Computer-aided detection mammography for breast cancer screening: systematic review and meta-analysis
Computer-aided detection mammography for breast cancer screening: systematic review and meta-analysis
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DOI：
10.1007/s00404-008-0841-y
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发表时间：
2009-06-01
影响因子：
2.6
通讯作者：
Schoelles, Karen
中科院分区：
文献类型：
--
作者：
Noble, Meredith;Bruening, Wendy;Schoelles, Karen
乳房x光检查被普遍认为是最好的乳腺癌筛查方法；然而，一些在乳房x线摄影图像上可检测到的癌症被遗漏了。乳房x光检查的计算机辅助检测（CAD）系统旨在通过标记乳房x光检查的可疑区域以供审查员考虑，从而减少假阴性。尽管提高乳房x光筛查灵敏度的前景已经导致CAD在乳房x光检查中的普及，但人们对其诊断准确性知之甚少。评估CAD在乳腺x线摄影筛查中的诊断性能，包括敏感性和特异性、增量召回率、活检和癌症诊断率。通过对17个数据库（包括MEDLINE、EMBASE和Cochrane图书馆）的系统文献检索，检索到2008年9月25日为止的已发表文献。一名审稿人和一名信息专家选择了完整的英文文章，这些文章招募了无症状妇女进行常规乳腺癌筛查，并提供了我们使用先验标准进行分析所需的数据。我们确定了75篇可能相关的出版物，其中7篇（9%）被纳入。数据提取和内部效度评估由一名综述作者完成，表格由共同作者批准。3项研究（n = 347,324）报告了敏感性和特异性，或计算它们的数据，5项研究（n = 51162）报告了计算未患乳腺癌的女性癌症诊断、召回和活检的增量率的数据。合并敏感性为86.0% (95% CI 84.2-87.6%)，特异性为88.2% （95% CI 88.1-88.3%）。在100,000名筛查的女性中，CAD产生了额外的50例（95% CI 30-80）正确的乳腺癌诊断，1190例（95% CI 1,090-1,290）健康女性的回忆，80例（95% CI 60-100）健康女性的活组织检查。96% （95% CI 93.9-97.3%）的女性基于CAD被召回，65.1% （95% CI 52.3-76.0%）的女性基于CAD活检是健康的。没有研究报告患者导向的临床结果。
Mammography is generally accepted as the best available breast cancer screening method; however, some cancers detectable on mammography images are missed. Computer-aided detection (CAD) systems for mammography are intended to reduce false negatives by marking suspicious areas of the mammograms for reviewers to consider. Although the prospect of improving the sensitivity of screening mammograms has led to the diffusion of CAD for mammography, little is known about its diagnostic accuracy.To assess the diagnostic performance of CAD for screening mammography in terms of sensitivity and specificity and incremental recall, biopsy, and cancer diagnosis rates.Published literature identified by systematic literature searches of 17 databases, including MEDLINE, EMBASE, and the Cochrane Library, searched through 25 September 2008.A reviewer and an information specialist selected full-length English-language articles that enrolled asymptomatic women for routine breast cancer screening and provided data needed for our analyses using criteria established a priori. We identified 75 potentially relevant publications, of which 7 (9%) were included.Data were extracted and internal validity was assessed by a single review author, and forms were approved by the co-authors.Three studies (n = 347,324) reported sensitivity and specificity, or data to calculate them, and five studies (n = 51,162) reported data to calculate incremental rates of cancer diagnoses and recall and biopsy of women who did not have breast cancer. The pooled sensitivity was 86.0% (95% CI 84.2-87.6%) and specificity was 88.2% (95% CI 88.1-88.3%). Of the 100,000 women screened, CAD yielded an additional 50 (95% CI 30-80) correct breast cancer diagnoses, 1,190 (95% CI 1,090-1,290) recalls of healthy women, and 80 (95% CI 60-100) biopsies of healthy women. A total of 96% (95% CI 93.9-97.3%) of women recalled based upon CAD and 65.1% (95% CI 52.3-76.0%) of women biopsied based upon CAD were healthy. No studies reported patient-oriented clinical outcomes.