Variability in the interpretation of screening mammograms by US radiologists - Findings from a national sample
Variability in the interpretation of screening mammograms by US radiologists - Findings from a national sample
复制标题
DOI：
10.1001/archinte.156.2.209
复制
发表时间：
1996-01-22
影响因子：
--
通讯作者：
Sullivan, DC
中科院分区：
文献类型：
--
作者：
Beam, CA;Layde, PM;Sullivan, DC
目的：为了评估筛查乳腺X线摄影的有效性，通过估计放射科医生的能力，以检测乳腺癌在美国人口的放射科医生在乳腺X线摄影中心由美国放射学院认可的变异。从美国各地随机抽取了50家拥有美国放射学会认证单位的乳房X光检查中心。来自这些中心的108名放射科医生对同一组随机选择的79张筛查乳腺X线照片进行了盲态解读。这些乳房X光照片来自在一个大型筛查中心接受过筛查的妇女。在采样之前，这些女性已根据其乳腺疾病状态进行分层，该状态通过活检或2年随访确定。活检建议率按敏感性和特异性的平均值、中位数、最小值、最大值和范围进行总结。通过受试者工作特征曲线面积的类似统计量总结总体癌症检测能力。百分之九十五的置信下限的范围内的准确性measures.Results建立了bootstrapping：有一个范围至少有40%的美国放射科医生在他们的筛选灵敏度。没有乳腺癌的妇女被建议进行活检的比率至少为45%。受试者工作特征曲线面积显示，放射科医师对乳腺癌X线片的检测能力差异高达11%。结论：我们的研究结果表明，美国放射科医师对乳腺癌X线片解读的准确性存在很大的差异。目前的认证计划只认证放射摄影设备和图像的技术质量，而不认证乳房X光检查结果的准确性，这可能不足以帮助乳房X光检查充分发挥其降低乳腺癌死亡率的潜力。
Objective: To evaluate the effectiveness of screening mammography by estimating the variability in radiologists' ability to detect breast cancer within the US population of radiologists at mammography centers accredited by the American College of Radiology.Methods: A two-way sample survey design was used as follows. Fifty mammography centers having an American College of Radiology-accredited unit were randomly sampled from across the United States. One hundred eight radiologists from these centers gave blinded interpretation to the same set of 79 randomly selected screening mammograms. The mammograms were from women who had been screened at a large screening center. Before their sampling, these women had been stratified by their breast disease status, established either by biopsy or by 2-year follow-up. Rates of biopsy recommendations were summarized by the mean, median, minimum, maximum, and range of sensitivity and specificity. Overall cancer detection ability was summarized by similar statistics for receiver operating characteristic curve areas. Ninety-five percent lower confidence bounds on the ranges in accuracy measures were established by bootstrapping.Results: There is a range of at least 40% among US radiologists in their screening sensitivity. There is a range of at least 45% in the rates at which women without breast cancer are recommended for biopsy. As indicated by receiver operating characteristic curve areas, the ability of radiologists to detect cancer mammograms varies by as much as 11%.Conclusions: Our findings indicate that there is wide variability in the accuracy of mammogram interpretation in the population of US radiologists. Current accreditation programs that certify the technical quality of radiographic equipment and images but not the accuracy of the interpretation given to mammograms may not be sufficient to help mammography fully realize its potential to reduce breast cancer mortality.