Radiologist Interpretive Volume and Breast Cancer Screening Accuracy in a Canadian Organized Screening Program
Radiologist Interpretive Volume and Breast Cancer Screening Accuracy in a Canadian Organized Screening Program
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DOI：
10.1093/jnci/djt461
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发表时间：
2014-03-01
影响因子：
10.3
通讯作者：
Brisson, Jacques
中科院分区：
文献类型：
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作者：
Theberge, Isabelle;Chang, Sue-Ling;Brisson, Jacques
为了加强放射科医师乳房X光检查解释容量要求所依据的证据，我们评估了魁北克乳腺癌筛查项目中容量与准确性的关系。体积与敏感度、假阳性率和准确性(敏感度/假阳性率)的相关性通过具有稳健误差方差的多变量Poisson回归来评估。所有的统计检验都是双面的。与每年一致解读至少500张乳房X光照片的放射科医生相比，一致解读每年不到500张乳房X光照片的放射科医生经历了58%的准确性下降(调整后的准确率为0.42；95%可信区间[CI]0.24至0.74)。此外，精确度随着年总量的增加而递增(P-趋势.0005)。与每年解释500至999张乳房X光照片的放射科医生相比，每年至少解释4000张乳房X光照片的放射科医生的准确率提高了32%(调整后的准确率为1.32；95%可信区间为1.13至1.54)。准确率的提高归因于随着总容量的增加假阳性率降低(P-趋势.001)。敏感度随总容量变化不大(P-趋势.68)。准确率的提高更大，每年大约有3000次乳房X光检查。在北美，每年至少需要500次乳房X光检查是合理的；如果解释数量持续低于这一要求，放射科医生的准确性可能会受到影响。提高解释容量可能有助于在不损失灵敏度的情况下减少假阳性的频率。随着每年多达约3000份乳房X光检查的数量增加，准确度可能会有更大的提高。
To strengthen evidence on which radiologist mammography interpretive volume requirements can be based, we assessed the relation of volume to accuracy in the Quebec Breast Cancer Screening Program.Annual interpretive volume (total, screening, and diagnostic) for all 340 radiologists who interpreted 1315327 screening examinations in the period from 2000 to 2006 was obtained using provincial databases. The association of volume to sensitivity, false-positive rate, and accuracy (sensitivity/false-positive rate) was assessed by multivariable Poisson regression with robust error variance. All statistical tests were two-sided.Radiologists consistently interpreting less than 500 mammograms annually experienced a 58% reduction in accuracy (adjusted accuracy ratio 0.42; 95% confidence interval [CI] 0.24 to 0.74) compared with those who consistently interpreted at least 500 mammograms annually. Moreover, accuracy increased progressively as total annual volume increased (P-trend .0005). Radiologists interpreting at least 4000 mammograms annually experienced a 32% increase in accuracy (adjusted accuracy ratio 1.32; 95% CI 1.13 to 1.54) compared with those interpreting 500 to 999 mammograms annually. This increase in accuracy is attributable to a reduction in false-positive rate as total volume increased (P-trend .001). Sensitivity changed little with total volume (P-trend .68). Gains in accuracy were greater up to approximately 3000 mammograms interpreted annually.The minimum annual volume of 500 mammograms required in North America is justified; radiologist accuracy may be compromised if interpretive volume is consistently less than this requirement. Raising interpretive volume may help to reduce the frequency of false positives without loss of sensitivity. Possible gains in accuracy may be greater with increases in volume of up to approximately 3000 mammograms interpreted annually.