Birdwell Robyn L, Bandodkar Parul, Ikeda Debra M
Department of Radiology, S092, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105, USA.
Radiology. 2005 Aug;236(2):451-7. doi: 10.1148/radiol.2362040864.
To prospectively assess the effect of computer-aided detection (CAD) on screening mammogram interpretation in an academic medical center to determine if the outcome is different than that previously reported for community practices.
Institutional review board approval was granted, and informed consent was waived. During a 19-month period, 8682 women (median age, 54 years; range, 33-95 years) underwent screening mammography. Each mammogram was interpreted by one of seven radiologists, followed by immediate re-evaluation of the mammogram with CAD information. Each recalled case was classified as follows: radiologist perceived the finding and CAD marked it, radiologist perceived the finding and CAD did not mark it, or CAD prompted the radiologist to perceive the finding and recall the patient. Lesion type was also recorded. Recalled patients were tracked to determine the effect of CAD on recall and biopsy recommendation rates, positive predictive value (PPV) of biopsy, and cancer detection rate. A 95% confidence interval was calculated for cancer detection rate. Pathologic examination was performed for all cancers.
Of 8682 patients, 863 (9.9%) with 960 findings were recalled for further work-up (Breast Imaging Reporting and Data System category 0). After further diagnostic imaging, it was recommended that biopsy or aspiration be performed for 181 of 960 findings (19%); 165 interventions were confirmed to have been performed. Twenty-nine cancers were found in this group, with a PPV for biopsy of 18% (29 of 165 findings) and a cancer detection rate of 3.3 per 1000 screening mammograms (29 of 8682 patients). CAD-prompted recalls contributed 8% (73 of 960 findings) of total recalled findings and 7% (two of 29 lesions) of cancers detected. Of 29 cancers (59%), 17 manifested as masses and 12 (41%) were microcalcifications. Ten (34%) cancers were ductal carcinoma in situ, and the remaining cancers had an invasive component. Both cancers found with CAD manifested as masses, and both were invasive ductal carcinoma.
Prospective clinical use of CAD in a university hospital setting resulted in a 7.4% increase (from 27 to 29) in cancers detected. Both cancers were nonpalpable masses.
前瞻性评估计算机辅助检测（CAD）对学术医疗中心乳腺筛查钼靶解读的影响，以确定结果是否与先前社区实践报告的不同。
获得机构审查委员会批准，且无需知情同意。在19个月期间，8682名女性（中位年龄54岁；范围33 - 95岁）接受了乳腺筛查钼靶检查。每张钼靶片由7名放射科医生之一进行解读，随后根据CAD信息对钼靶片进行即时重新评估。每个召回病例分类如下：放射科医生察觉到病变且CAD标记了该病变；放射科医生察觉到病变但CAD未标记该病变；或CAD促使放射科医生察觉到病变并召回患者。还记录了病变类型。对召回患者进行跟踪，以确定CAD对召回率和活检推荐率、活检阳性预测值（PPV）以及癌症检出率的影响。计算癌症检出率的95%置信区间。对所有癌症进行病理检查。
8682例患者中，960处病变的863例（9.9%）被召回进一步检查（乳腺影像报告和数据系统0类）。经过进一步的诊断性影像学检查后，960处病变中的181处（19%）建议进行活检或穿刺；确认进行了165次干预。该组中发现29例癌症，活检的PPV为18%（165处病变中的29例），癌症检出率为每1000例筛查钼靶检查3.3例（8682例患者中的29例）。CAD促使召回的病变占总召回病变的8%（960处病变中的73例），占检出癌症的7%（29处病变中的2例）。29例癌症中（59%），17例表现为肿块，12例（41%）为微钙化。10例（34%）癌症为导管原位癌，其余癌症有浸润成分。通过CAD发现的2例癌症均表现为肿块，且均为浸润性导管癌。
在大学医院环境中对CAD进行前瞻性临床应用，使癌症检出率提高了7.4%（从27例增至29例）。2例癌症均为不可触及的肿块。
