Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States
Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States
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DOI：
10.1148/radiol.10101698
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发表时间：
2011-04-01
期刊：
影响因子：
19.7
通讯作者：
Miglioretti, Diana L.
中科院分区：
文献类型：
--
作者：
Buist, Diana S. M.;Anderson, Melissa L.;Miglioretti, Diana L.
目的：研究美国放射科医生的解读量是否会影响其筛查性乳房x光检查的表现。材料和方法：收集了乳腺癌监测联盟（BCSC）的120名放射科医生的年度解释量测量（总数、筛查、诊断和筛查重点[筛查与诊断乳房x线照片的比例]），他们在2002年至2006年期间解释了783965张乳房x线筛查照片。1年内的体积测量采用多变量logistic回归，与筛查敏感性、假阳性率和次年的癌症检出率相关。BCSC登记处和统计协调中心获得了机构审查委员会对主动或被动同意程序的批准，以及对参与妇女、医生和设施的联邦保密证书和其他保护。所有程序都符合《健康保险流通与责任法》的规定。结果：平均敏感性为85.2%(95%可信区间[CI]: 83.7%, 86.6%)，对于筛查重点较大的放射科医生而言，敏感性显著降低（P = 0.023），但在总（P = 0.47）、筛查（P = 0.33）或诊断（P = 0.23）量方面无显著差异。平均假阳性率为9.1% (95% CI: 8.1%, 10.1%)，总容量（P = 0.008）和筛查量（P = 0.015）最低的放射科医生的假阳性率明显更高。诊断量低（P = 0.004和P = 0.008）和筛查重点高（P = 0.003和P = 0.002）的放射科医生的假阳性和癌症检出率分别显著降低。中位浸润性肿瘤的大小和早期发现的癌症比例没有随体积变化。结论：在美国增加最低解释容量要求的同时增加诊断解释的最低要求可以在不妨碍癌症检测的情况下减少假阳性检查的数量。这些结果提供了乳房x线照相术数量和性能之间的详细联系，供决策者在重新评估需求时考虑劳动力、实践组织、访问问题和放射科医生经验。(c) rsna, 2011
Purpose: To examine whether U. S. radiologists' interpretive volume affects their screening mammography performance.Materials and Methods: Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certificate of Confidentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act.Results: Mean sensitivity was 85.2% (95% confidence interval [CI]: 83.7%, 86.6%) and was significantly lower for radiologists with a greater screening focus (P = .023) but did not significantly differ by total (P = .47), screening (P = .33), or diagnostic (P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates significantly higher for radiologists who had the lowest total (P = .008) and screening (P = .015) volumes. Radiologists with low diagnostic volume (P = .004 and P = .008) and a greater screening focus (P = .003 and P = .002) had significantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume.Conclusion: Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements. (C) RSNA, 2011