Hakim Christiane M, Anello Marie I, Cohen Cathy S, Ganott Marie A, Lu Amy H, Perrin Ronald L, Shah Ratan, Lee Spangler Marion, Bandos Andriy I, Gur David
Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
Department of Radiology, Magee-Womens Hospital of University of Pittsburgh Medical Center, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213.
Acad Radiol. 2014 Apr;21(4):445-9. doi: 10.1016/j.acra.2013.10.015. Epub 2013 Dec 5.
To assess the interaction between the availability of prior examinations and digital breast tomosynthesis (DBT) in decisions to recall a woman during interpretation of mammograms.
Eight radiologists independently interpreted twice 36 mammography examinations, each of which had current and prior full-field digital mammography images (FFDM) and DBT under a Health Insurance Portability and Accountability Act-compliant, institutional review board-approved protocol (written consent waived). During the first reading, three sequential ratings were provided using FFDM only, followed by FFDM + DBT, and then followed by FFDM + DBT + priors. The second reading included FFDM only, then FFDM + priors, and then FFDM + priors + DBT. Twenty-two benign cases clinically recalled, 12 negative/benign examinations (not recalled), and two verified cancer cases were included. Recall recommendations and interaction between the effect of priors and DBT on decisions were assessed (P = .05 significance level) using generalized linear model (PROC GLIMMIX, SAS, version 9.3; SAS Institute, Cary, NC) accounting for case and reader variability.
Average recall rates in noncancer cases were significantly reduced (51%; P < .001) with the addition of DBT and with addition of priors (23%; P = .01). In absolute terms, the addition of DBT to FFDM reduced the recall rates from 0.67 to 0.42 and from 0.54 to 0.27 when DBT was available before and after priors, respectively. Recall reductions were from 0.64 to 0.54 and from 0.42 to 0.33 when priors were available before and after DBT, respectively. Regardless of the sequence in presentation, there were no statistically significant interactions between the effect of availability of DBT and priors (P = .80).
Availability of both priors and DBT are independent primary factors in reducing recall recommendations during mammographic interpretations.
评估在乳腺钼靶解读过程中，既往检查结果的可用性与数字乳腺断层合成（DBT）在决定召回女性患者方面的相互作用。
八位放射科医生独立对36例乳腺钼靶检查进行两次解读，每次检查均有当前及既往的全视野数字乳腺钼靶图像（FFDM）以及DBT图像，遵循符合《健康保险流通与责任法案》且经机构审查委员会批准的方案（无需书面同意）。在第一次解读时，仅使用FFDM依次给出三个连续的评级，随后是FFDM + DBT，接着是FFDM + DBT + 既往检查结果。第二次解读包括仅FFDM，然后是FFDM + 既往检查结果，再然后是FFDM + 既往检查结果 + DBT。纳入了22例临床召回的良性病例、12例阴性/良性检查（未召回）以及2例经证实的癌症病例。使用广义线性模型（PROC GLIMMIX，SAS，9.3版；SAS Institute，卡里，北卡罗来纳州）评估召回建议以及既往检查结果和DBT对决策影响之间的相互作用（显著性水平P = 0.05），同时考虑病例和读者的变异性。
在非癌症病例中，添加DBT和添加既往检查结果后，平均召回率显著降低（分别为51%；P < 0.001和23%；P = 0.01）。从绝对值来看，当DBT在既往检查结果之前和之后可用时，FFDM添加DBT后召回率分别从0.67降至0.42以及从0.54降至0.27。当既往检查结果在DBT之前和之后可用时，召回率分别从0.64降至0.54以及从0.42降至0.33。无论呈现顺序如何，DBT可用性和既往检查结果的影响之间均无统计学显著的相互作用（P = 0.80）。
既往检查结果和DBT的可用性都是在乳腺钼靶解读过程中降低召回建议的独立主要因素。
