Servei d'Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain.
Br J Radiol. 2012 Nov;85(1019):1465-70. doi: 10.1259/bjr/21256379. Epub 2012 Sep 19.
The aim of this study was to evaluate reader variability in screening mammograms according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) assessment and breast density categories.
A stratified random sample of 100 mammograms was selected from a population-based breast cancer screening programme in Barcelona, Spain: 13 histopathologically confirmed breast cancers and 51 with true-negative and 36 with false-positive results. 21 expert radiologists from radiological units of breast cancer screening programmes in Catalonia, Spain, reviewed the mammography images twice within a 6-month interval. The readers described each mammography using BI-RADS assessment and breast density categories. Inter- and intraradiologist agreement was assessed using percentage of concordance and the kappa (κ) statistic.
Fair interobserver agreement was observed for the BI-RADS assessment [κ=0.37, 95% confidence interval (CI) 0.36-0.38]. When the categories were collapsed in terms of whether additional evaluation was required (Categories III, 0, IV, V) or not (I and II), moderate agreement was found (κ=0.53, 95% CI 0.52-0.54). Intra-observer agreement for BI-RADS assessment was moderate using all categories (κ=0.53, 95% CI 0.50-0.55) and substantial on recall (κ=0.66, 95% CI 0.63-0.70). Regarding breast density, inter- and intraradiologist agreement was substantial (κ=0.73, 95% CI 0.72-0.74 and κ=0.69, 95% CI 0.68-0.70, respectively).
We observed a substantial intra-observer agreement in the BI-RADS assessment but only moderate interobserver agreement. Both inter- and intra-observer agreement in mammographic interpretation of breast density was substantial. Advances in knowledge Educational efforts should be made to decrease radiologists' variability in BI-RADS assessment interpretation in population-based breast screening programmes.
本研究旨在评估根据美国放射学院乳腺成像报告和数据系统（BI-RADS）评估以及乳腺密度分类的筛查性乳房 X 光检查中的读者变异性。
从西班牙巴塞罗那的一项基于人群的乳腺癌筛查计划中抽取了 100 例乳腺 X 光片进行分层随机抽样：13 例经组织病理学证实的乳腺癌，51 例真阴性和 36 例假阳性结果。来自西班牙加泰罗尼亚乳腺癌筛查计划放射科的 21 名专家放射科医生在 6 个月的时间内对乳腺 X 光片进行了两次复查。读者使用 BI-RADS 评估和乳腺密度分类来描述每一张乳腺 X 光片。使用一致性百分比和kappa（κ）统计量评估观察者间和观察者内的一致性。
BI-RADS 评估的观察者间一致性为中等[κ=0.37，95%置信区间（CI）0.36-0.38]。当将类别按是否需要进一步评估（类别 III、0、IV、V）或不需要（类别 I 和 II）进行分组时，发现一致性适中（κ=0.53，95%CI 0.52-0.54）。使用所有类别，BI-RADS 评估的观察者内一致性为中等（κ=0.53，95%CI 0.50-0.55），在召回时为显著（κ=0.66，95%CI 0.63-0.70）。关于乳腺密度，观察者间和观察者内的一致性均为显著（κ=0.73，95%CI 0.72-0.74 和 κ=0.69，95%CI 0.68-0.70）。
我们观察到 BI-RADS 评估的观察者内一致性很大，但观察者间的一致性仅为中等。乳腺密度的乳腺 X 光解释的观察者间和观察者内的一致性均为显著。知识的进步应在基于人群的乳腺癌筛查计划中开展教育工作，以减少放射科医生在 BI-RADS 评估解释方面的变异性。
