Boyd N F, Wolfson C, Moskowitz M, Carlile T, Petitclerc M, Ferri H A, Fishell E, Gregoire A, Kiernan M, Longley J D, Simor I S, Miller A B
J Natl Cancer Inst. 1982 Mar;68(3):357-63.
We have examined variation in the interpretation of xeromammograms among radiologists designated to take part in a Canadian multicenter randomized controlled trial of screening for breast cancer. Radiologists read 100 xeromammograms comprising 10 histologically proved cancers, 40 benign abnormalities, and 50 normal films. Radiologists' opinions differed widely on the frequency of suspected or identified cancer. The diagnostic category "suspicion of cancer" or "cancer" was selected by radiologists for 10-55% of the films, and biopsy or aspiration was recommended for 21 to 53% of patients whose films were examined. Agreement on specific diagnostic categories was greatest for the diagnosis of cancer; agreement was least for the diagnosis of benign abnormalities and intermediate for the diagnosis of normality. Known cancers were in general correctly identified. These results indicate a need for development of methods to reduce observer variation in a interpretation of xeromammograms while preserving diagnostic sensitivity and validity. Results also emphasize the importance of developing strategies to ensure quality control in multicenter trials.
我们对参与加拿大一项乳腺癌筛查多中心随机对照试验的放射科医生对干板乳房X线照片的解读差异进行了研究。放射科医生阅读了100张干板乳房X线照片，其中包括10例经组织学证实的癌症、40例良性异常和50例正常片子。放射科医生对疑似或确诊癌症的发生率看法差异很大。对于10%至55%的片子，放射科医生选择了“怀疑癌症”或“癌症”的诊断类别，对于21%至53%接受片子检查的患者建议进行活检或穿刺抽吸。对于癌症诊断，在特定诊断类别上的一致性最高；对于良性异常诊断，一致性最低，对于正常诊断，一致性处于中间水平。已知癌症总体上能被正确识别。这些结果表明，需要开发方法来减少干板乳房X线照片解读中的观察者差异，同时保持诊断敏感性和有效性。结果还强调了制定策略以确保多中心试验质量控制的重要性。
