Variability in Interpretive Performance at Screening Mammography and Radiologists' Characteristics Associated with Accuracy
Variability in Interpretive Performance at Screening Mammography and Radiologists' Characteristics Associated with Accuracy
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DOI：
10.1148/radiol.2533082308
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发表时间：
2009-12-01
期刊：
影响因子：
19.7
通讯作者：
Buist, Diana S. M.
中科院分区：
文献类型：
--
作者：
Elmore, Joann G.;Jackson, Sara L.;Buist, Diana S. M.
目的：为了确定放射科医师的特点与解释性能在筛选mammography.Materials和Methods：该研究是由华盛顿大学（西雅图，华盛顿州）和机构的机构审查委员会批准在7个乳腺癌监测联盟网站，知情同意书，并获得程序符合HIPAA。在美国七个地区解释乳房X线照片的放射科医生完成了一项自我管理的邮寄调查;收集了有关人口统计学，实践类型以及普通放射学和乳房成像的经验和看法的信息。调查数据与1998年1月1日至2005年12月31日期间放射科医生解释的筛查性乳房X线照片数据相关联，包括患者风险因素，乳腺成像报告和数据系统评估以及随访乳腺癌数据。71%（257/364）的放射科医生返回了调查; 56%（205/364）的合格放射科医生提供了研究期间筛查乳腺X线照片的完整数据;这些数据用于最终分析。放射科医师的特征是否与筛查检查的回忆率、假阳性率、敏感性或回忆的阳性预测值（PPV 1）相关的评估采用Logistic回归模型进行，该模型根据患者的特征和放射科医师特异性随机效应进行调整。检测到4961例乳腺癌。中位数百分比和四分位数范围分别如下：召回率，9.3%和6.3%-13.2%;假阳性率，8.9%和5.9%-12.8%;敏感性，83.8%和74.5%-92.3%; PPV 1，4.0%和2.6%-5.9%。即使在具有相似假阳性率的放射科医生中，也注意到灵敏度的广泛变化。在调整后的回归模型中，女性放射科医师或接受过研究员培训的放射科医师的回忆率和假阳性率显著较高（P <0.05）。乳腺成像方面的研究员培训是唯一与提高灵敏度显著相关的特征（比值比，2.32; 95%置信区间：1.42，3.80; P < .001）和总体准确性参数（比值比，1.61; 95%可信区间：1.05，2.45; P = 0.028）。乳腺成像研究员培训可能会提高癌症检测，但它与更高的假阳性率有关。(C)RSNA，2009年
Purpose: To identify radiologists' characteristics associated with interpretive performance in screening mammography.Materials and Methods: The study was approved by institutional review boards of University of Washington (Seattle, Wash) and institutions at seven Breast Cancer Surveillance Consortium sites, informed consent was obtained, and procedures were HIPAA compliant. Radiologists who interpreted mammograms in seven U.S. regions completed a self-administered mailed survey; information on demographics, practice type, and experience in and perceptions of general radiology and breast imaging was collected. Survey data were linked to data on screening mammograms the radiologists interpreted between January 1, 1998, and December 31, 2005, and included patient risk factors, Breast Imaging Reporting and Data System assessment, and follow-up breast cancer data. The survey was returned by 71% (257 of 364) of radiologists; in 56% (205 of 364) of the eligible radiologists, complete data on screening mammograms during the study period were provided; these data were used in the final analysis. An evaluation of whether the radiologists' characteristics were associated with recall rate, false-positive rate, sensitivity, or positive predictive value of recall (PPV1) of the screening examinations was performed with logistic regression models that were adjusted for patients' characteristics and radiologist-specific random effects.Results: Study radiologists interpreted 1 036 155 screening mammograms; 4961 breast cancers were detected. Median percentages and interquartile ranges, respectively, were as follows: recall rate, 9.3% and 6.3%-13.2%; false-positive rate, 8.9% and 5.9%-12.8%; sensitivity, 83.8% and 74.5%-92.3%; and PPV1, 4.0% and 2.6%-5.9%. Wide variability in sensitivity was noted, even among radiologists with similar false-positive rates. In adjusted regression models, female radiologists or fellowship-trained radiologists had significantly higher recall and false-positive rates (P < .05, all). Fellowship training in breast imaging was the only characteristic significantly associated with improved sensitivity (odds ratio, 2.32; 95% confidence interval: 1.42, 3.80; P < .001) and the overall accuracy parameter (odds ratio, 1.61; 95% confidence interval: 1.05, 2.45; P = .028).Conclusion: Fellowship training in breast imaging may lead to improved cancer detection, but it is associated with higher false-positive rates. (C) RSNA, 2009