Skaane P, Olsen J B, Sager E M, Abdelnoor M, Berger A, Kullmann G, Wolff P A
Department of Radiology, Ullevaal University Hospital, Oslo, Norway.
Acta Radiol. 1999 Mar;40(2):169-75. doi: 10.3109/02841859909177733.
To analyze interobserver variability of ultrasonography (US) as an adjunct to mammography in patients with palpable noncalcified breast tumors.
Mammographic, US, and combined reading of 200 patients with palpable noncalcified breast masses were performed independently by four experienced radiologists. Nonneoplastic abnormalities and mammographically obvious cancers were excluded. Receiver operating characteristic (ROC) analysis based on 115 tumors was carried out for mammography, US, and both combined for each radiologist. The US diagnoses of the 45 cancers excluded from ROC analysis and the 55 cancers included were compared.
One radiologist revealed a significantly higher diagnostic performance with US than with mammography. Combined reading showed the highest performance for all observers, but the improvement as compared with mammography was significant for only two. Higher accuracy on combined reading was mainly caused by correct upgrading of tumors with benign or indeterminate mammographic findings. One radiologist had benefit of US for downgrading of tumors. All four radiologists made a malignant US diagnosis twice as often in mammographically obvious cancers than in mammographically nonconclusive tumors.
Radiologists differ substantially in interpretation of breast imaging. Combined reading offers the highest diagnostic accuracy mainly by correct upgrading of tumors on US. The role of US for downgrading tumors is operator-dependent.
分析超声检查（US）作为乳腺钼靶检查辅助手段在可触及的非钙化乳腺肿瘤患者中的观察者间变异性。
由四位经验丰富的放射科医生独立对200例可触及非钙化乳腺肿块的患者进行乳腺钼靶、超声检查及联合阅片。排除非肿瘤性异常及乳腺钼靶检查中明显的癌症。对每位放射科医生基于115个肿瘤进行乳腺钼靶、超声及两者联合的受试者操作特征（ROC）分析。比较从ROC分析中排除的45例癌症及纳入的55例癌症的超声诊断结果。
一位放射科医生的超声诊断性能显著高于乳腺钼靶。联合阅片对所有观察者显示出最高的性能，但与乳腺钼靶相比，仅两位观察者的性能有显著提高。联合阅片的更高准确性主要是由于对乳腺钼靶表现为良性或不确定的肿瘤进行了正确的升级。一位放射科医生从超声对肿瘤的降级中获益。所有四位放射科医生对乳腺钼靶检查中明显的癌症做出恶性超声诊断的频率是乳腺钼靶检查结果不明确的肿瘤的两倍。
放射科医生在乳腺影像解读方面存在很大差异。联合阅片主要通过对超声检查中的肿瘤进行正确升级而提供最高的诊断准确性。超声对肿瘤降级的作用取决于操作者。
