Henderson Louise M, Benefield Thad, Bowling J Michael, Durham Danielle D, Marsh Mary W, Schroeder Bruce F, Yankaskas Bonnie C
1 Department of Radiology, The University of North Carolina, CB 7515, Chapel Hill, NC 27599-7515.
AJR Am J Roentgenol. 2015 Apr;204(4):903-8. doi: 10.2214/AJR.14.12903.
The purpose of this study was to determine whether the technologist has an effect on the radiologists' interpretative performance of diagnostic mammography.
Using data from a community-based mammography registry from 1994 to 2009, we identified 162,755 diagnostic mammograms interpreted by 286 radiologists and performed by 303 mammographic technologists. We calculated sensitivity, false-positive rate, and positive predictive value (PPV) of the recommendation for biopsy from mammography for examinations performed (i.e., images acquired) by each mammographic technologist, separately for conventional (film-screen) and digital modalities. We assessed the variability of these performance measures among mammographic technologists, using mixed effects logistic regression and taking into account the clustering of examinations within women, radiologists, and radiology practices.
Among the 291 technologists performing conventional examinations, mean sensitivity of the examinations performed was 83.0% (95% CI, 80.8-85.2%), mean false-positive rate was 8.5% (95% CI, 8.0-9.0%), and mean PPV of the recommendation for biopsy from mammography was 27.1% (95% CI, 24.8-29.4%). For the 45 technologists performing digital examinations, mean sensitivity of the examinations they performed was 79.6% (95% CI, 73.1-86.2%), mean false-positive rate was 8.8% (95% CI, 7.5-10.0%), and mean PPV of the recommendation for biopsy from mammography was 23.6% (95% CI, 18.8-28.4%). We found significant variation by technologist in the sensitivity, false-positive rate, and PPV of the recommendation for biopsy from mammography for conventional but not digital mammography (p < 0.0001 for all three interpretive performance measures).
Our results suggest that the technologist has an influence on radiologists' interpretive performance for diagnostic conventional but not digital mammography. Future studies should examine why this difference between modalities exists and determine if similar patterns are observed for screening mammography.
本研究旨在确定乳腺摄影技师是否会对放射科医生的诊断性乳腺钼靶解读表现产生影响。
利用1994年至2009年一个基于社区的乳腺钼靶登记处的数据，我们识别出由286名放射科医生解读、303名乳腺摄影技师操作的162,755份诊断性乳腺钼靶检查。我们分别针对传统（屏-片）和数字成像方式，计算了每位乳腺摄影技师所进行检查（即获取的图像）的乳腺钼靶活检推荐的敏感度、假阳性率和阳性预测值（PPV）。我们采用混合效应逻辑回归，并考虑到女性、放射科医生和放射科实践中检查的聚类情况，评估了这些乳腺摄影技师之间这些性能指标的变异性。
在进行传统检查的291名技师中，所进行检查的平均敏感度为83.0%（95%可信区间，80.8 - 85.2%），平均假阳性率为8.5%（95%可信区间，8.0 - 9.0%），乳腺钼靶活检推荐的平均PPV为27.1%（95%可信区间，24.8 - 29.4%）。对于进行数字检查的45名技师，他们所进行检查的平均敏感度为79.6%（95%可信区间，73.1 - 86.2%），平均假阳性率为8.8%（95%可信区间，7.5 - 10.0%），乳腺钼靶活检推荐的平均PPV为23.6%（95%可信区间，18.8 - 28.4%）。我们发现，对于传统乳腺钼靶而非数字乳腺钼靶，技师在乳腺钼靶活检推荐的敏感度、假阳性率和PPV方面存在显著差异（所有三项解读性能指标的p均<0.0001）。
我们的结果表明，乳腺摄影技师对诊断性传统乳腺钼靶而非数字乳腺钼靶的放射科医生解读表现有影响。未来的研究应探讨不同成像方式之间存在这种差异的原因，并确定在筛查性乳腺钼靶中是否观察到类似模式。
