National Lung Screening Trial: Variability in Nodule Detection Rates in Chest CT Studies
National Lung Screening Trial: Variability in Nodule Detection Rates in Chest CT Studies
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DOI：
10.1148/radiol.13121530
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发表时间：
2013-09-01
期刊：
影响因子：
19.7
通讯作者：
Amorosa, Judith
中科院分区：
文献类型：
--
作者：
Pinsky, Paul F.;Gierada, David S.;Amorosa, Judith
目的：描述放射科医生对国家肺部筛查试验（NLST）中计算机断层扫描（CT）研究解释的变异性（包括假阳性率[FPR]和灵敏度的评估），以检查导致变异的因素，并评估不同放射科医师组之间FPR和灵敏度之间的权衡。材料和方法：符合HIPAA的NLST由每个筛查中心的机构审查委员会批准;所有参与者均提供知情同意书。NLST放射科医生报告了总体筛查结果、结节特异性结果和诊断随访建议。4 mm或更大的非钙化结节构成阳性筛查结果。FPR定义为1年内没有癌症诊断的参与者的阳性筛查检查率。采用描述性分析和混合效应模型。所有对的放射科医师的假阳性结果的平均比值比（OR）被用来作为variability.Results的措施：112名放射科医师在32个筛选中心，每个解释100或更多的NLST CT研究，解释72 160的75 126总NLST CT研究的总和。放射科医生的平均FPR为28.7% +/- 13.7（标准差），范围为3.8%-69.0%。该模型得出的所有放射科医生对的平均OR为2.49，同一筛选中心内的放射科医生对的OR为1.83。学术中心与非学术中心的平均FPR相似（分别为27.9%和26.7%），美国国内中心（25.0%）与国外中心（28.7%）相似。S.“组织胞浆菌病带。“FPR高于中位数的放射科医生的总体敏感性为96.5%（27.1%），而FPR低于中位数的放射科医生的总体敏感性为91.9%（P = 0.02）。较高的FPR与适度较高的敏感性相关。（C）RSNA，2013年
Purpose: To characterize the variability in radiologists' interpretations of computed tomography (CT) studies in the National Lung Screening Trial (NLST) (including assessment of false-positive rates [FPRs] and sensitivity), to examine factors that contribute to variability, and to evaluate trade-offs between FPRs and sensitivity among different groups of radiologists.Materials and Methods: The HIPAA-compliant NLST was approved by the institutional review board at each screening center; all participants provided informed consent. NLST radiologists reported overall screening results, nodule-specific findings, and recommendations for diagnostic follow-up. A noncalcified nodule of 4 mm or larger constituted a positive screening result. The FPR was defined as the rate of positive screening examinations in participants without a cancer diagnosis within 1 year. Descriptive analyses and mixed-effects models were utilized. The average odds ratio (OR) for a false-positive result across all pairs of radiologists was used as a measure of variability.Results: One hundred twelve radiologists at 32 screening centers each interpreted 100 or more NLST CT studies, interpreting 72 160 of 75 126 total NLST CT studies in aggregate. The mean FPR for radiologists was 28.7% +/- 13.7 (standard deviation), with a range of 3.8%-69.0%. The model yielded an average OR of 2.49 across all pairs of radiologists and an OR of 1.83 for pairs within the same screening center. Mean FPRs were similar for academic versus nonacademic centers (27.9% and 26.7%, respectively) and for centers inside (25.0%) versus outside (28.7%) the U. S. "histoplasmosis belt." Aggregate sensitivity was 96.5% for radiologists with FPRs higher than the median (27.1%), compared with 91.9% for those with FPRs lower than the median (P = .02).Conclusion: There was substantial variability in radiologists' FPRs. Higher FPRs were associated with modestly higher sensitivity. (C)RSNA, 2013