{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:23:44Z","timestamp":1787304224524,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Breast cancer continues to be a major contributor to illness among women in Jordan, particularly in underserved regions. Despite the establishment of mammography services in southern Jordan, no formal quality assurance audit has evaluated diagnostic performance or geographic equity of access. This study aimed to evaluate the diagnostic performance of mammography services using established quality assurance indicators and to investigate geographic variation in mammographic findings and diagnostic pathways among women attending a regional referral center in southern Jordan. Methods: This study employed a retrospective hospital-based clinical audit that was conducted using mammography records from Ma\u2019an Hospital between 2016 and 2024. A total of 592 women aged 20 years and older who underwent mammography were included. Data extracted from electronic and paper-based medical records included demographic characteristics, mammography indication, BI-RADS\u00ae classifications, follow-up procedures, reporting timelines, and histopathological outcomes. Histopathological confirmation served as the reference standard for diagnostic accuracy analyses. Diagnostic performance was evaluated using Cancer Detection Rate (CDR), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Geographic variation was evaluated according to place of residence, while multivariable logistic regression was used to determine whether associations remained independent of age and mammography indication. Results: Of the 592 mammography examinations, 354 (59.8%) were performed for screening purposes and 238 (40.2%) for diagnostic evaluation. BI-RADS\u00ae 1 and BI-RADS\u00ae 2 were the most frequently assigned categories, accounting for 38.3% and 28.7% of examinations, respectively, whereas BI-RADS\u00ae 4 and 5 findings accounted for 6.3% and 1.0%. The overall CDR was 52.4 per 1000 examinations with sensitivity (93.9% (95% CI 80.4\u201398.3%)) and specificity (97.4% (95% CI 95.3\u201398.5%)), positive predictive value (PPV) (73.8% (95% CI 58.0\u201386.1%)), and negative predictive value (NPV) (99.5% (95% CI 98.2\u201399.9%)). Suspicious findings (BI-RADS\u00ae 4\u20135) were significantly more frequent among urban than rural women (9.4% vs. 3.7%; adjusted OR 3.05, 95% CI 1.37\u20136.78), whereas reporting delay, ultrasound use, biopsy rate, and further follow-up did not differ significantly by residence. Conclusions: Mammography services at Ma\u2019an Hospital exhibit high diagnostic accuracy and strong clinical performance in breast cancer detection over the nine-year study period. Women in rural areas were less likely to have suspicious mammographic findings detected than those in urban areas, regardless of age and mammography type. No significant differences were observed in reporting timelines or follow-up procedures by place of residence. These findings underscore the value of regional quality assurance audits in identifying service disparities and guiding improvements in breast cancer screening and diagnostic services, especially in underserved communities.<\/jats:p>","DOI":"10.3390\/diagnostics16162668","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:14:01Z","timestamp":1787300041000},"page":"2668","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance and Geographic Variation in Mammography Services: A Nine-Year Audit from Southern Jordan"],"prefix":"10.3390","volume":"16","author":[{"given":"Sanaa Hussein","family":"Alnaimat","sequence":"first","affiliation":[{"name":"Centre of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia"},{"name":"Department of Chemistry, Faculty of Sciences, Al-Hussein Bin Talal University, P.O. Box 20, Ma\u2019an 71111, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3877-1292","authenticated-orcid":false,"given":"Norhashimah Mohd","family":"Norsuddin","sequence":"additional","affiliation":[{"name":"Centre of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8421-8095","authenticated-orcid":false,"given":"Iza Nurzawani","family":"Che Isa","sequence":"additional","affiliation":[{"name":"Centre of Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Alshipli","sequence":"additional","affiliation":[{"name":"Faculty of Applied Medical Sciences, Al Al-Bayt University, P.O. Box 130040, Mafraq 25113, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7796-6562","authenticated-orcid":false,"given":"Ahmad A.","family":"Abushattal","sequence":"additional","affiliation":[{"name":"Department of Physics, Al-Hussein Bin Talal University, P.O. Box 20, Ma\u2019an 71111, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1488-7696","authenticated-orcid":false,"given":"Deshinta Arrova","family":"Dewi","sequence":"additional","affiliation":[{"name":"Faculty of Data Science and Information Technology, INTI International University, Nilai 71800, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shereen A.","family":"Alrawadeih","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Ma\u2019an Hospital, Jordanian Ministry of Health, Ma\u2019an 71111, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahem","family":"Kreshan","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Ma\u2019an Hospital, Jordanian Ministry of Health, Ma\u2019an 71111, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","first-page":"583","article-title":"Breast cancer screening attitudes, beliefs, and behaviors of Zuni Pueblo women: Identifying cornerstones for building effective mammogram screening intervention programs","volume":"35","author":"Cartwright","year":"2024","journal-title":"Cancer Causes Control"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chandra, M., Varghese, B., and Sah, A. 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