使用《乳腺影像报告和数据系统（BI-RADS）-超声》第五版（2013年）时，教员与住院医师之间观察者表现的差异
Variability in Observer Performance Between Faculty Members and Residents Using Breast Imaging Reporting and Data System (BI-RADS)-Ultrasound, Fifth Edition (2013).
作者信息
Lee Youn Joo, Choi So Young, Kim Kyu Sun, Yang Po Song
机构信息
Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea.
Department of Radiology, Eulji University Hospital, Daejeon, Republic of Korea.
出版信息
Iran J Radiol. 2016 Jan 9;13(3):e28281. doi: 10.5812/iranjradiol.28281. eCollection 2016 Jul.
BACKGROUND
Ultrasonography (US) is a useful tool for breast imaging, yet is highly operator-dependent.
OBJECTIVES
We evaluated inter-observer variability and performance discrepancies between faculty members and radiology residents when describing breast lesions, by the fifth edition of breast imaging reporting and data system (BI-RADS)-US lexicon, and then attempted to identify whether inter-observer variability could be improved after one education session.
PATIENTS AND METHODS
In total, 50 malignant lesions and 70 benign lesions were considered in our retrospective study. Two faculty members, two senior residents, and two junior residents separately assessed the US images. After the first assessment, the readers received one education session, and then reassessed the images in a random order. Inter-observer variability was measured using the kappa coefficient (κ). Performance discrepancy was evaluated by receiver operating characteristic (ROC) curves.
RESULTS
For the faculty members, fair-to-good agreement was obtained in all descriptors and final assessment, while for residents, poor-to-moderate agreement was obtained. The areas under the ROC curves were 0.78 for the faculty members, 0.59 for the senior residents, and 0.52 for the junior residents, respectively. Diagnostic performance was significantly higher in the faculty members than the senior and junior residents (P = 0.0001 and < 0.0001, respectively). After one education session, the agreement in the final assessment was one level higher in the faculty members and senior residents, yet in the senior residents, the degree of agreement was still only fair. Moreover, in the junior residents, there was no improvement.
CONCLUSION
Investigative assessment of breast US by residents is inadvisable. We recommend continued professional resident training to improve the degree of agreement and performance.
背景
超声检查（US）是乳腺成像的一种有用工具，但高度依赖操作者。
目的
我们依据乳腺影像报告和数据系统（BI-RADS）-US词典第五版，评估了教员与放射科住院医师在描述乳腺病变时的观察者间变异性及表现差异，然后试图确定经过一次培训课程后观察者间变异性是否能得到改善。
患者与方法
在我们的回顾性研究中，共纳入50个恶性病变和70个良性病变。两名教员、两名高年资住院医师和两名低年资住院医师分别对超声图像进行评估。首次评估后，观察者接受一次培训课程，然后以随机顺序重新评估图像。观察者间变异性采用kappa系数（κ）进行测量。通过受试者操作特征（ROC）曲线评估表现差异。
结果
对于教员，在所有描述符和最终评估中均获得了中等至良好的一致性，而对于住院医师，则获得了差至中等的一致性。教员、高年资住院医师和低年资住院医师的ROC曲线下面积分别为0.78、0.59和0.52。教员的诊断表现显著高于高年资和低年资住院医师（P分别为0.0001和<0.0001）。经过一次培训课程后，教员和高年资住院医师在最终评估中的一致性提高了一个等级，但高年资住院医师的一致程度仍仅为中等。此外，低年资住院医师没有改善。
结论
住院医师对乳腺超声进行研究性评估是不可取的。我们建议持续对住院医师进行专业培训，以提高一致性程度和表现。
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