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数字化乳腺X线计算机辅助诊断系统临床应用价值的初步探讨
作者姓名:Sun Z  Li S  Xu HM
作者单位:1. 110001,沈阳,中国医科大学附属一院肿瘤外科
2. 110001,沈阳,中国医科大学附属一院放射线科
摘    要:目的 评价数字化乳腺X线摄影的计算机辅助诊断(CAD)系统的临床应用价值。方法 随机抽取120例乳腺癌患者数字化乳腺X线平片,比较放射科医师应用CAD前后诊断乳腺癌敏感度的差异。详细记录患者乳腺密度、肿块直径、钙化直径、是否为毛刺样肿块、病理类型等特点,探讨其对CAD辅助放射科医师诊断乳腺癌敏感度的影响。结果 放射科医师应用CAD前后诊断乳腺癌的敏感度分别为74.2%和89.2%(χ^2=37.628,P=0.000)。乳腺密度(χ2=7.352,P=0.007)、钙化直径(χ^2=10.549,P=0.014)和病理类型(χ^2=13.751,P=0.003)对CAD提高放射科医师诊断敏感度的影响具有重要意义。CAD可以显著降低致密型乳腺内病变、直径小的钙化灶、导管内癌及浸润性导管癌的漏诊率;但对其余各种病变的辅助诊断价值有限。放射科医师漏诊的原因主要有:大量阅片过程中,视觉疲劳、注意力降低而忽略了一些微小的病灶(Ⅰ型漏诊);无典型的恶性肿块或钙化(Ⅱ型漏诊)。应用CAD可以有效地避免Ⅰ型漏诊,但对Ⅱ型漏诊的帮助意义较小。结论 基于数字化乳腺X摄影的CAD系统对提高放射科医师诊断乳腺癌的敏感度有较大帮助,但它仅能作为放射科医生的诊断助手,而不能对乳腺疾病的良恶性作出判断。

关 键 词:临床应用价值  计算机辅助诊断系统  数字化  初步探讨  放射科医师  乳腺X线摄影  医师诊断  浸润性导管癌  乳腺密度  病理类型  乳腺癌患者  敏感度  致密型乳腺  CAD系统  乳腺X摄影  放射科医生  X线平片  重要意义  导管内癌  诊断价值

Clinical value of computer aided detection system in direct full-field digital mammography: a preliminary evaluation
Sun Z,Li S,Xu HM.Clinical value of computer aided detection system in direct full-field digital mammography: a preliminary evaluation[J].National Medical Journal of China,2005,85(24):1692-1695.
Authors:Sun Zhe  Li Shu  Xu Hui-mian
Institution:Department of Oncologic Surgery, First Affiliated Hospital, China Medical University, Shenyang 110001, China.
Abstract:OBJECTIVE: To study the clinical value of computer aided detection (CAD) in direct full-field digital mammography. METHODS: 480 digital mammograms of 120 patients with pathologically proved breast cancer were randomly selected and interpreted by an expert radiologist without knowing the pathologic diagnosis, then analyzed by CAD system, and finally read by the radiologist again to make the final diagnosis. The sensitivity for breast cancer detection of the radiologist in diagnosis of breast cancer was calculated before and after using CAD. Data of the breast density, diameters of mass and calcification, being spiculate or not, and pathology of each case were reviewed to determine how they impacted on the improvement of sensitivity with the assistance of CAD. RESULTS: The sensitivity for breast cancer detection by the radiologist before using CAD was 74.2%, significantly lower than that after using CAD (89.2%, chi(2) = 37.628, P = 0.000). Breast density (chi(2) = 7.352, P = 0.007), diameter of calcification (chi(2) = 10.549, P = 0.014) and pathologic pattern (chi(2) = 13.751, P = 0.003) were highly correlated with the improvement of sensitivity. Use of CAD might overcome type 1 missed diagnosis, and not type 2 missed diagnosis. CONCLUSION: Computer-aided detection helps radiologist improve their diagnostic accuracy of breast cancer, however, is not capable of differentiating benign from malignant lesions.
Keywords:Diagnosis  computer assisted  Breast neoplasms  Full-field digital mammography
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