Gromet Matthew
Breast Imaging Section, Charlotte Radiology, P.A., 1701 East Blvd., Charlotte, NC 28203, USA.
AJR Am J Roentgenol. 2008 Apr;190(4):854-9. doi: 10.2214/AJR.07.2812.
This study compares the efficacy of single reading with computer-aided detection (CAD) to double reading and also to the first reader (without CAD) in a double-reading program.
A review was performed of 231,221 screening mammograms interpreted by experienced mammographers from 2001 through 2005 in a community-based mammography program. In 112,413 (48.6%), mammographers performed the first of two readings. In 118,808 (51.4%), they performed a single reading aided by CAD.
For double reading, the first reader's recall rate was 10.2%; sensitivity, 81.4%; positive predictive value, as a percentage of positive screening mammograms resulting in a tissue diagnosis of cancer within 1 year (PPV(1)), 4.1%; and cancer detection rate, 4.12 per 1,000. After the double-reading process, the final recall rate was 11.9%; sensitivity, 88.0%; PPV(1), 3.7%; and cancer detection rate, 4.46 per 1,000. For single-reading with CAD, the recall rate was 10.6%; sensitivity, 90.4%; PPV(1), 3.9%; and cancer detection rate, 4.20 per 1,000. Statistically significant results included a lower recall rate with CAD compared with double reading (10.6% vs 11.9%, respectively; p < 0.0001); increased sensitivity with CAD compared with the first reader (90.4% vs 81.4%, p < 0.0001); and increased recall rate with CAD compared with the first reader (10.6% vs 10.2%, p < 0.0001).
Double reading increased sensitivity with a modest increase in the recall rate compared with single reading. Single reading with CAD, compared with double reading, resulted in a small, but not statistically significant, increase in sensitivity with a lower recall rate. Our results indicate that CAD enhances performance of a single reader, yielding increased sensitivity with only a small increase in recall rate.
本研究比较了在双重读片程序中单次读片与计算机辅助检测（CAD）读片以及与首次读片者（无CAD）读片的效果。
回顾了2001年至2005年在一项基于社区的乳腺X线筛查项目中，由经验丰富的乳腺放射科医生解读的231,221例乳腺X线筛查图像。在112,413例（48.6%）中，放射科医生进行了两次读片中的首次读片。在118,808例（51.4%）中，他们进行了单次CAD辅助读片。
对于双重读片，首次读片者的召回率为10.2%；敏感度为81.4%；阳性预测值，即导致1年内癌症组织诊断的阳性乳腺X线筛查图像的百分比（PPV(1)）为4.1%；癌症检出率为每1000例4.12例。经过双重读片过程后，最终召回率为11.9%；敏感度为88.0%；PPV(1)为3.7%；癌症检出率为每1000例4.46例。对于CAD单次读片，召回率为10.6%；敏感度为90.4%；PPV(1)为3.9%；癌症检出率为每1000例4.20例。具有统计学意义的结果包括，与双重读片相比，CAD读片的召回率较低（分别为10.6%对11.9%；p < 0.0001）；与首次读片者相比，CAD读片的敏感度更高（90.4%对81.4%，p < 0.0001）；与首次读片者相比，CAD读片的召回率更高（10.6%对10.2%，p < 0.0001）。
与单次读片相比，双重读片提高了敏感度，召回率有适度增加。与双重读片相比，CAD单次读片导致敏感度有小幅但无统计学意义的增加，召回率较低。我们的结果表明，CAD提高了单次读片者的表现，在召回率仅小幅增加的情况下提高了敏感度。
