From the Dutch Expert Centre for Screening (LRCB), Wijchenseweg 101, 6538 SW Nijmegen, the Netherlands (T.D.G., D.v.d.W., R.M.P., M.J.M.B.); Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands (W.S.P., J.N., B.K.); Department of Radiology, Amphia Hospital, Breda, the Netherlands (E.T.); Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands (R.M.P.); Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands (M.J.M.B.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.).
Radiology. 2022 Feb;302(2):276-283. doi: 10.1148/radiol.2021210746. Epub 2021 Nov 9.
Background In the Dutch breast cancer screening program, mammograms are preread by technologists to identify possible abnormalities, leading to "warning signals" (an audible and visual alert if the technologist observed an abnormality suspicious for cancer) for radiologists. The best moment to present these warning signals is unknown. Purpose To determine the effect that blinding of technologists' warning signals has on radiologists' early screening outcome measures during interpretation of mammograms. Materials and Methods In this prospective study from September 2017 to May 2019, on alternating months, radiologists were either blinded or nonblinded to the warning signals of the technologist when interpreting screening mammograms for breast cancer. All discrepancies between radiologists and technologists were reviewed during quality assurance sessions every 6 weeks, which could result in secondary recalls. The outcome measures of this study were recall rate, cancer detection rate, and positive predictive value of recall. A χ test was used to test for differences between the two groups. Results During the study period, 109 596 women (mean age, 62 years ± 7 [standard deviation]), including 53 291 in the blinded and 56 305 in the nonblinded groups, participated. The overall recall rate (including secondary recalls) was lower for women in the blinded group than in the nonblinded group (blinded: 1140 of 53 291 women [2.1%], nonblinded: 1372 of 56 305 women [2.4%]; = .001). There was no evidence of cancer detection rate differences between the groups (blinded: 349 of 53 291 women [6.5 per 1000 screening examinations], nonblinded: 360 of 56 305 women [6.4 per 1000 screening examinations]; = .75). The blinded group thus had a higher positive predictive value of recall (blinded: 349 of 1140 women [30.6%], nonblinded: 360 of 1372 women [26.2%]; = .02). Conclusion While interpreting screening mammograms for breast cancer, radiologists blinded to technologists' warning signals had lower recall rates with higher positive predictive values than nonblinded radiologists, yet cancer detection rates seemed to remain unchanged. See also the editorial by Hofvind and Lee in this issue. © RSNA, 2021.
背景 在荷兰乳腺癌筛查计划中，技术员会预先阅读乳房 X 光片，以识别可能的异常情况，从而为放射科医生发出“警告信号”（如果技术员观察到可疑癌症的异常情况，会发出声音和视觉警报）。目前尚不清楚呈现这些警告信号的最佳时机。目的 确定技术员的警告信号对放射科医生在解读乳房 X 光片进行早期筛查时的早期筛查结果指标的影响。材料与方法 本前瞻性研究于 2017 年 9 月至 2019 年 5 月进行，在交替月份，当放射科医生对乳腺癌筛查乳房 X 光片进行解读时，技术员的警告信号对放射科医生进行了盲法或非盲法处理。每 6 周进行一次质量保证会议，审查放射科医生和技术员之间的所有差异，这可能导致二次召回。本研究的结果指标包括召回率、癌症检出率和召回的阳性预测值。使用 χ 检验比较两组之间的差异。结果 在研究期间，共有 109596 名女性（平均年龄 62 岁±7[标准差]）参加了研究，其中盲法组 53291 名，非盲法组 56305 名。与非盲法组相比，盲法组的整体召回率（包括二次召回）较低（盲法组：53291 名女性中有 1140 名[2.1%]，非盲法组：56305 名女性中有 1372 名[2.4%]； =.001）。两组之间的癌症检出率无差异（盲法组：53291 名女性中有 349 名[6.5 例/1000 次筛查检查]，非盲法组：56305 名女性中有 360 名[6.4 例/1000 次筛查检查]； =.75）。盲法组的召回阳性预测值较高（盲法组：1140 名女性中有 349 名[30.6%]，非盲法组：1372 名女性中有 360 名[26.2%]； =.02）。结论 在为乳腺癌进行筛查乳房 X 光片解读时，与非盲法放射科医生相比，盲法放射科医生的召回率较低，阳性预测值较高，但癌症检出率似乎保持不变。也请参阅本期 Hofvind 和 Lee 的社论。 © 2021 RSNA。
