Ciatto S, Houssami N, Apruzzese A, Bassetti E, Brancato B, Carozzi F, Catarzi S, Lamberini M P, Marcelli G, Pellizzoni R, Pesce B, Risso G, Russo F, Scorsolini A
Centro per lo Studio e la Prevenzione Oncologica, Viale A. Volta 171, I-50131 Firenze, Italy; Screening and Test Evaluation Programme, School of Public Health, University of Sydney, Australia.
Breast. 2005 Aug;14(4):269-75. doi: 10.1016/j.breast.2004.12.004.
The inter- and intraobserver agreement (kappa-statistic) in reporting according to Breast Imaging Reporting and Data System (BI-RADS((R))) breast density categories was tested in 12 dedicated breast radiologists reading a digitized set of 100 two-view mammograms. Average intraobserver agreement was substantial (kappa=0.71, range 0.32-0.88) on a four-grade scale (D1/D2/D3/D4) and almost perfect (kappa=0.81, range 0.62-1.00) on a two-grade scale (D1-2/D3-4). Average interobserver agreement was moderate (kappa=0.54, range 0.02-0.77) on a four-grade scale and substantial (kappa=0.71, range 0.31-0.88) on a two-grade scale. Major disagreement was found for intermediate categories (D2=0.25, D3=0.28). Categorization of breast density according to BI-RADS is feasible and consistency is good within readers and reasonable between readers. Interobserver inconsistency does occur, and checking the adoption of proper criteria through a proficiency test and appropriate training might be useful. As inconsistency is probably due to erroneous perception of classification criteria, standard sets of reference images should be made available for training.
在12位专业乳腺放射科医生阅读100例数字化双视图乳房X线照片时，对依据乳腺影像报告和数据系统（BI-RADS((R))）乳房密度分类进行报告的观察者间和观察者内一致性（kappa统计量）进行了测试。在四级分类（D1/D2/D3/D4）中，观察者内平均一致性较高（kappa=0.71，范围0.32-0.88），在两级分类（D1-2/D3-4）中几乎完美（kappa=0.81，范围0.62-1.00）。在四级分类中，观察者间平均一致性为中等（kappa=0.54，范围0.02-0.77），在两级分类中较高（kappa=0.71，范围0.31-0.88）。发现中间类别（D2=0.25，D3=0.28）存在较大分歧。依据BI-RADS对乳房密度进行分类是可行的，读者内部的一致性良好，读者之间的一致性合理。观察者间不一致确实存在，通过能力测试和适当培训检查正确标准的采用情况可能会有所帮助。由于不一致可能是由于对分类标准的错误认知，应提供标准参考图像集用于培训。
