Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
Radiology. 2011 Apr;259(1):72-84. doi: 10.1148/radiol.10101698. Epub 2011 Feb 22.
To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance.
Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certificate of Confidentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act.
Mean sensitivity was 85.2% (95% confidence interval [CI]: 83.7%, 86.6%) and was significantly lower for radiologists with a greater screening focus (P = .023) but did not significantly differ by total (P = .47), screening (P = .33), or diagnostic (P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates significantly higher for radiologists who had the lowest total (P = .008) and screening (P = .015) volumes. Radiologists with low diagnostic volume (P = .004 and P = .008) and a greater screening focus (P = .003 and P = .002) had significantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume.
Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements.
研究美国放射科医生的诊断量是否会影响其筛查乳房 X 光摄影术的表现。
从 2002 年至 2006 年，对参与乳腺癌监测联合会（BCSC）的 120 名放射科医生的年度诊断量（总数、筛查、诊断和筛查重点[筛查与诊断乳房 X 光摄影术之比]）进行了收集，这些放射科医生共对 783965 次筛查乳房 X 光摄影术进行了解读。通过多元逻辑回归，对次年的筛查敏感性、假阳性率和癌症检出率与 1 年内的体积测量值进行了检查。BCSC 登记处和统计协调中心收到了机构审查委员会的批准，通过主动或被动同意程序以及为参与的女性、医生和医疗机构提供联邦保密证书等其他保护措施，所有程序均符合《健康保险携带和责任法案》的规定。
平均敏感性为 85.2%（95%置信区间：83.7%，86.6%），具有更大筛查重点的放射科医生的敏感性明显降低（P =.023），但总体（P =.47）、筛查（P =.33）或诊断（P =.23）体积无显著差异。平均假阳性率为 9.1%（95%置信区间：8.1%，10.1%），总（P =.008）和筛查（P =.015）体积最低的放射科医生的假阳性率明显更高。诊断量低（P =.004 和 P =.008）和筛查重点较大（P =.003 和 P =.002）的放射科医生的假阳性和癌症检出率分别显著降低。侵袭性肿瘤大小中位数和早期检出癌症的比例与体积无关。
在美国增加最低诊断量要求并增加最低诊断解读要求，可以在不影响癌症检出率的情况下减少假阳性工作的数量。这些结果为决策者提供了与劳动力、实践组织以及获取问题相关的详细的乳房 X 光摄影术体积与表现之间的关联，当重新评估要求时，还应考虑放射科医生的经验。
