Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, China.
Chin Med J (Engl). 2013 Jan;126(1):68-71.
Early detection with screening mammography can potentially reduce breast cancer mortality rates. To achieve an efficient screening, a peer review system provides a compensatory double-check reviewing, will hopefully to prevent the omission of detectable lesions and reduce unnecessary recall.
In 2009, 4643 initial mammographic screenings reported by 74 screening radiologists had negative results with a recall rate of less than 5%. In the same year, 2538 initial positives screened by 18 screening radiologists had a recall rate higher than 15%. Those 7181 randomized screenings were evenly distributed for reassessment by 39 reviewing radiologists. The disagreement of assessments between the reviewers and screening radiologists was recorded. The differential rate was defined as the number of the disagreements divided by the number of audited films reviewed by a screening radiologist. The equality of the differential rates for each screening radiologists with negative and positive assessments was compared by a Chi-square test. The performance of the 39 auditors was measured by the Kendall's tau statistic. P values less than 0.05 were considered statistically significant.
The mean differential rate for screening radiologists of negative assessments was 6.7% (P = 0.588), while 35.0% for positive assessments were significant (P < 0.001). The result indicated that most of the initial negative assessments reported by the screening radiologists were generally accepted by the reviewers but not the positive assessments. With respect to the 39 reviewers, there was no significant evidence for the association of the difference rates between negative and positive assessments. Nine reviewers were found to have their differential rate for negative and positive assessments larger than the average of the population. Eleven reviewers were found to have their differential rates smaller than the average for both. Thirteen reviewers had their differential rates smaller than the average for negative assessments but larger than the average for positive assessments. The opposite condition was found for six reviewers. The Kendall's tau statistic was 0.038 (P = 0.735).
Reviewers usually agreed with the opinion of the initial screening doctors who reported negative findings. Therefore, a 5% recall rate as the lower range of reviewing negatives may be still too high. The recall rate of more than 15% was significantly related to improper interpretation, especially when the differential rate is 25% or higher, a warning to the underperforming screening radiologist is recommended. An ideal reviewer should interpret films independently. Reviewers with tendencies to be followers or contrarians should not be enrolled in the reviewing system.
早期筛查乳房 X 光摄影术可以降低乳腺癌死亡率。为了实现高效的筛查，同行评审系统提供了补偿性的二次检查，有望防止漏诊可检测到的病变并减少不必要的召回。
2009 年，74 名筛查放射科医生报告了 4643 例初始乳房 X 光筛查，结果均为阴性，召回率低于 5%。同年，18 名筛查放射科医生筛查了 2538 例初筛阳性，召回率高于 15%。这些 7181 次随机筛查结果由 39 名审查放射科医生平均分配进行重新评估。记录审查员与筛查放射科医生评估之间的意见分歧。差异率定义为分歧数除以筛查放射科医生审查的受审影片数。通过卡方检验比较阴性和阳性评估的每位筛查放射科医生的差异率是否相等。使用 Kendall's tau 统计量衡量 39 名审核员的表现。P 值小于 0.05 被认为具有统计学意义。
阴性评估的筛查放射科医生的平均差异率为 6.7%（P = 0.588），而阳性评估的差异率为 35.0%，差异具有统计学意义（P < 0.001）。结果表明，筛查放射科医生报告的大多数初始阴性评估结果通常被审查员接受，但阳性评估结果未被接受。对于 39 名审查员，没有证据表明阴性和阳性评估之间的差异率存在关联。发现有 9 名审查员的阴性和阳性评估差异率大于人群的平均值。还发现有 11 名审查员的阴性和阳性评估差异率均小于平均值。有 13 名审查员的阴性评估差异率小于平均值，但阳性评估差异率大于平均值。相反的情况则适用于 6 名审查员。Kendall's tau 统计量为 0.038（P = 0.735）。
审查员通常同意报告阴性结果的初始筛查医生的意见。因此，5%的召回率作为审查阴性的下限可能仍然过高。召回率超过 15%与不当解释显着相关，尤其是当差异率为 25%或更高时，建议向表现不佳的筛查放射科医生发出警告。理想的审查员应该独立解读影片。倾向于跟风或持相反意见的审查员不应被纳入审查系统。
