Implementation of Breast Tomosynthesis in a Routine Screening Practice: An Observational Study
Implementation of Breast Tomosynthesis in a Routine Screening Practice: An Observational Study
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DOI：
10.2214/ajr.12.9672
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发表时间：
2013-06-01
影响因子：
5
通讯作者：
Sexton, Russell, Jr.
中科院分区：
文献类型：
--
作者：
Rose, Stephen L.;Tidwell, Andra L.;Sexton, Russell, Jr.
OBJECTIVE.数字乳腺X射线摄影结合断层合成摄影正在获得临床认可，但显示其在临床环境中的影响的数据有限。我们评估了将断层合成系统引入临床实践后性能指标的变化（如果有）。在这项观察性研究中，我们使用经过验证的实践和结局相关数据库，计算并比较了6名放射科医生的召回率、活检率、癌症检出率和阳性预测值，这些放射科医生解释了不使用断层合成摄影（n = 13，856）和使用断层合成摄影（n = 9499）的筛查性乳腺X射线摄影研究。进行双侧分析（显著性声明为p < 0.05），解释阅片者的变异性、参与者的年龄以及所讨论的检查是否为基线。对于整个研究组，引入和常规使用断层合成技术导致了召回率从8.7%到5.5%的显著变化（p < 0.001），活检率无显著变化，从每1000次筛查15.2例增至13.5例（p = 0.59），癌症检出率为每1000次筛查4.0至5.4（p = 0.18）。浸润性癌症检出率从每1000次筛查检查2.8例增加到4.3例（p = 0.07）。回忆的阳性预测值从4.7%增加到10.1%（p < 0.001）。在我们的实践中引入乳腺断层合成摄影与召回率的显着降低和乳腺癌检出率的同时增加有关。
OBJECTIVE. Digital mammography combined with tomosynthesis is gaining clinical acceptance, but data are limited that show its impact in the clinical environment. We assessed the changes in performance measures, if any, after the introduction of tomosynthesis systems into our clinical practice.MATERIALS AND METHODS. In this observational study, we used verified practice- and outcome-related databases to compute and compare recall rates, biopsy rates, cancer detection rates, and positive predictive values for six radiologists who interpreted screening mammography studies without (n = 13,856) and with (n = 9499) the use of tomosynthesis. Two-sided analyses (significance declared at p < 0.05) accounting for reader variability, age of participants, and whether the examination in question was a baseline were performed.RESULTS. For the group as a whole, the introduction and routine use of tomosynthesis resulted in significant observed changes in recall rates from 8.7% to 5.5% (p < 0.001), nonsignificant changes in biopsy rates from 15.2 to 13.5 per 1000 screenings (p = 0.59), and cancer detection rates from 4.0 to 5.4 per 1000 screenings (p = 0.18). The invasive cancer detection rate increased from 2.8 to 4.3 per 1000 screening examinations (p = 0.07). The positive predictive value for recalls increased from 4.7% to 10.1% (p < 0.001).CONCLUSION. The introduction of breast tomosynthesis into our practice was associated with a significant reduction in recall rates and a simultaneous increase in breast cancer detection rates.