Théberge Isabelle, Guertin Marie-Hélène, Vandal Nathalie, Daigle Jean-Marc, Dufresne Michel-Pierre, Wadden Nancy, Shumak Rene, Samson Caroline, Langlois André, Larocque Isabelle, Perron Linda, Pelletier Éric, Brisson Jacques
Institut national de santé publique du Québec, Quebec City, Québec, Canada; Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Québec, Canada.
Institut national de santé publique du Québec, Quebec City, Québec, Canada.
Can Assoc Radiol J. 2018 Feb;69(1):16-23. doi: 10.1016/j.carj.2017.09.002.
The study sought to examine the association between clinical image quality of mammograms and screening sensitivity.
Four radiologists evaluated the clinical image quality of 374 invasive screen-detected cancers and 356 invasive interval breast cancers for which quality evaluation of screening mammograms could be assessed from cancers diagnosed among participants in the Quebec Breast Cancer Screening Program in 2007. Quality evaluation was based on the Canadian Association of Radiologists accreditation criteria, which are similar to those of the American College of Radiology. The association between clinical quality and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and adjusted sensitivity ratios were obtained through marginal standardization. No institutional review board approval was required.
A proportion of 28% (206 of 730) of screening mammograms had lower overall quality for the majority of assessments. Positioning was the quality attribute that was the most frequently deficient. The 2-year screening sensitivity reached 68%. Sensitivity of screening was not statistically associated with the overall quality (ratio of 2-year sensitivity = 1.03; 95% confidence interval: 0.93-1.15) or with any quality attributes (positioning, exposure, compression, sharpness, artifacts, contrast). Results were similar for the 1-year sensitivity.
Although not all mammograms in the Quebec screening program met the optimum quality required by the Canadian Association of Radiologists or American College of Radiology accreditation, the screening mammograms produced in this population-based organized screening program reached a high enough level of quality so that the remaining variation in quality is too little to impair screening sensitivity.
本研究旨在探讨乳腺钼靶临床图像质量与筛查敏感性之间的关联。
四位放射科医生对374例浸润性筛查发现癌和356例浸润性间期乳腺癌的临床图像质量进行了评估，这些病例来自2007年魁北克乳腺癌筛查项目参与者中诊断出的癌症，其筛查钼靶的质量评估可以进行。质量评估基于加拿大放射科医生协会的认证标准，该标准与美国放射学会的标准相似。通过逻辑回归评估临床质量与筛查敏感性之间的关联。通过边际标准化获得调整后的敏感性和调整后的敏感性比率。无需机构审查委员会批准。
在大多数评估中，28%（730例中的206例）的筛查钼靶总体质量较低。定位是最常出现缺陷的质量属性。两年筛查敏感性达到68%。筛查敏感性与总体质量（两年敏感性比率=1.03；95%置信区间：0.93 - 1.15）或任何质量属性（定位、曝光、压迫、清晰度、伪影、对比度）均无统计学关联。一年敏感性的结果相似。
尽管魁北克筛查项目中的并非所有钼靶都符合加拿大放射科医生协会或美国放射学会认证所需的最佳质量要求，但在这个基于人群的有组织筛查项目中产生的筛查钼靶达到了足够高的质量水平，以至于质量的剩余差异太小，不会损害筛查敏感性。
