肺癌筛查中随访 CT 扫描解读的读者间变异性评估。
Evaluation of reader variability in the interpretation of follow-up CT scans at lung cancer screening.
机构信息
Department of Radiology, University of Alabama Hospitals, 619 19th St South, Birmingham, AL 35249, USA.
出版信息
Radiology. 2011 Apr;259(1):263-70. doi: 10.1148/radiol.10101254. Epub 2011 Jan 19.
PURPOSE
To measure reader agreement in determining whether lung nodules detected at baseline screening computed tomography (CT) had changed at subsequent screening examinations and to evaluate the variability in recommendations for further follow-up.
MATERIALS AND METHODS
All subjects were enrolled in the National Lung Screening Trial (NLST), and each participant consented to the use of their de-identified images for research purposes. The authors randomly selected 100 cases of nodules measuring at least 4.0 mm at 1-year screening CT that were considered by the original screening CT reader to be present on baseline CT scans; nodules considered by the original reader to have changed were oversampled. Selected images from each case showing the entire nodule at both examinations were preloaded on a picture archiving and communication system workstation. Nine radiologists served as readers, and they evaluated whether the nodule was present at baseline and recorded the bidimensional measurements and nodule characteristics at each examination, presence or absence of change, results of screening CT, and follow-up recommendations (high-level follow-up, low-level follow-up, no follow-up).
RESULTS
On the basis of reviews during case selection, five nodules seen at follow-up were judged not to have been present at baseline; for 19 of the remaining 95 cases, at least one reader judged the nodule not to have been present at baseline. For the 76 nodules that were unanimously considered to have been present at baseline, 21%-47% (mean ± standard deviation, 30% ± 9) were judged to have grown. The κ values were similar for growth (κ = 0.55) and a positive screening result (κ = 0.51) and were lower for a change in margins and attenuation (κ = 0.27-0.31). The κ value in the recommendation of high- versus low-level follow-up was high (κ = 0.66).
CONCLUSION
Reader agreement on nodule growth and screening result was moderate to substantial. Agreement on follow-up recommendations was lower.
目的
测量在后续筛查检查中确定基线筛查 CT 检测到的肺结节是否发生变化的读者间一致性，并评估进一步随访建议的可变性。
材料和方法
所有受试者均参加了国家肺癌筛查试验（NLST），每位参与者均同意将其匿名图像用于研究目的。作者随机选择了 100 例在 1 年筛查 CT 时直径至少为 4.0 毫米的结节，这些结节被原始筛查 CT 读者认为存在于基线 CT 扫描中；对原始读者认为已经发生变化的结节进行了过采样。每个病例的显示两次检查中整个结节的图像都预先加载在图像存档和通信系统工作站上。9 名放射科医生作为读者进行评估，他们判断结节是否存在于基线期，并记录每次检查的二维测量值和结节特征、结节是否发生变化、筛查 CT 的结果以及随访建议（高级别随访、低级别随访、无需随访）。
结果
根据病例选择期间的审查，5 个在随访中看到的结节被判断为不存在于基线期；在其余 95 例中，至少有一位读者判断结节不存在于基线期。对于 76 个被一致认为存在于基线期的结节，有 21%-47%（平均值±标准差，30%±9）被判断为发生了生长。生长（κ=0.55）和阳性筛查结果（κ=0.51）的 κ 值相似，边缘和衰减变化的 κ 值较低（κ=0.27-0.31）。高与低水平随访建议的 κ 值较高（κ=0.66）。
结论
读者对结节生长和筛查结果的判断具有中等至较大的一致性。对随访建议的判断一致性较低。
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