Beam C A, Layde P M, Sullivan D C
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, USA.
Arch Intern Med. 1996 Jan 22;156(2):209-13.
To evaluate the effectiveness of screening mammography by estimating the variability in radiologists' ability to detect breast cancer within the US population of radiologists at mammography centers accredited by the American College of Radiology.
A two-way sample survey design was used as follows. Fifty mammography centers having an American College of Radiology-accredited unit were randomly sampled from across the United States. One hundred eight radiologists from these centers gave blinded interpretation to the same set of 79 randomly selected screening mammograms. The mammograms were from women who had been screened at a large screening center. Before their sampling, these women had been stratified by their breast disease status, established either by biopsy or by 2-year follow-up. Rates of biopsy recommendations were summarized by the mean, median, minimum, maximum, and range of sensitivity and specificity. Overall cancer detection ability was summarized by similar statistics for receiver operating characteristic curve areas. Ninety-five percent lower confidence bounds on the ranges in accuracy measures were established by boo-strapping.
There is a range of at least 40% among US radiologists in their screening sensitivity. There is a range of at least 45% in the rates at which women without breast cancer are recommended for biopsy. As indicated by receiver operating characteristic curve areas, the ability of radiologists to detect cancer mammograms varies by as much as 11%.
Our findings indicate that there is wide variability in the accuracy of mammogram interpretation in the population of US radiologists. Current accreditation programs that certify the technical quality of radiographic equipment and images but not the accuracy of the interpretation given to mammograms may not be sufficient to help mammography fully realize its potential to reduce breast cancer mortality.
通过评估美国放射学会认可的乳腺摄影中心的放射科医生检测乳腺癌能力的变异性，来评价乳腺摄影筛查的有效性。
采用双向抽样调查设计，具体如下。从美国各地随机抽取50个拥有美国放射学会认可单位的乳腺摄影中心。来自这些中心的108名放射科医生对79份随机选取的筛查乳腺造影片进行盲法解读。这些乳腺造影片来自在一个大型筛查中心接受筛查的女性。在抽样之前，这些女性已根据活检或2年随访确定的乳腺疾病状态进行了分层。活检建议率通过敏感性和特异性的均值、中位数、最小值、最大值及范围进行总结。总体癌症检测能力通过受试者操作特征曲线面积的类似统计数据进行总结。通过自助法确定准确性测量范围的95%置信下限。
美国放射科医生的筛查敏感性范围至少为40%。建议对无乳腺癌的女性进行活检的比率范围至少为45%。如受试者操作特征曲线面积所示，放射科医生检测癌症乳腺造影片的能力差异高达11%。
我们的研究结果表明，美国放射科医生群体对乳腺造影片解读的准确性存在很大差异。当前认证项目仅对放射设备和图像的技术质量进行认证，而不对乳腺造影片解读的准确性进行认证，这可能不足以帮助乳腺摄影充分发挥其降低乳腺癌死亡率的潜力。
