Elmore J G, Wells C K, Howard D H, Feinstein A R
Department of Internal Medicine, University of Washington, Seattle, USA.
JAMA. 1997 Jan 1;277(1):49-52.
To determine whether mammographic interpretations are biased by the patient's clinical history.
On 2 occasions, separated by a 5-month wash-out period, 10 radiologists read mammograms for the same 100 women, randomly divided into 2 groups of 50. For 1 group, the clinical history was supplied for the first reading and omitted (except for age) for the second reading. This sequence was reversed in the other group. In addition, 5 cases were shown a third time with a deliberately leading sham history.
Selected with stratified random sampling from 3 categories of diagnostic findings (64 had mammographic abnormalities) and from the definitive designation of breast cancer or no breast cancer (18 had breast cancer).
Radiologists' diagnostic accuracy and directional changes in interpretations and recommendations between the 2 readings.
The direction suggested by the history led to small but consistent changes in the interpretations. Overall diagnostic accuracy was not altered, but recommendations were affected for appropriate further diagnostic workup: an alerting history (eg, breast symptoms or family history of breast cancer) increased the number of workups recommended in patients without cancer (P=.01); and a nonalerting history led to fewer recommended workups in the cancer patients (P=.02). The direction of the sham histories led an average of 4 of the 10 radiologists to change previous diagnoses and an average of 1 radiologist to change a previous biopsy recommendation.
Knowledge of the clinical history may alter a radiologist's level of diagnostic suspicion without improving performance in either diagnosis or management recommendations.
确定乳房X光检查的解读是否会受到患者临床病史的影响。
在两次检查中，间隔5个月的洗脱期，10位放射科医生对同一100名女性的乳房X光片进行阅片，这些女性被随机分为两组，每组50人。对于一组，第一次阅片时提供临床病史，第二次阅片时省略（年龄除外）。另一组则顺序相反。此外，5个病例第三次展示时伴有故意引导性的虚假病史。
从3类诊断结果（64例乳房X光检查有异常）以及乳腺癌确诊或无乳腺癌的明确诊断中分层随机抽样选取（18例患有乳腺癌）。
放射科医生的诊断准确性以及两次阅片之间解读和建议的方向性变化。
病史所提示的方向导致解读出现微小但一致的变化。总体诊断准确性未改变，但对适当的进一步诊断检查的建议受到影响：警示性病史（如乳房症状或乳腺癌家族史）增加了无癌症患者建议进行的检查数量（P = 0.01）；而非警示性病史导致癌症患者建议进行的检查减少（P = 0.02）。虚假病史的方向平均使10位放射科医生中的4位改变了先前的诊断，平均使1位放射科医生改变了先前的活检建议。
临床病史的知晓可能会改变放射科医生的诊断怀疑程度，而不会提高诊断或管理建议方面的表现。
