Association of volume and volume-independent factors with accuracy in screening mammogram interpretation
Association of volume and volume-independent factors with accuracy in screening mammogram interpretation
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DOI：
10.1093/jnci/95.4.282
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发表时间：
2003-02-19
期刊：
影响因子：
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通讯作者：
Sickles, EA
中科院分区：
文献类型：
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作者：
Beam, CA;Conant, EF;Sickles, EA
背景资料：乳腺癌的早期发现与筛查乳房X线照片的准确阅读相关，但影响阅读准确性的因素还不清楚。因此，我们调查了阅读量和其他因素是否与美国放射科医师群体中阅读筛查乳房X线照片的准确性独立相关。研究方法：从292名同意参加的放射科医生中随机选择110名，如果被选中，则解释148名随机选择的妇女的筛查乳房X线照片。原始索引乳房X线照片（即，使用每侧乳房的内外侧斜位和头尾位视图）;可用时提供对比原始乳房X线照片。放射科医生和设施水平的因素进行了调查。两个标准的筛选准确性指标，均基于受试者工作特征曲线，进行了分析。在控制其他因素后，用多元回归分析评估体积对准确性的影响。结果：当前阅读量与判读准确性无统计学显著相关。最近接受培训的放射科医生比早期接受培训的放射科医生更准确地解释乳房X线照片（自住院以来，每年灵敏度降低-0.76%[95%置信区间（CI）=-1.75%至-0.02%]）。具有统计学显著性且与更高准确性独立相关的设施水平因素是进行的诊断性乳腺成像检查和图像引导乳腺介入手术的数量（提供的每项检查或程序的准确性增加0.55%[95% CI = 0.11%至2.40%]），被归类为综合性乳腺诊断和/或筛查中心或独立的乳腺X射线摄影中心（比医院放射科或多专科医疗诊所高1.39%[95% CI = 0.15%-3.82%]），并且是实行双重阅读的机构（比没有这种做法的机构高1.61%[95% CI = 1.99%-11.65%]）。结论：个别放射科医师目前的阅读量与阅读筛查乳房X线照片的准确性在统计学上没有显著相关性，但其他几个因素与此相关。专业知识反映了一个复杂的多因素过程，需要进一步澄清。
Background: Early detection of breast cancer is associated with the accurate reading of screening mammograms, but factors that influence reading accuracy are not well understood. We thus investigated whether reading volume and other factors were independently associated with accuracy in reading screening mammograms in a population of U.S. radiologists. Methods: A random selection of 110 of 292 radiologists who agreed to participate, if selected, interpreted screening mammograms from 148 randomly selected women. Original index mammograms (i.e., mediolateral oblique and craniocaudal views of each breast) were used; comparison original mammograms were provided when available. Radiologist-level and facility-level factors were surveyed. Two standard metrics of screening accuracy, both based on receiver operating characteristic curves, were analyzed. The influence of volume on accuracy after controlling for other factors was assessed with multiple regression analysis. Results: Current reading volume was not statistically significantly associated with interpretive accuracy. More recently trained radiologists interpreted mammograms more accurately than those trained earlier (-0.76% [95% confidence interval (CI) = -1.75% to -0.02%] reduction in sensitivity per year since residency). Facility-level factors that were statistically significantly and independently associated with better accuracy were the number of diagnostic breast imaging examinations and image-guided breast interventional procedures performed (0.55% [95% CI = 0.11% to 2.40%] increase in accuracy per examination or procedure offered), being classified as a comprehensive breast diagnostic and/or screening center or freestanding mammography center (1.39% [95% CI = 0.15% to 3.82%] higher than a hospital radiology department or multispecialty medical clinic), and being a facility that practiced double reading (1.61% [95% CI = 1.99% to 11.65%]) higher than in a facility without such practice). Conclusions: Individual radiologists' current reading volume was not statistically significantly associated with accuracy in reading screening mammograms, but several other factors were. Expertise reflects a complex multifactorial process that needs further clarification.