Georgian-Smith Dianne, Moore Richard H, Halpern Elkan, Yeh Eren D, Rafferty Elizabeth A, D'Alessandro Helen Anne, Staffa Mary, Hall Deborah A, McCarthy Kathleen A, Kopans Daniel B
Department of Radiology, Breast Imaging, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
AJR Am J Roentgenol. 2007 Nov;189(5):1135-41. doi: 10.2214/AJR.07.2393.
The purpose of this study was to compare a human second reader with computer-aided detection (CAD) for the reduction of false-negative cases by a primary radiologist. We retrospectively reviewed our clinical practice.
We found that 6,381 consecutive screening mammograms were interpreted by a primary reader. This radiologist then reinterpreted the studies using CAD ("CAD reader"). A second human reader who was blinded to the CAD results but knowledgeable of the primary reader's findings reviewed the studies, looking for abnormalities not seen by the first reader.
Two cancers were called back by the second human reader that were not called back by the CAD reader; however, the CAD system had marked the findings, but they were dismissed by the primary reader. Because of the small numbers, the difference between the CAD and second human reader was not statistically significant. The CAD and human second readers increased the recall rates 6.4% and 7.2% (p = 0.70), respectively, and the biopsy rates 10% and 14.7%. The positive predictive value was 0% (0/3) for the CAD reader and was 40% (2/5) for the human second reader. The relative increases in the cancer detection rate compared with the primary reader's detection rate were 0% for the CAD reader and 15.4% (2/13) for the human second reader (p = 0.50).
A human second reader or the use of a CAD system can increase the cancer detection rate, but we found no statistical difference between the two because of the small sample size. A possible benefit from a human second reader is that CAD systems can only point to possible abnormalities, whereas a human must determine the significance of the finding. Having two humans review a study may increase detection rates due to interpreter--hence, perceptual--variability and not just increased detection.
本研究旨在比较人工二次阅片与计算机辅助检测（CAD）在减少初级放射科医生漏诊病例方面的效果。我们回顾性地分析了我们的临床实践。
我们发现一名初级阅片者解读了6381例连续的乳腺筛查钼靶片。然后该放射科医生使用CAD重新解读这些片子（“CAD阅片者”）。一名对CAD结果不知情但了解初级阅片者诊断结果的人工二次阅片者对这些片子进行复查，寻找初级阅片者未发现的异常。
人工二次阅片者召回了两例CAD阅片者未召回的癌症病例；然而，CAD系统标记了这些发现，但被初级阅片者忽略了。由于数量较少，CAD与人工二次阅片者之间的差异无统计学意义。CAD和人工二次阅片者分别将召回率提高了6.4%和7.2%（p = 0.70），活检率分别提高了10%和14.7%。CAD阅片者的阳性预测值为0%（0/3），人工二次阅片者为40%（2/5）。与初级阅片者的癌症检出率相比，CAD阅片者的相对增幅为0%，人工二次阅片者为15.4%（2/13）（p = 0.50）。
人工二次阅片或使用CAD系统均可提高癌症检出率，但由于样本量小，我们发现两者之间无统计学差异。人工二次阅片的一个潜在优势在于，CAD系统只能指出可能的异常，而最终必须由人来判断这些发现的意义。让两个人复查片子可能会由于解读差异——即感知差异——而提高检出率，而不仅仅是增加了检测次数。
