Miglioretti Diana L, Smith-Bindman Rebecca, Abraham Linn, Brenner R James, Carney Patricia A, Bowles Erin J Aiello, Buist Diana S M, Elmore Joann G
Group Health Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA.
J Natl Cancer Inst. 2007 Dec 19;99(24):1854-63. doi: 10.1093/jnci/djm238. Epub 2007 Dec 11.
Extensive variability has been noted in the interpretive performance of screening mammography; however, less is known about variability in diagnostic mammography performance.
We examined the performance of 123 radiologists who interpreted 35895 diagnostic mammography examinations that were obtained to evaluate a breast problem from January 1, 1996, through December 31, 2003, at 72 facilities that contribute data to the Breast Cancer Surveillance Consortium. We modeled the influence of radiologist characteristics on the sensitivity and false-positive rate of diagnostic mammography, adjusting for patient characteristics by use of a Bayesian hierarchical logistic regression model.
The median sensitivity was 79% (range = 27%-100%) and the median false-positive rate was 4.3% (range = 0%-16%). Radiologists in academic medical centers, compared with other radiologists, had higher sensitivity (88%, 95% confidence interval [CI] = 77% to 94%, versus 76%, 95% CI = 72% to 79%; odds ratio [OR] = 5.41, 95% Bayesian posterior credible interval [BPCI] = 1.55 to 21.51) with a smaller increase in their false-positive rates (7.8%, 95% CI = 4.8% to 12.7%, versus 4.2%, 95% CI = 3.8% to 4.7%; OR = 1.73, 95% BPCI = 1.05 to 2.67) and a borderline statistically significant improvement in accuracy (OR = 3.01, 95% BPCI = 0.97 to 12.15). Radiologists spending 20% or more of their time on breast imaging had statistically significantly higher sensitivity than those spending less time on breast imaging (80%, 95% CI = 76% to 83%, versus 70%, 95% CI = 64% to 75%; OR = 1.60, 95% BPCI = 1.05 to 2.44) with non-statistically significant increased false-positive rates (4.6%, 95% CI = 4.0% to 5.3%, versus 3.9%, 95% CI = 3.3% to 4.6%; OR = 1.17, 95% BPCI = 0.92 to 1.51). More recent training in mammography and more experience performing breast biopsy examinations were associated with a decreased threshold for recalling patients, resulting in similar statistically significant increases in both sensitivity and false-positive rates.
We found considerable variation in the interpretive performance of diagnostic mammography across radiologists that was not explained by the characteristics of the patients whose mammograms were interpreted. This variability is concerning and likely affects many women with and without breast cancer.
乳腺钼靶筛查的解读表现存在广泛差异；然而，对于诊断性乳腺钼靶检查表现的差异了解较少。
我们评估了123名放射科医生的表现，这些医生解读了1996年1月1日至2003年12月31日期间在72家向乳腺癌监测联盟提供数据的机构进行的35895例用于评估乳腺问题的诊断性乳腺钼靶检查。我们使用贝叶斯分层逻辑回归模型，在调整患者特征的情况下，模拟放射科医生特征对诊断性乳腺钼靶检查敏感性和假阳性率的影响。
中位敏感性为79%（范围 = 27% - 100%），中位假阳性率为4.3%（范围 = 0% - 16%）。与其他放射科医生相比，学术医疗中心的放射科医生具有更高的敏感性（88%，95%置信区间[CI] = 77%至94%，而其他为76%，95% CI = 72%至79%；优势比[OR] = 5.41，95%贝叶斯后验可信区间[BPCI] = 1.55至21.51），其假阳性率的增加幅度较小（7.8%，95% CI = 4.8%至12.7%，而其他为4.2%，95% CI = 3.8%至4.7%；OR = 1.73，95% BPCI = 1.05至2.67），并且准确性有边缘统计学显著提高（OR = 3.01，95% BPCI = 0.97至12.15）。将20%或更多时间用于乳腺影像诊断的放射科医生，其敏感性在统计学上显著高于那些用于乳腺影像诊断时间较少的医生（80%，95% CI = 76%至83%，而其他为70%，95% CI = 64%至75%；OR = 1.60，95% BPCI = 1.05至2.44），假阳性率虽有增加但无统计学意义（4.6%，95% CI = 4.0%至5.3%，而其他为3.9%，95% CI = 3.3%至4.6%；OR = 1.17，95% BPCI = 0.92至1.51）。最近接受乳腺钼靶检查培训以及有更多乳腺活检检查经验与召回患者阈值降低相关，导致敏感性和假阳性率在统计学上均有类似的显著增加。
我们发现不同放射科医生在诊断性乳腺钼靶检查的解读表现上存在相当大的差异，这种差异无法通过所解读乳腺钼靶检查患者的特征来解释。这种变异性令人担忧，可能会影响许多患有或未患乳腺癌的女性。
