Screening for Lung Cancer with Digital Chest Radiography: Sensitivity and Number of Secondary Work-up CT Examinations
Screening for Lung Cancer with Digital Chest Radiography: Sensitivity and Number of Secondary Work-up CT Examinations
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DOI：
10.1148/radiol.09091308
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发表时间：
2010-05-01
期刊：
影响因子：
19.7
通讯作者：
Prokop, Mathias
中科院分区：
文献类型：
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作者：
de Hoop, Bartjan;Schaefer-Prokop, Cornelia;Prokop, Mathias
目的：为了估计性能的数字化胸部X线摄影检测肺癌。材料和方法：该研究已获得伦理委员会的批准，并采用巢式病例对照设计，包括55例肺癌患者在计算机断层扫描（CT）检测，并确认与组织学检查和样本的4873例对照组在CT无结节。所有患者在筛查CT后2个月内接受了两次直接探测器数字胸部X线摄影。4名经验不同的放射科医生使用1级（无病变）至5级（明确病变）的置信度在胸片上识别和定位潜在的癌症。进行定位受试者工作特征（ROC）分析。在胸部X线检查中发现可疑病变的假设基础上，将导致进一步的工作与CT检查，工作的CT检查每检测到的癌症（CT检查每癌症）的数量计算在不同的置信水平的筛选人口（研究人群的癌症率，1.3%）。定位ROC曲线下面积范围为0.52 - 0.69。检测率因观察者的经验和置信水平而存在很大差异：在置信水平为5时，检测率范围从每种癌症进行1次CT检查时的18%到每种癌症进行13次CT检查时的53%。在置信水平为2或更高时，每种癌症的检出率从62次CT检查的94%到44次CT检查的78%不等。对于CT筛查发现的直径为6.8-50.7 mm的肺部肿瘤，胸部X线摄影的检出率可达94%，但其代价是假阳性率高和工作量过大-CT检查。检测性能与观察者密切相关。(C)RSNA，2010年
Purpose: To estimate the performance of digital chest radiography for detection of lung cancer.Materials and Methods: The study had ethics committee approval, and a nested case-control design was used and included 55 patients with lung cancer detected at computed tomography (CT) and confirmed with histologic examination and a sample of 72 of 4873 control subjects without nodules at CT. All patients underwent direct-detector digital chest radiography in two projections within 2 months of the screening CT. Four radiologists with varying experience identified and localized potential cancers on chest radiographs by using a confidence scale of level 1 (no lesion) to 5 (definite lesion). Localization receiver operating characteristic (ROC) analysis was performed. On the basis of the assumption that suspicious lesions seen at chest radiography would lead to further work-up with CT, the number of work-up CT examinations per detected cancer (CT examinations per cancer) was calculated at various confidence levels for the screening population (cancer rate in study population, 1.3%).Results: Tumor size ranged from 6.8 to 50.7 mm (median, 11.8 mm). Areas under the localization ROC curve ranged from 0.52 to 0.69. Detection rates substantially varied with the observers' experience and confidence level: At a confidence level of 5, detection rates ranged from 18% at one CT examination per cancer to 53% at 13 CT examinations per cancer. At a confidence level of 2 or higher, detection rates ranged from 94% at 62 CT examinations per cancer to 78% at 44 CT examinations per cancer.Conclusion: A detection rate of 94% for lung tumors with a diameter of 6.8-50.7 mm found at CT screening was achievable with chest radiography only at the expense of a high false-positive rate and an excessive number of work-up CT examinations. Detection performance is strongly observer dependent. (C) RSNA, 2010