among 36,384 screening mammograms, 4,647 were BI-RADS 0 (recall rate 12.8%); 57 (1.2%) were expedited. After excluding 247 standard pathway cases without follow-up, 4,400 were analyzed. Expedited patients were older (median 64.6 vs 52.5 years, p<0.001) with shorter median screening-to-diagnostic (7 vs 25 days), diagnostic-to-biopsy (14 vs 19 days), and screening-to-biopsy intervals (24 vs 45 days; all p<0.001). Delayed diagnostic imaging (7.0% vs 38.2%, p<0.001) and biopsy (1.8% vs 14.5%, p=0.004) were less frequent. Expedited cases had higher BI-RADS 4/5 rates (96.5% vs 30.1%, p<0.001) and malignancy yield (PPV1 91.2% vs 5.2%; PPV3 94.5% vs 18.2%; p<0.001). Multivariable logistic regression among 278 cancers identified mass findings (OR 3.36, p<0.001) and imaging size (OR 1.03/mm, p=0.003) as predictors of expedited routing.DISCUSSION: Radiologists identified highly suspicious screening mammography findings for expedited evaluation. Expedited routing was associated with shorter diagnostic and biopsy intervals and high malignancy yield, supporting diagnostic resource prioritization.
