Ikeda Debra M, Birdwell Robyn L, O'Shaughnessy Kathryn F, Sickles Edward A, Brenner R James
Department of Radiology, Stanford University Medical Center, Room S-068A, Rte 1, 300 Pasteur Dr, Stanford, CA 94305-5105, USA.
Radiology. 2004 Mar;230(3):811-9. doi: 10.1148/radiol.2303030254. Epub 2004 Feb 5.
To evaluate, by using a computer-aided detection (CAD) program, the nonspecific findings on normal screening mammograms obtained in women in whom breast cancer was later detected at follow-up screening mammography.
Four hundred ninety-three mammogram pairs-an initial negative screening mammogram and a subsequently obtained screening mammogram showing cancer-were collected. The mean interval between examinations was 14.6 months. In 169 cases, in which 172 cancers were later depicted, findings on the initial mammogram were subtle enough that either none or only one or two of five blinded radiologists recommended screening recall. On the initial negative mammograms, of the 172 areas where cancer later developed, 137 (80%) had subtle nonspecific findings and were retrospectively judged as having a benign or normal appearance. The mammograms with these subtle findings were evaluated with a commercially available CAD program, and the numbers of CAD marks on these nonspecific findings were analyzed.
Of the 172 cancers, 129 (75%) were invasive and 43 (25%) were ductal carcinoma in situ. The CAD program marked 72 (42%) of the 172 findings that subsequently developed into cancer: 24 (29%) of 82 findings recalled by none, 25 (49%) of 51 findings recalled by one, and 23 (59%) of 39 findings recalled by two of the five radiologists. Among the 137 areas with nonspecific normal or benign findings, 41 (30%) areas where cancer subsequently developed were marked by the CAD program.
A subset of cancers have perceptible but nonspecific mammographic findings that may be marked by a CAD program, even when the findings do not warrant recall as judged at blinded and unblinded radiologist review. The authors believe failure to act on such nonspecific but CAD-marked findings prospectively does not constitute interpretation below a reasonable standard of care.
通过使用计算机辅助检测（CAD）程序，评估在后续筛查乳腺钼靶检查中被诊断出患有乳腺癌的女性的正常筛查乳腺钼靶片上的非特异性表现。
收集了493对乳腺钼靶片——一张初始的阴性筛查乳腺钼靶片和一张随后显示癌症的筛查乳腺钼靶片。两次检查之间的平均间隔时间为14.6个月。在169例病例中，后来发现了172处癌症，初始乳腺钼靶片上的表现非常细微，以至于5名不知情的放射科医生中无人或只有一两人建议进行筛查召回。在初始的阴性乳腺钼靶片上，后来发生癌症的172个区域中，有137个（80%）有细微的非特异性表现，并且回顾性判断为具有良性或正常外观。使用商用CAD程序对有这些细微表现的乳腺钼靶片进行评估，并分析这些非特异性表现上的CAD标记数量。
在172处癌症中，129处（75%）为浸润性癌，43处（25%）为导管原位癌。CAD程序标记了172处后来发展为癌症的表现中的72处（42%）：在82处无人召回的表现中标记了24处（29%），在51处被一人召回的表现中标记了25处（49%），在5名放射科医生中被两人召回的39处表现中标记了23处（59%）。在137处具有非特异性正常或良性表现的区域中，CAD程序标记了后来发生癌症的41个（30%）区域。
一部分癌症具有可察觉但非特异性的乳腺钼靶表现，这些表现可能会被CAD程序标记出来，即使这些表现根据不知情和知情的放射科医生的判断并不需要召回。作者认为，前瞻性地不对这些非特异性但被CAD标记的表现采取行动并不构成低于合理医疗标准的解读。
