James J J, Cornford E J
Nottingham Breast Institute, Nottingham City Hospital, Nottingham, UK.
Clin Radiol. 2009 Jan;64(1):46-51. doi: 10.1016/j.crad.2008.07.008. Epub 2008 Sep 4.
To investigate whether a computer-aided detection (CAD) system could act as an arbitrator of discordant double-reading opinions, replacing the need for an independent third film reader.
The mammograms of the 240 women that underwent arbitration by an independent third reader were identified from the 16,629 women attending our screening centre between July 2003 and April 2004. Mammograms of the arbitration cases were digitized and analysed by a CAD system. To assess the ability of CAD to act as the arbitrator, the site of the CAD prompts was retrospectively compared to the site of any abnormality noted by the original film readers. If a CAD prompt was placed on a region marked by one of the film readers then the decision of CAD as the arbitrator was that the women should be recalled for further assessment. If no mark was placed then the region was considered low risk and the decision was not to recall. The decision of CAD as the arbitrator was retrospectively compared with the original recall decision of the independent third reader.
There were 21 cancer cases in the group of women undergoing arbitration, diagnosed both at the original screening episode and subsequently. The independent third reader recalled 15/18 (83%) of the cancers that corresponded with the arbitrated lesion. CAD as the arbitrator would have recalled 16/18 (89%) of the cancers that corresponded to the arbitrated lesion. CAD acting as the arbitrator would have resulted in a significant increase in normal women being recalled to assessment in the arbitration group (P<0.001). The extra 50 recalls would have potentially increased the overall recall rate to assessment from 3.1 to 3.4%; a relative increase of 10%.
The main effect of CAD acting as an arbitrator of discordant double-reading opinions is to increase the recall rate, significantly above what is found when arbitration is performed by an independent third reader. Using CAD as an arbitrator may be an option to deal with discordant double-reading opinions when no other method of consensus or arbitration is available.
研究计算机辅助检测（CAD）系统能否作为不一致的双人读片意见的仲裁者，从而取代独立第三方阅片者的需求。
从2003年7月至2004年4月期间在我们筛查中心就诊的16629名女性中，识别出由独立第三方阅片者进行仲裁的240名女性的乳腺钼靶片。仲裁病例的乳腺钼靶片进行数字化处理，并由CAD系统进行分析。为评估CAD作为仲裁者的能力，将CAD提示的部位与原始阅片者记录的任何异常部位进行回顾性比较。如果CAD提示位于其中一位阅片者标记的区域，则CAD作为仲裁者的决定是该女性应被召回进行进一步评估。如果未标记，则该区域被视为低风险，决定不召回。将CAD作为仲裁者的决定与独立第三方阅片者的原始召回决定进行回顾性比较。
接受仲裁的女性组中有21例癌症病例，在最初的筛查阶段及随后均被诊断出来。独立第三方阅片者召回了与仲裁病变对应的15/18（83%）的癌症病例。CAD作为仲裁者将召回与仲裁病变对应的16/18（89%）的癌症病例。CAD作为仲裁者会导致仲裁组中被召回进行评估的正常女性数量显著增加（P<0.001）。额外的50次召回可能会使总体召回评估率从3.1%提高到3.4%；相对增加10%。
CAD作为不一致的双人读片意见的仲裁者的主要作用是提高召回率，显著高于独立第三方阅片者进行仲裁时的召回率。当没有其他达成共识或仲裁的方法时，使用CAD作为仲裁者可能是处理不一致的双人读片意见的一种选择。
