Hakim Christiane M, Catullo Victor J, Chough Denise M, Ganott Marie A, Kelly Amy E, Shinde Dilip D, Sumkin Jules H, Wallace Luisa P, Bandos Andriy I, Gur David
From the Department of Radiology, Division of Breast Imaging, Magee-Womens Hospital of UPMC, 300 Halket St, Pittsburgh, PA 15213 (C.M.H., V.J.C., D.M.C., M.A.G., A.E.K., D.D.S., J.H.S., L.P.W.); Department of Biostatistics, Graduate School of Public Health (A.I.B.), and Department of Radiology, Division of Research Imaging (D.G.), University of Pittsburgh, Pittsburgh, Pa.
Radiology. 2015 Jul;276(1):65-72. doi: 10.1148/radiol.15142009. Epub 2015 Mar 13.
To assess the effect of and interaction between the availability of prior images and digital breast tomosynthesis (DBT) images in decisions to recall women during mammogram interpretation.
Verbal informed consent was obtained for this HIPAA-compliant institutional review board-approved protocol. Eight radiologists independently interpreted twice deidentified mammograms obtained in 153 women (age range, 37-83 years; mean age, 53.7 years ± 9.3 [standard deviation]) in a mode by reader by case-balanced fully crossed study. Each study consisted of current and prior full-field digital mammography (FFDM) images and DBT images that were acquired in our facility between June 2009 and January 2013. For one reading, sequential ratings were provided by using (a) current FFDM images only, (b) current FFDM and DBT images, and (c) current FFDM, DBT, and prior FFDM images. The other reading consisted of (a) current FFDM images only, (b) current and prior FFDM images, and (c) current FFDM, prior FFDM, and DBT images. Fifty verified cancer cases, 60 negative and benign cases (clinically not recalled), and 43 benign cases (clinically recalled) were included. Recall recommendations and interaction between the effect of prior FFDM and DBT images were assessed by using a generalized linear model accounting for case and reader variability.
Average recall rates in noncancer cases were significantly reduced with the addition of prior FFDM images by 34% (145 of 421) and 32% (106 of 333) without and with DBT images, respectively (P < .001). However, this recall reduction was achieved at the cost of a corresponding 7% (23 of 345) and 4% (14 of 353) reduction in sensitivity (P = .006). In contrast, availability of DBT images resulted in a smaller reduction in recall rates (false-positive interpretations) of 19% (76 of 409) and 26% (71 of 276) without and with prior FFDM images, respectively (P = .001). Availability of DBT images resulted in 4% (15 of 338) and 8% (25 of 322) increases in sensitivity, respectively (P = .007). The effects of the availability of prior FFDM images or DBT images did not significantly change regardless of the sequence in presentation (P = .81 and P = .47 for specificity and sensitivity, respectively).
The availability of prior FFDM or DBT images is a largely independent contributing factor in reducing recall recommendations during mammographic interpretation.
评估在乳腺钼靶检查解读过程中，既往影像的可用性与数字乳腺断层合成（DBT）影像对召回女性决策的影响及相互作用。
对于本符合健康保险流通与责任法案（HIPAA）的机构审查委员会批准的方案，已获得口头知情同意。8名放射科医生以病例平衡的完全交叉研究模式，对153名女性（年龄范围37 - 83岁；平均年龄53.7岁±9.3[标准差]）的两次去识别化乳腺钼靶影像进行独立解读。每项研究包括2009年6月至2013年1月在我们机构获取的当前及既往全视野数字乳腺钼靶（FFDM）影像和DBT影像。对于一次解读，依次使用（a）仅当前FFDM影像、（b）当前FFDM和DBT影像、（c）当前FFDM、DBT和既往FFDM影像进行评分。另一次解读包括（a）仅当前FFDM影像、（b）当前和既往FFDM影像、（c）当前FFDM、既往FFDM和DBT影像。纳入了50例经证实的癌症病例、60例阴性和良性病例（临床未召回）以及43例良性病例（临床召回）。通过使用考虑病例和阅片者变异性的广义线性模型，评估召回建议以及既往FFDM和DBT影像效果之间的相互作用。
在非癌症病例中，添加既往FFDM影像后，平均召回率显著降低，无DBT影像时降低34%（421例中的145例），有DBT影像时降低32%（333例中的106例）（P <.001）。然而，这种召回率的降低是以相应的敏感性降低7%（345例中的23例）和4%（353例中的14例）为代价的（P =.006）。相比之下，DBT影像的可用性导致召回率（假阳性解读）降低幅度较小，无既往FFDM影像时降低19%（409例中的76例），有既往FFDM影像时降低26%（276例中的71例）（P =.001）。DBT影像的可用性分别使敏感性提高4%（338例中的15例）和8%（322例中的25例）（P =.007）。既往FFDM影像或DBT影像可用性的影响，无论呈现顺序如何，均无显著变化（特异性和敏感性的P值分别为.81和.47）。
既往FFDM或DBT影像的可用性在乳腺钼靶检查解读过程中，是降低召回建议的一个基本独立的影响因素。
