Screening mammograms by community radiologists: variability in false-positive rates.
Screening mammograms by community radiologists: variability in false-positive rates.
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DOI：
10.1093/jnci/94.18.1373
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发表时间：
2002-09
期刊：
影响因子：
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通讯作者：
J. Elmore;D. Miglioretti;L. Reisch;M. Barton;W. Kreuter;C. Christiansen;S. Fletcher
中科院分区：
文献类型：
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作者：
J. Elmore;D. Miglioretti;L. Reisch;M. Barton;W. Kreuter;C. Christiansen;S. Fletcher
背景技术先前的研究表明，放射科医师对乳房X线照片测试集的解释一致性相对较低。然而，现实世界中可用的数据很少。我们研究了在社区环境中执业的放射科医生对乳房X线检查的解释，并评估了假阳性率的变异性是否可以通过患者、放射科医生和/或测试特征来解释。方法 我们使用了随机选择的 40-69 岁女性的医疗记录，这些女性在 1985 年 1 月 1 日至 1993 年 6 月 30 日期间在社区环境中至少接受过一次筛查性乳房 X 光检查。24 名放射科医生解读了 2169 名女性的 8734 张筛查性乳房 X 光检查。使用分层逻辑回归模型来检查患者、放射科医生和测试特征的影响。所有统计检验都是双面的。结果 放射科医生对乳房 X 光检查的解释差异很大，在乳房 X 光检查中，肿块占 0%-7.9%，钙化占 0%-21.3%，纤维囊性变化占 1.6%-27.8%。假阳性率范围为 2.6% 至 15.9%。年轻且最近接受过培训的放射科医生的假阳性率较高。对患者、放射科医生和检测特征进行调整，将假阳性率范围缩小至 3.5%-7.9%。如果一位女性去找两名随机选择的放射科医生，调整后，与风险最低的放射科医生相比，假阳性读数风险较高的放射科医生获得假阳性读数的几率会高出 1.5 倍（95% 最高后验密度区间 [类似于置信区间] = 1.17 至 2.08）。结论 社区放射科医生在筛查乳房 X 光检查时的假阳性率差异很大；在对患者、放射科医生和测试特征进行统计调整后，这种变异范围减少了一半，但并未消除。在评估社区乳房X光检查筛查中的假阳性率时需要考虑这些特征。
BACKGROUND Previous studies have shown that the agreement among radiologists interpreting a test set of mammograms is relatively low. However, data available from real-world settings are sparse. We studied mammographic examination interpretations by radiologists practicing in a community setting and evaluated whether the variability in false-positive rates could be explained by patient, radiologist, and/or testing characteristics. METHODS We used medical records on randomly selected women aged 40-69 years who had had at least one screening mammographic examination in a community setting between January 1, 1985, and June 30, 1993. Twenty-four radiologists interpreted 8734 screening mammograms from 2169 women. Hierarchical logistic regression models were used to examine the impact of patient, radiologist, and testing characteristics. All statistical tests were two-sided. RESULTS Radiologists varied widely in mammographic examination interpretations, with a mass noted in 0%-7.9%, calcification in 0%-21.3%, and fibrocystic changes in 1.6%-27.8% of mammograms read. False-positive rates ranged from 2.6% to 15.9%. Younger and more recently trained radiologists had higher false-positive rates. Adjustment for patient, radiologist, and testing characteristics narrowed the range of false-positive rates to 3.5%-7.9%. If a woman went to two randomly selected radiologists, her odds, after adjustment, of having a false-positive reading would be 1.5 times greater for the radiologist at higher risk of a false-positive reading, compared with the radiologist at lowest risk (95% highest posterior density interval [similar to a confidence interval] = 1.17 to 2.08). CONCLUSION Community radiologists varied widely in their false-positive rates in screening mammograms; this variability range was reduced by half, but not eliminated, after statistical adjustment for patient, radiologist, and testing characteristics. These characteristics need to be considered when evaluating false-positive rates in community mammographic examination screening.