Physician predictors of mammographic accuracy
Physician predictors of mammographic accuracy
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DOI：
10.1093/jnci/dji060
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发表时间：
2005-03-02
影响因子：
10.3
通讯作者：
Kerlikowske, K
中科院分区：
文献类型：
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作者：
Smith-Bindman, R;Chu, P;Kerlikowske, K
背景。在社区实践中，医生经验与乳房x光筛查准确性之间的关系尚未得到很好的研究。我们确定了与筛查乳房x光检查准确性相关的美国医生的特征。方法：数据来自乳腺癌监测联盟和美国医学协会主档案。根据医师特征计算未调整乳房x线摄影的敏感性和特异性。我们通过多变量逻辑回归将乳房x光检查的敏感性和特异性作为患者和医生特征的函数进行建模。所有统计检验均为双侧检验。结果：从1995年1月1日到2000年12月31日，我们研究了209名医生，他们解读了1220046张筛查性乳房x光片，其中7143张（每1000张乳房x光片5.9张）在筛查后的12个月内与乳腺癌相关。每位医生平均解读了6011张筛查性乳房x光片（95%可信区间[CI] = 4998至6677），其中诊断为乳腺癌的女性平均解读了34张（95% Cl = 28至40）。平均敏感性为77%。（范围= 29% ~ 97%），平均假阳性率为10%（范围= 1% ~ 29%）。在对他们解释的乳房x线照片的患者特征进行调整后，医生特征与特异性密切相关。较高的特异性与获得医学学位后至少25年（相对于少于10年）（执业2529年的医生，比值比[OR] = 1.54, 95% CI = 1.14至2.08;P = 0.006）、每年2500-4000次（相对于481-750次）乳房x光检查的解释（OR= 1.30, 95% CI = 1.06至1.59;P = 0.011）以及与诊断性乳房x光检查相比，高度关注筛查性乳房x光检查（OR= 1.59, 95% CI = 1.37至1.82;P = 0.06）相关
Background. The association between physician experience and the accuracy of screening mammography in community practice is not well studied. We identified characteristics of U.S. physicians associated with the accuracy of screening mammography. Methods: Data were obtained from the Breast Cancer Surveillance Consortium and the American Medical Association Master File. Unadjusted mammography sensitivity and specificity were calculated according to physician characteristics. We modeled mammography sensitivity and specificity by multivariable logistic regression as a function of patient and physician characteristics. All statistical tests were two-sided. Results: We studied 209 physicians who interpreted 1220 046 screening mammograms from January 1, 1995, through December 31, 2000, of which 7143 (5.9 per 1000 mammograms) were associated with breast cancer within 12 months of screening. Each physician interpreted a mean of 6011 screening mammograms (95% confidence interval [CI] = 4998 to 6677), including a mean of 34 (95% Cl = 28 to 40) from women diagnosed with breast cancer. The mean sensitivity was 77%. (range = 29%-97%), and the mean false-positive rate was 10%, (range = 1%-29%). After adjustment for the patient characteristics of those whose mammograms they interpreted, physician characteristics were strongly associated with specificity. Higher specificity was associated with at least 25 years (versus less than 10 years) since receipt of a medical degree (for physicians practicing for 2529 years, odds ratio [OR] = 1.54, 95% CI = 1.14 to 2.08; P =.006), interpretation of 2500-4000 (versus 481-750) screening mammograms annually (OR= 1.30, 95% CI = 1.06 to 1.59; P =.011) and a high focus on screening mammography compared with diagnostic mammography (OR = 1.59, 95% CI = 1.37 to 1.82; P