Elmore J G, Wells C K, Howard D H
Department of Internal Medicine, University of Washington School of Medicine, Seattle, USA.
J Womens Health. 1998 May;7(4):443-9. doi: 10.1089/jwh.1998.7.443.
This study was designed to determine if radiologists' experience in mammography is associated with their performance in correctly interpreting mammograms. Study mammograms (n = 150) were chosen by stratified random sampling from those interpreted as normal, abnormal-benign or abnormal-suspicious for cancer, with oversampling of cancer cases. Ten radiologists who had varying amounts of experience were asked to read the mammograms. Associations between the levels of the radiologists' experience and their accuracy in reading mammograms were assessed. Significant associations (p < 0.05) were found between the frequency of immediate workup recommendations in cancer patients and obtaining feedback, total lifetime mammograms read, number of mammography continuing medical education (CME) credits, and practice type. Radiologists with more experience also noted smaller cancer lesions. However, these experience variables were also associated with increased workup recommendations in the noncancer patients (p < 0.10). In multivariable analysis, obtaining regular feedback and the total lifetime number of mammograms read were independently associate with the number of times immediate workup was recommended in the cancer cases. The most experienced radiologist had the highest sensitivity in diagnosing breast cancer. Further studies are needed to assess whether the current requirements of the U.S. Food and Drug Administration for radiologists who read mammograms ensure acceptable levels of accuracy.
本研究旨在确定放射科医生的乳腺钼靶检查经验是否与其正确解读乳腺钼靶片的表现相关。通过分层随机抽样从解读为正常、良性异常或可疑癌症的乳腺钼靶片中选取研究用乳腺钼靶片（n = 150），对癌症病例进行了过度抽样。邀请了10位经验各异的放射科医生阅读这些乳腺钼靶片。评估了放射科医生的经验水平与其阅读乳腺钼靶片准确性之间的关联。在癌症患者中立即进行检查建议的频率与获得反馈、阅读的乳腺钼靶片总数量、乳腺钼靶继续医学教育（CME）学分数量以及执业类型之间发现了显著关联（p < 0.05）。经验更丰富的放射科医生还能发现更小的癌症病灶。然而，这些经验变量也与非癌症患者中更多的检查建议相关（p < 0.10）。在多变量分析中，获得定期反馈和阅读的乳腺钼靶片总数量与癌症病例中立即进行检查建议的次数独立相关。经验最丰富的放射科医生在诊断乳腺癌方面具有最高的敏感性。需要进一步研究来评估美国食品药品监督管理局对阅读乳腺钼靶片的放射科医生的当前要求是否能确保可接受的准确性水平。
