Duijm Lucien E M, Groenewoud Johanna H, Fracheboud Jacques, van Ineveld B Martin, Roumen Rudi M H, de Koning Harry J
Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
Eur J Cancer. 2008 Jun;44(9):1223-8. doi: 10.1016/j.ejca.2008.03.003. Epub 2008 Apr 8.
To determine the effect of introducing radiographer double reading, in addition to standard radiologist double reading, on screening mammography outcome.
In period A, 66,225 mammograms were read by two screening radiologists. In period B, 78,325 mammograms were read by two radiographers in addition and radiologists were blinded to the referral opinion of the radiographers. Mammograms, for which only radiographers had suggested referral, (i.e. cases that would only be referred by technologists) were re-evaluated by the screening radiologists. Women were referred if at least one radiologist considered this necessary, and diagnostic costs of these additional referrals were estimated.
In period A, 322 cancers were diagnosed after referral of 678 women. During period B, radiologists initially referred 1122 patients and 411 cancers were detected. Radiologists' referral rate was higher in period B than in period A (1.43% versus 1.02%, p<0.001), as well as the cancer detection rate per 1000 women screened (CDR) (5.25 versus 4.86, p=0.3). The positive predictive value of referral (PPV) was 36.6% versus 47.5% (p<0.001). In period B, radiologist review of 544 additional positive radiographer readings led to 102 extra referrals, with 29 additional cancers detected, resulting in an overall referral rate of 1.56% (compared to period A, p<0.001), an overall CDR of 5.62 (p=0.048) and an overall PPV of 35.9% (p<0.001). Workup expenses of the 102 additional referrals were euro60,274.
Additional radiographer double reading detected cancers that would have been missed by radiologists. Mean expenses for diagnostic confirmation of these extra cancers was euro2078 per cancer.
确定除标准的放射科医生双人阅片外，引入放射技师双人阅片对乳腺筛查结果的影响。
在A阶段，由两名乳腺筛查放射科医生阅读66225份乳房X光片。在B阶段，另外由两名放射技师阅读78325份乳房X光片，且放射科医生对放射技师的转诊意见不知情。对于只有放射技师建议转诊的乳房X光片（即只有技术人员会转诊的病例），由筛查放射科医生重新评估。如果至少有一名放射科医生认为有必要，女性患者会被转诊，并估算这些额外转诊的诊断费用。
在A阶段，678名女性被转诊后诊断出322例癌症。在B阶段，放射科医生最初转诊了1122名患者，检测出411例癌症。B阶段放射科医生的转诊率高于A阶段（1.43%对1.02%，p<0.001），每1000名接受筛查女性的癌症检出率（CDR）也是如此（5.25对4.86，p=0.3）。转诊的阳性预测值（PPV）为36.6%对47.5%（p<0.001）。在B阶段，放射科医生对放射技师另外544份阳性阅片进行复查，导致额外转诊102例，又检测出29例癌症，总体转诊率为1.56%（与A阶段相比，p<0.001），总体CDR为5.62（p=0.048），总体PPV为35.9%（p<0.001）。额外102例转诊的检查费用为60274欧元。
放射技师额外的双人阅片检测出了放射科医生会漏诊的癌症。这些额外癌症的诊断确认平均费用为每例癌症2078欧元。
