Christensen M, Rødbro P
Dan Med Bull. 1986 Aug;33(4):203-5.
In 185 consecutive, surgical patients with suspected or proven gastrointestinal cancer a preoperative liver scintigraphy was performed; liver metastases were bioptically verified in 28 patients. A seven-class descriptive system was used for blind classification of the scintigraphies according to conferential consensus. Two years later (with the knowledge of the verified incidence of metastatic liver disease) the scintigraphies were reclassified. Considering the verified state of the patients, the latter classification was substantially improved. Probability for metastatic disease increased with more abnormal class label. At best, reliability for a twice interpreted scintigraphy as a binary test to denote the true state of the liver was 92 percent. The best cut-off level for diagnostic purposes yields a probability of 1.00 for an abnormal scintigraphy to denote liver metastases, accepting that 54 percent of patients with liver metastases were not found. For screening purposes, at best, a probability of 0.98 for a normal scintigraphy to denote no liver metastases was noted; thus, 83 percent of patients with normal liver state were missed. In conclusion, we find the liver scintigraphy classification system useful to find or exclude metastases in the test population and we think the procedure applied could be useful as a vehicle to report test results for any imaging modality.
对185例疑似或确诊为胃肠道癌的外科手术患者进行了术前肝脏闪烁扫描；28例患者经活检证实有肝转移。根据专家共识，采用一种七分类描述系统对闪烁扫描图像进行盲法分类。两年后（已知已证实的肝转移疾病发生率），对闪烁扫描图像重新进行分类。考虑到患者的实际情况，后一种分类有了很大改进。转移疾病的可能性随着分类标签异常程度的增加而增大。将两次解读的闪烁扫描图像作为二元检验来判断肝脏真实状况时，其可靠性最高为92%。出于诊断目的，最佳临界值可使异常闪烁扫描图像提示肝转移的概率达到1.00，但有54%的肝转移患者未被发现。用于筛查时，正常闪烁扫描图像提示无肝转移的概率最高为0.98；因此，83%肝脏状态正常的患者被漏诊。总之，我们发现肝脏闪烁扫描分类系统有助于在受试人群中发现或排除转移灶，并且我们认为所采用的方法可用作报告任何成像模态检查结果的一种手段。
