Carl J. Vyborny Translational Laboratory for Breast Cancer Research, Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC-2026, Chicago, IL 60637, USA.
AJR Am J Roentgenol. 2012 Mar;198(3):708-16. doi: 10.2214/AJR.11.6423.
The purpose of this study was to determine the effectiveness with which radiologists can use computer-aided detection (CADe) to detect cancer missed at screening.
An observer study was performed to measure the ability of radiologists to detect breast cancer on mammograms with and without CADe. The images in the study were from 300 analog mammographic examinations. In 234 cases the mammograms were read clinically as normal and free of cancer for at least 2 subsequent years. In the other 66 cases, cancers were missed clinically. In 256 cases, current and previous mammograms were available. Eight radiologists read the dataset and recorded a BI-RADS assessment, the location of the lesion, and their level of confidence that the patient should be recalled for diagnostic workup for each suspicious lesion. Jackknife alternative free-response receiver operating characteristic analysis was used.
The jackknife alternative free-response receiver operating characteristic figure of merit was 0.641 without aid and 0.659 with aid (p = 0.06; 95% CI, -0.001 to 0.036). The sensitivity increased 9.9% (95% CI, 3.4-19%) and the callback rate 12.1% (95% CI, 7.3-20%) with CADe. Both increases were statistically significant (p < 0.001). Radiologists on average ignored 71% of correct computer prompts.
Use of CADe can increase radiologist sensitivity 10% with a comparable increase in recall rate. There is potential for CADe to have a bigger clinical impact because radiologists failed to recognize a correct computer prompt in 71% of missed cancer cases [corrected].
本研究旨在确定放射科医师使用计算机辅助检测（CADe）检测筛查漏诊癌症的有效性。
本研究采用观察者研究方法，以评估放射科医师在使用和不使用 CADe 的情况下在乳腺 X 线照片上检测乳腺癌的能力。研究中的图像来自 300 例模拟乳腺 X 线检查。在 234 例中，乳腺 X 线照片在临床阅读时被认为正常，并且至少在 2 年后无癌症。在另外 66 例中，癌症在临床检查中被漏诊。在 256 例中，有当前和以前的乳腺 X 线照片可用。8 名放射科医师阅读了数据集，并记录了 BI-RADS 评估、病变位置以及他们对每位可疑病变患者进行诊断性检查的召回水平的置信度。使用 Jackknife 替代自由反应接受者操作特征分析。
Jackknife 替代自由反应接受者操作特征的优势值为 0.641（无辅助）和 0.659（有辅助）（p = 0.06；95%置信区间，-0.001 至 0.036）。使用 CADe 后，敏感性增加了 9.9%（95%置信区间，3.4-19%），召回率增加了 12.1%（95%置信区间，7.3-20%）。这两个增加均具有统计学意义（p<0.001）。放射科医师平均忽略了 71%的正确计算机提示。
使用 CADe 可使放射科医师的敏感性提高 10%，同时召回率也相应提高。CADe 有可能产生更大的临床影响，因为放射科医师在 71%的漏诊癌症病例中未能识别正确的计算机提示[更正]。
