Expedited pathway for mammo recalls nearly halves diagnostic timeline
An expedited recall pathway for highly suspicious screening mammography findings has the potential to significantly expedite the diagnostic evaluation process.
A new paper in the Journal of the American College of Radiology details the utility of follow-up protocols that cater specifically to cases of recalls for highly suspicious lesions. Patients with these findings are at higher risk of being diagnosed with cancer, making expedited follow-up care a critical part of the diagnostic process.
“Although some facilities offer same-day diagnostic evaluation when resources permit, recalled patients typically return on a separate date for diagnostic imaging and, if needed, another date for image-guided biopsy,” Babita Panigrahi, MD, with Johns Hopkins University School of Medicine, and colleagues noted. “Delays are associated with later stage disease, decreased likelihood of breast conserving surgery, and decreased survival. In addition, delays can contribute to patient anxiety and failure to complete recommended diagnostic follow-up.”
The organization recently integrated an expedited recall workflow into their EHR (Epic) to bring highly suspicious findings to the attention of administrative personnel responsible for scheduling follow-up evaluations. The group hypothesized that doing so would reduce the time between screening and diagnostic exams and cancer diagnoses.
The workflow allowed radiologists to flag particularly suspicious BI-RADS 0 findings and arrange diagnostic appointments by telephone, with reserved appointment slots targeting evaluation within one week. Researchers assessed outcomes from screening mammograms performed between November 2024 and January 2026.
Of 36,384 screening mammograms, 4,647 resulted in a BI-RADS 0 assessment, representing a recall rate of 12.8%; of those recalls, 57 cases (1.2%) were routed through the expedited pathway. Patients in the expedited pathway had a median screening-to-diagnostic interval of seven days, compared with 25 days for patients in the standard pathway. Median time from diagnostic mammogram to biopsy was 14 days for expedited cases and 19 days for standard cases. Overall, the median interval from screening to biopsy was 24 days in the expedited group, compared with 45 days in the standard group.
The expedited group also had a substantially higher malignancy yield, reflecting the radiologists’ selection of highly suspicious findings. Positive predictive value for an initial abnormal screening assessment was 91.2% in the expedited group, compared with 5.2% in the standard group, while PPV among patients undergoing biopsy was 94.5% versus 18.2%.
The researchers concluded that radiologist-directed expedited recalls can prioritize resources for highly suspicious findings and reduce the time patients wait for the nest step of the diagnostic process. They added that achieving these results did not require a significant IT undertaking for their organization, indicating that others could likely accomplish the same results.
“The expedited pathway required minimal infrastructure: an electronic flag within our EHR, reserved appointment slots, and staff education,” the authors noted. “As a result, we achieved substantial reductions in diagnostic intervals for high suspicion cases with high PPVs.”
Read more about the group’s work here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.