Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
Cancer Research Institute, Seoul National University, Seoul, South Korea.
Eur Radiol. 2021 May;31(5):2845-2855. doi: 10.1007/s00330-020-07424-1. Epub 2020 Oct 30.
To evaluate the degree of variability in computer-assisted interpretation of low-dose chest CTs (LDCTs) among radiologists in a nationwide lung cancer screening (LCS) program, through comparison with a retrospective interpretation from a central laboratory.
Consecutive baseline LDCTs (n = 3353) from a nationwide LCS program were investigated. In the institutional reading, 20 radiologists in 14 institutions interpreted LDCTs using computer-aided detection and semi-automated segmentation systems for lung nodules. In the retrospective central review, a single radiologist re-interpreted all LDCTs using the same system, recording any non-calcified nodules ≥ 3 mm without arbitrary rejection of semi-automated segmentation to minimize the intervention of radiologist's discretion. Positive results (requiring additional follow-up LDCTs or diagnostic procedures) were initially classified by the lung CT screening reporting and data system (Lung-RADS) during the interpretation, while the classifications based on the volumetric criteria from the Dutch-Belgian lung cancer screening trial (NELSON) were retrospectively applied. Variabilities in positive rates were assessed with coefficients of variation (CVs).
In the institutional reading, positive rates by the Lung-RADS ranged from 7.5 to 43.3%, and those by the NELSON ranged from 11.4 to 45.0% across radiologists. The central review exhibited higher positive rates by Lung-RADS (20.0% vs. 27.3%; p < .001) and the NELSON (23.1% vs. 37.0%; p < .001), and lower inter-institution variability (CV, 0.30 vs. 0.12, p = .003 by Lung-RADS; CV, 0.25 vs. 0.12, p = .014 by the NELSON) compared to the institutional reading.
Considerable inter-institution variability in the interpretation of LCS results is caused by different usage of the computer-assisted system.
• Considerable variability existed in the interpretation of screening LDCT among radiologists partly from the different usage of the computerized system. • A retrospective reading of low-dose chest CTs in the central laboratory resulted in reduced variability but an increased positive rate.
通过与中心实验室的回顾性解读进行比较，评估全国性肺癌筛查（LCS）项目中放射科医生对低剂量 CT（LDCT）的计算机辅助解读的变异性程度。
对一项全国性 LCS 项目中的连续基线 LDCT（n=3353）进行了研究。在机构阅读中，14 家机构的 20 名放射科医生使用计算机辅助检测和半自动化结节分割系统解读 LDCT。在回顾性中心审查中，一名放射科医生使用相同的系统重新解读所有 LDCT，记录任何非钙化结节≥3mm，不任意拒绝半自动化分割，以尽量减少放射科医生判断的干预。阳性结果（需要进一步进行 LDCT 随访或诊断程序）在解读过程中最初按照肺 CT 筛查报告和数据系统（Lung-RADS）进行分类，而基于荷兰-比利时肺癌筛查试验（NELSON）体积标准的分类则是回顾性应用的。通过变异系数（CV）评估阳性率的变异性。
在机构阅读中，Lung-RADS 的阳性率范围为 7.5%至 43.3%，NELSON 的阳性率范围为 11.4%至 45.0%，不同放射科医生之间存在差异。中心审查结果显示，Lung-RADS（20.0%对 27.3%；p<0.001）和 NELSON（23.1%对 37.0%；p<0.001）的阳性率更高，机构间的变异性更低（Lung-RADS 的变异系数为 0.30 对 0.12，p=0.003；NELSON 的变异系数为 0.25 对 0.12，p=0.014）。
在 LCS 结果的解读中，由于计算机辅助系统的使用不同，存在相当大的机构间变异性。
放射科医生在解读筛查性 LDCT 时存在相当大的差异，部分原因是计算机化系统的使用不同。
中心实验室对低剂量胸部 CT 的回顾性解读降低了变异性，但增加了阳性率。
