Posso Margarita C, Puig Teresa, Quintana Ma Jesus, Solà-Roca Judit, Bonfill Xavier
Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret, 167. Pavelló 18, planta 0, CP: 08025, Barcelona, Spain.
Eur Radiol. 2016 Sep;26(9):3262-71. doi: 10.1007/s00330-015-4175-4. Epub 2016 Jan 8.
To assess the costs and health-related outcomes of double versus single reading of digital mammograms in a breast cancer screening programme.
Based on data from 57,157 digital screening mammograms from women aged 50-69 years, we compared costs, false-positive results, positive predictive value and cancer detection rate using four reading strategies: double reading with and without consensus and arbitration, and single reading with first reader only and second reader only. Four highly trained radiologists read the mammograms.
Double reading with consensus and arbitration was 15 % (Euro 334,341) more expensive than single reading with first reader only. False-positive results were more frequent at double reading with consensus and arbitration than at single reading with first reader only (4.5 % and 4.2 %, respectively; p < 0.001). The positive predictive value (9.3 % and 9.1 %; p = 0.812) and cancer detection rate were similar for both reading strategies (4.6 and 4.2 per 1000 screens; p = 0.283).
Our results suggest that changing to single reading of mammograms could produce savings in breast cancer screening. Single reading could reduce the frequency of false-positive results without changing the cancer detection rate. These results are not conclusive and cannot be generalized to other contexts with less trained radiologists.
• Double reading of digital mammograms is more expensive than single reading. • Compared to single reading, double reading yields a higher proportion of false-positive results. • The cancer detection rate was similar for double and single readings. • Single reading may be a cost-effective strategy in breast cancer screening programmes.
评估在乳腺癌筛查项目中，数字化乳腺钼靶片双人读片与单人读片的成本及健康相关结果。
基于50 - 69岁女性的57157份数字化筛查乳腺钼靶片数据，我们采用四种读片策略比较成本、假阳性结果、阳性预测值和癌症检出率：有共识和仲裁的双人读片、无共识和仲裁的双人读片、仅由第一位阅片者进行的单人读片以及仅由第二位阅片者进行的单人读片。四位训练有素的放射科医生阅读这些乳腺钼靶片。
有共识和仲裁的双人读片比仅由第一位阅片者进行的单人读片贵15%（334341欧元）。有共识和仲裁的双人读片的假阳性结果比仅由第一位阅片者进行的单人读片更频繁（分别为4.5%和4.2%；p < 0.001）。两种读片策略的阳性预测值（分别为9.3%和9.1%；p = 0.812）和癌症检出率相似（每1000次筛查分别为4.6和4.2；p = 0.283）。
我们的结果表明，在乳腺癌筛查中改为单人读片可节省成本。单人读片可降低假阳性结果的频率，而不改变癌症检出率。这些结果并非结论性的，不能推广到放射科医生训练程度较低的其他情况。
• 数字化乳腺钼靶片双人读片比单人读片更昂贵。• 与单人读片相比，双人读片产生的假阳性结果比例更高。• 双人读片和单人读片的癌症检出率相似。• 单人读片可能是乳腺癌筛查项目中一种具有成本效益的策略。
