Department of Radiology, MC2026, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA.
Acad Radiol. 2013 Jul;20(7):847-53. doi: 10.1016/j.acra.2013.02.007. Epub 2013 Apr 17.
To evaluate variability in the clinical assessment of breast images, we evaluated scoring behavior of radiologists in a retrospective reader study combining x-ray mammography (XRM) and three-dimensional automated breast ultrasound (ABUS) for breast cancer detection in women with dense breasts.
The study involved 17 breast radiologists in a sequential study design with readers first interpreting XRM-alone followed by an interpretation of combined XRM + ABUS. Each interpretation included a forced Breast Imaging Reporting and Data System scale and a likelihood that the woman had breast cancer. The analysis included 164 asymptomatic patients, including 31 breast cancer patients, with dense breasts and a negative screening XRM. Of interest were interreader scoring variability for XRM-alone, XRM + ABUS, and the sequential effect. In addition, a simulated double reading by pairs of readers of XRM + ABUS was investigated. Performance analysis included receiver operating characteristic analysis, percentile analysis, and κ statistics. Bootstrapping was used to determine statistical significance.
The median change in area under the receiver operating characteristic curve after ABUS interpretation was 0.12 (range 0.04-0.19). Reader agreement was fair with the median interreader κ being 0.26 (0.05-0.48) for XRM-alone and 0.34 (0.11-0.55) for XRM + ABUS (95% confidence interval for the difference in κ, 0.06-0.11). Simulated double reading of XRM + ABUS demonstrated tradeoffs in sensitivity and specificity, but conservative simulated double reading resulted in a significant improvement in both sensitivity (16.7%) and specificity (7.6%) with respect to XRM-alone.
A modest, but statistically significant, increase in interreader agreement was observed after interpretation of ABUS.
为了评估乳腺影像临床评估的变异性，我们在一项回顾性阅读研究中评估了放射科医生的评分行为，该研究结合了 X 射线乳房摄影术（XRM）和三维自动乳腺超声（ABUS），用于检测致密乳腺女性的乳腺癌。
该研究采用顺序研究设计，共有 17 名乳腺放射科医生参与，首先对 XRM 进行解读，然后对 XRM+ABUS 进行解读。每次解读都包括强制使用乳腺影像报告和数据系统（BI-RADS）评分以及女性患有乳腺癌的可能性。该分析包括 164 名无症状患者，其中 31 名患者患有致密乳腺和阴性筛查 XRM 的乳腺癌。感兴趣的是 XRM 单独、XRM+ABUS 和顺序效应的读者评分变异性。此外，还研究了 XRM+ABUS 的读者对模拟双读。性能分析包括接受者操作特征（ROC）分析、百分位数分析和κ统计。使用引导法确定统计显著性。
ABUS 解读后 ROC 曲线下面积的中位数变化为 0.12（范围为 0.04-0.19）。读者间的一致性为中等，XRM 单独的中位数κ值为 0.26（0.05-0.48），XRM+ABUS 的中位数κ值为 0.34（0.11-0.55）（κ值差异的 95%置信区间为 0.06-0.11）。XRM+ABUS 的模拟双读显示出敏感性和特异性之间的权衡，但保守的模拟双读使 XRM 单独的敏感性（16.7%）和特异性（7.6%）显著提高。
在 ABUS 解读后，读者间的一致性略有但具有统计学意义的提高。
