Estimating the Relative Utility of Screening Mammography
Estimating the Relative Utility of Screening Mammography
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DOI：
10.1177/0272989x12470756
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发表时间：
2013-05-01
影响因子：
3.6
通讯作者：
Boone, John M.
中科院分区：
文献类型：
--
作者：
Abbey, Craig K.;Eckstein, Miguel P.;Boone, John M.
背景资料。诊断效用的概念是信号检测理论的一个基本组成部分，可以追溯到它的一些早期工作。将效用值附加到诊断测试的各种可能结果上，原则上应该导致评估和比较此类系统的有意义的方法。然而，在医学成像的许多领域，效用并没有被使用，因为它被认为是未知的。方法：研究方法。在这项工作中，我们使用已知的与最佳操作点的接收者工作特征(ROC)曲线的斜率的关系来估计筛查乳房X光检查的相对效用(检测相对于正确拒绝的效用收益)。该方法假定临床操作点对于最大化预期效用的目标是最佳的，因此该点的斜率意味着对于诊断任务和已知疾病流行的相对效用的值。我们使用数字乳房X光成像筛选试验(DMIST)数据在筛查乳房X光检查的背景下检查效用估计。结果。我们展示了各种条件如何影响估计的相对效用，包括评级尺度的特征、验证时间、概率模型和ROC曲线拟合的范围。相对效用估计在66到227之间。结论。我们论证了一组特定的条件，其结果是相对效用估计为162(+/-14%)。这与以前通过其他方法确定的筛查乳房X光检查的值大致一致。在DMIST研究中发现的疾病患病率(365天验证时为0.59%)，最佳ROC斜率接近于统一，这表明基于效用的筛查乳房X光检查评估将类似于使用Youden指数发现的评估。
Background. The concept of diagnostic utility is a fundamental component of signal detection theory, going back to some of its earliest works. Attaching utility values to the various possible outcomes of a diagnostic test should, in principle, lead to meaningful approaches to evaluating and comparing such systems. However, in many areas of medical imaging, utility is not used because it is presumed to be unknown. Methods. In this work, we estimate relative utility (the utility benefit of a detection relative to that of a correct rejection) for screening mammography using its known relation to the slope of a receiver operating characteristic (ROC) curve at the optimal operating point. The approach assumes that the clinical operating point is optimal for the goal of maximizing expected utility and therefore the slope at this point implies a value of relative utility for the diagnostic task, for known disease prevalence. We examine utility estimation in the context of screening mammography using the Digital Mammographic Imaging Screening Trials (DMIST) data. Results. We show how various conditions can influence the estimated relative utility, including characteristics of the rating scale, verification time, probability model, and scope of the ROC curve fit. Relative utility estimates range from 66 to 227. Conclusions. We argue for one particular set of conditions that results in a relative utility estimate of 162 (+/-14%). This is broadly consistent with values in screening mammography determined previously by other means. At the disease prevalence found in the DMIST study (0.59% at 365-day verification), optimal ROC slopes are near unity, suggesting that utility-based assessments of screening mammography will be similar to those found using Youden's index.