Diagnostic Accuracy of Digital Screening Mammography With and Without Computer-Aided Detection.
Diagnostic Accuracy of Digital Screening Mammography With and Without Computer-Aided Detection.
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DOI：
10.1001/jamainternmed.2015.5231
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发表时间：
2015-11
影响因子：
39
通讯作者：
Breast Cancer Surveillance Consortium
中科院分区：
文献类型：
--
作者：
Lehman CD;Wellman RD;Buist DS;Kerlikowske K;Tosteson AN;Miglioretti DL;Breast Cancer Surveillance Consortium
在1998年美国食品和药物管理局（FDA）批准计算机辅助检测（CAD）用于乳房X光检查后，医疗保险和医疗补助服务中心（CMS）在2002年提供了更多的付款，CAD技术迅速传播。尽管很少有证据表明CAD提高了乳腺X线摄影解释的准确性，并且每年花费超过4亿美元，但CAD目前用于美国大多数筛查乳腺X线摄影。我们比较了2003年至2009年323，973名女性中使用（N= 495，818）与不使用（N= 129，807）计算机辅助检测的数字筛查乳腺X线摄影的准确性。来自乳腺癌监测联盟66个机构的271名放射科医生对乳房X线照片进行了解读。与肿瘤登记处的联系在筛查的一年内确定了323，973名妇女中的3，159例乳腺癌。使用放射科医生特异性随机效应的逻辑回归对乳腺X线检查性能（灵敏度、特异性和筛查检测到的癌症和每1，000名女性的间隔癌症）进行建模，以解释由同一放射科医生解释的检查之间的相关性，调整患者年龄、种族/民族、自上次乳腺X线检查以来的时间、检查年份和登记。条件Logistic回归被用来比较107名放射科医生的表现，他们在有和没有计算机辅助检测的情况下解释乳房X线照片。计算机辅助检测对评估的任何指标均未改善筛选性能。有计算机辅助检测的乳腺X线摄影灵敏度为85.3%（95%置信区间[CI]=83.6-86.9），无计算机辅助检测的乳腺X线摄影灵敏度为87.3%（95% CI 84.5-89.7）。有计算机辅助检测的特异性为91.6%（95%CI =91.0-92.2），无计算机辅助检测的特异性为91.4%（95%CI =90.6-92.0）。癌症检出率没有差异（每1 000名妇女中有4.1人接受了计算机辅助检测和无计算机辅助检测）。计算机辅助检测并没有改善放射科医师的表现。在使用和不使用计算机辅助检测进行解读的放射科医生亚组中，使用和不使用计算机辅助检测进行解读的乳腺X线照片的灵敏度显著降低（OR 0.53，95%CI=0.29-0.97）。CAD并不能提高乳腺X线摄影的诊断准确性，可能会导致漏诊癌症。这些结果表明，保险公司为计算机辅助检测支付更多费用，但对女性没有确定的好处。
After the Food and Drug Administration (FDA) approved computer-aided detection (CAD) for mammography in 1998, and Centers for Medicare and Medicaid Services (CMS) provided increased payment in 2002, CAD technology disseminated rapidly. Despite sparse evidence that CAD improves accuracy of mammographic interpretations, and costs over $400 million dollars a year, CAD is currently used for the majority of screening mammograms in the U.S. To measure performance of digital screening mammography with and without computer-aided detection in U.S. community practice. We compared the accuracy of digital screening mammography interpreted with (N=495,818) vs. without (N=129,807) computer-aided detection from 2003 through 2009 in 323,973 women. Mammograms were interpreted by 271 radiologists from 66 facilities in the Breast Cancer Surveillance Consortium. Linkage with tumor registries identified 3,159 breast cancers in 323,973 women within one year of the screening. Mammography performance (sensitivity, specificity, and screen detected and interval cancers per 1,000 women) was modeled using logistic regression with radiologist-specific random effects to account for correlation among examinations interpreted by the same radiologist, adjusting for patient age, race/ethnicity, time since prior mammogram, exam year, and registry. Conditional logistic regression was used to compare performance among 107 radiologists who interpreted mammograms both with and without computer-aided detection. Screening performance was not improved with computer-aided detection on any metric assessed. Mammography sensitivity was 85.3% (95% confidence interval [CI]=83.6–86.9) with and 87.3% (95% CI 84.5–89.7) without computer-aided detection. Specificity was 91.6% (95% CI=91.0–92.2) with and 91.4% (95% CI=90.6–92.0) without computer-aided detection. There was no difference in cancer detection rate (4.1/1000 women screened with and without computer-aided detection). Computer-aided detection did not improve intra-radiologist performance. Sensitivity was significantly decreased for mammograms interpreted with versus without computer-aided detection in the subset of radiologists who interpreted both with and without computer-aided detection (OR 0.53, 95%CI=0.29–0.97). CAD does not improve diagnostic accuracy of mammography and may result in missed cancers. These results suggest that insurers pay more for computer-aided detection with no established benefit to women.