Effectiveness of Computer-Aided Detection in Community Mammography Practice
Effectiveness of Computer-Aided Detection in Community Mammography Practice
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DOI：
10.1093/jnci/djr206
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发表时间：
2011-08-01
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影响因子：
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通讯作者：
Barlow, William E.
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作者：
Fenton, Joshua J.;Abraham, Linn;Barlow, William E.
背景计算机辅助检测（CAD）每年在数百万美国妇女的筛查性乳腺X线摄影中应用，尽管社区放射科医生使用CAD是否能提高乳腺癌的检出率尚不确定。方法我们研究了在筛查性乳腺X线摄影中使用CAD与乳腺癌的特异性、敏感性、阳性预测值、癌症检出率和预后特征之间的关系。（分期、大小和淋巴结受累）。从1998年到2006年，在美国七个州的乳腺癌监测联盟机构接受了超过160万次电影屏幕乳房X线检查的684956名妇女的记录进行了分析。我们使用随机效应逻辑回归来估计CAD和特异性之间的关联（无乳腺癌妇女的真阴性检查），敏感性（乳房X线摄影检查后1年内诊断为乳腺癌的女性中的真阳性检查），以及阳性预测值（在阳性乳房X线摄影后诊断的乳腺癌），同时调整乳房X线摄影登记、患者年龄、自上次乳房X线摄影以来的时间、乳腺密度，使用激素替代疗法和检查年份（1998-2002年与2003-2006年）。结果在90个机构中，25个（27.8%）采用CAD，平均使用时间为27.5个月。在校正分析中，CAD使用与统计学显著较低的特异性（OR = 0.87，95%置信区间[CI] = 0.85至0.89，P <0.001）和阳性预测值（OR = 0.89，95% CI = 0.80至0.99，P = 0.03）相关。CAD的总体敏感性增加无统计学显著性（OR = 1.06，95%CI = 0.84 - 1.33，P = 0.62）归因于导管原位癌敏感性增加（OR = 1.55，95%CI = 0.83 - 2.91; P = 0.17），尽管对浸润性癌的敏感性与有无CAD相似（OR = 0.96，95%CI = 0.75 - 1.24; P = 0.77）。CAD是不相关的较高的乳腺癌的检出率或更有利的阶段，大小，或浸润性乳腺cancer.Conclusion乳腺癌的淋巴结状态在美国的电影屏幕筛查期间使用CAD与特异性下降，但不改善浸润性乳腺癌的检出率或预后特征。J Natl Cancer Inst 2011; 103：1152-1161
Background Computer-aided detection (CAD) is applied during screening mammography for millions of US women annually, although it is uncertain whether CAD improves breast cancer detection when used by community radiologists.Methods We investigated the association between CAD use during film-screen screening mammography and specificity, sensitivity, positive predictive value, cancer detection rates, and prognostic characteristics of breast cancers (stage, size, and node involvement). Records from 684 956 women who received more than 1.6 million film-screen mammograms at Breast Cancer Surveillance Consortium facilities in seven states in the United States from 1998 to 2006 were analyzed. We used random-effects logistic regression to estimate associations between CAD and specificity (true-negative examinations among women without breast cancer), sensitivity (true-positive examinations among women with breast cancer diagnosed within 1 year of mammography), and positive predictive value (breast cancer diagnosed after positive mammograms) while adjusting for mammography registry, patient age, time since previous mammography, breast density, use of hormone replacement therapy, and year of examination (1998-2002 vs 2003-2006). All statistical tests were two-sided.Results Of 90 total facilities, 25 (27.8%) adopted CAD and used it for an average of 27.5 study months. In adjusted analyses, CAD use was associated with statistically significantly lower specificity (OR = 0.87, 95% confidence interval [CI] = 0.85 to 0.89, P < .001) and positive predictive value (OR = 0.89, 95% CI = 0.80 to 0.99, P = .03). A non-statistically significant increase in overall sensitivity with CAD (OR = 1.06, 95% CI = 0.84 to 1.33, P = .62) was attributed to increased sensitivity for ductal carcinoma in situ (OR = 1.55, 95% CI = 0.83 to 2.91; P = .17), although sensitivity for invasive cancer was similar with or without CAD (OR = 0.96, 95% CI = 0.75 to 1.24; P = .77). CAD was not associated with higher breast cancer detection rates or more favorable stage, size, or lymph node status of invasive breast cancer.Conclusion CAD use during film-screen screening mammography in the United States is associated with decreased specificity but not with improvement in the detection rate or prognostic characteristics of invasive breast cancer. J Natl Cancer Inst 2011; 103: 1152-1161