Clinically Missed Cancer: How Effectively Can Radiologists Use Computer-Aided Detection?
Clinically Missed Cancer: How Effectively Can Radiologists Use Computer-Aided Detection?
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DOI：
10.2214/ajr.11.6423
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发表时间：
2012-03-01
影响因子：
5
通讯作者：
Stull, Margaret A.
中科院分区：
文献类型：
--
作者：
Nishikawa, Robert M.;Schmidt, Robert A.;Stull, Margaret A.
OBJECTIVE.本研究的目的是确定放射科医生使用计算机辅助检测（CADe）检测筛查时漏诊的癌症的有效性。进行了一项观察者研究，以测量放射科医生在使用和不使用CADe的乳房X线照片上检测乳腺癌的能力。研究中的图像来自300次模拟乳腺X线检查。在234例病例中，乳房X线照片在临床上被解读为正常，并且至少在随后的2年内没有癌症。在其他66例病例中，癌症在临床上被遗漏。在256例病例中，可获得当前和以前的乳房X线照片。八名放射科医生阅读数据集，并记录BI-RADS评估，病变的位置，以及他们对每个可疑病变应召回患者进行诊断检查的信心水平。Jackknife交替自由响应接收机工作特性分析。在无辅助的情况下，折叠式替代自由响应接收器操作特性优值为0.641，在有辅助的情况下为0.659（p = 0.06; 95% CI，-0.001至0.036）。CADe的敏感性增加9.9%（95%CI，3.4-19%），回收率增加12.1%（95%CI，7.3-20%）。两种增加都具有统计学显著性（p < 0.001）。放射科医师平均忽略了71%的正确计算机检查。使用CADe可以使放射科医师的灵敏度提高10%，召回率也有相当的提高。CADe有可能产生更大的临床影响，因为放射科医生在癌症被遗漏的情况下无法识别71%的正确计算机提示。
OBJECTIVE. The purpose of this study was to determine the effectiveness with which radiologists can use computer-aided detection (CADe) to detect cancer missed at screening.MATERIALS AND METHODS. An observer study was performed to measure the ability of radiologists to detect breast cancer on mammograms with and without CADe. The images in the study were from 300 analog mammographic examinations. In 234 cases the mammograms were read clinically as normal and free of cancer for at least 2 subsequent years. In the other 66 cases, cancers were missed clinically. In 256 cases, current and previous mammograms were available. Eight radiologists read the dataset and recorded a BI-RADS assessment, the location of the lesion, and their level of confidence that the patient should be recalled for diagnostic workup for each suspicious lesion. Jackknife alternative free-response receiver operating characteristic analysis was used.RESULTS. The jackknife alternative free-response receiver operating characteristic figure of merit was 0.641 without aid and 0.659 with aid (p = 0.06; 95% CI, -0.001 to 0.036). The sensitivity increased 9.9% (95% CI, 3.4-19%) and the callback rate 12.1% (95% CI, 7.3-20%) with CADe. Both increases were statistically significant (p < 0.001). Radiologists on average ignored 71% of correct computer prompts.CONCLUSION. Use of CADe can increase radiologist sensitivity 10% with a comparable increase in recall rate. There is clinical potential for CADe to have a bigger clinical impact because radiologists failed to recognize 71% of correct computer prompts in cases in which cancers were missed.