评估阅片者在肺癌CT筛查的随访过程中影像诊断结果的变异性

目的检测阅片者对于CT筛查中肺内结节灶是否变化的诊断一致性,并评估对进一步随访建议的变异性。材料与方法本实验所有对象来自国家肺部筛检试验(NLST)     

阅片者自身及阅片者之间肿瘤CT测量的差异

正目的探讨多个器官的、大小及边缘锐利度不同肿瘤的CT测量差异,阅片者包括不同经验水平的医师,这种情形见于日常临床工作。方法本回顾性研究经伦理委员会批     

美国医师年度阅片量对乳腺X线筛查的影响

目的调查美国放射科医师的阅片量是否对乳腺X线筛查能力产生影响。材料与方法乳腺癌监管联合会(BCSC)的120名放射学专家自2002年—2006年间共阅读     

胸片中肺癌的计算机辅助检测(CAD):对阅片者绩效的影响

目的评价在胸片发现的早期肺癌中,计算机辅助检测(CAD)是如何影响阅片者的绩效。材料与方法经伦理委员会批准,本回顾性研究包括46例CT发现并经组织学证实     

乳腺摄片筛查双读片者意见分歧时小组协商讨论可最大限度地提高乳腺癌检出率：爱尔兰全国乳腺筛查计划的经验

目的 评价爱尔兰全国乳腺筛查（NBSP）第一个6年计划中，乳腺摄片筛查意见分歧时小组协商讨论的敏感性、安全性和总体效果。方法 参加NBSP的妇女签署资料使用的书面知情同意书，研究获地方伦理委员会批准。接受研究的人群包括2000--2005年间在东爱尔兰2个乳腺筛查中心之一接受了首次乳腺摄片筛查的NBSP妇女。     

肺小结节：多层CT在肺癌筛查中容积测量的可重复性

目的评价肺癌筛查研究中使用自动化计算软件对在体肺内小结节容积测量的可重复性。方法本研究经机构伦理委员会批准,并获得所有参与者的书面知情同意书。数据由意大利多中心肺（癌）发现计划收集,此项目为一随机对照肺癌筛查研究。研究分析了在米兰国家肿瘤研究所完成的首批连续1236例的初次CT检查。在登记的全部参与者中．只考虑那些在之后的3个月进行低剂量CT复查并且至少有一个体积超过60mm,（直径≥4．8mm）的不确定结节的病人。     

对腔内fly-through CT结肠成像中的粪便标记进行彩色编码容积再现后对阅片效果的影响

本研究经伦理审查委员会批准并获得病人知情同意。研究评价腔内三维fly-through CT结肠成像时对粪便标记进行彩色编码技术的价值,并评价其对阅片效果的影响。     

在肺癌筛查人群中修正冠状动脉钙化评分与FEV1、肺气肿的相互关系和预后价值:MILD试验

目的评估修正冠状动脉钙化(mCAC)评分与第1秒末呼气量(FEV1)和肺气肿的关系,以及这些因素在肺癌病人CT筛查试验中与各种原因所致的死亡和心血管意外(CVE)的关系。材料与方法此研究得到机构审查委员会批     

采用数字乳腺摄影后假阳性结果减低:西班牙乳腺癌人群的4种筛查程序分析

目的评价引入数字乳腺摄影后,对西班牙乳腺癌人群4种筛查程序中大样本受检妇女召回率、检出率、假阳性率与有创处理率的影响。材料与方法研究由伦理委员会     

上盂唇前后撕裂:多层CT关节成像诊断的准确度及阅片者间可信度

目的评估多层CT关节成像对上盂唇前后(SLAP)损伤的诊断及分类的准确性与阅片者间的可信度。材料与方法本研究经机构审查委员会批准并获得知情同意。回顾性     

Pulmonary nodules detected at lung cancer screening: interobserver variability of semiautomated volume measurements

PURPOSE: To retrospectively determine interobserver variability of semiautomated volume measurements of pulmonary nodules and the potential reasons for variability. MATERIALS AND METHODS: The Dutch-Belgian lung cancer screening trial (NELSON) is a lung cancer screening study that includes men between the ages of 50 and 75 years who are current or former heavy smokers. The NELSON project was approved by the Dutch Ministry of Health and the ethics committee of each participating hospital. Informed consent was obtained from all participants. For this study, the authors evaluated 1200 consecutive low-dose computed tomographic (CT) scans of the chest obtained during the NELSON project and identified subjects who had at least one 50-500-mm(3) nodule. One local and one central observer independently evaluated the scans and measured the volume of any detected nodule by using semiautomated software. Noncalcified solid nodules with volumes of 15-500 mm(3) were included in this study if they were fully surrounded by air (intraparenchymal) and were detected by both observers. The mean volume and the difference between both measurements were calculated for all nodules. Intermeasurement agreement was assessed with the Spearman correlation coefficient. Potential reasons for discrepancies were assessed. RESULTS: There were 232 men (mean age, 60 years; age range, 52-73 years) with 430 eligible nodules (mean volume, 77.8 mm(3); range, 15.3-499.5 mm(3)). Interobserver correlation was high (r = 0.99). No difference in volume was seen for 383 nodules (89.1%). Discrepant results were obtained for 47 nodules (10.9%); in 16 cases (3.7%), the discrepancy was larger than 10%. The most frequent cause of variability was incomplete segmentation due to an irregular shape or irregular margins. CONCLUSION: In a minority (approximately 11%) of small solid intraparenchymal nodules, semiautomated measurements are not completely reproducible and, thus, may cause errors in the assessment of nodule growth. For small or irregularly shaped nodules, an observer should check the segmentation shown by the program.     

低剂量螺旋CT筛选检查早期肺癌的初步研究

目的 评价低剂量螺旋CT筛选检查（简称筛检）对肺癌高危险人群早期肺癌的检出率。方法 对无症状300例体检者胸片及CT进行前瞻性研究，纳入标准为年龄45岁以上，吸烟10年包（10年以上，每日1包）以上，或既往有慢性阻塞性肺疾病病史，以前无癌症史，身体状况适合手术治疗者，低剂量CT扫描采用Philip SR 7000及GE LightSpeed Plus多层面CT扫描机。图像由2位放射医师在工作站显示器上以电影显示方式观察，存储至影像存储与传输系统（PACS）。结果 低剂量CT共检出56例（19％）非钙化结节（其中恶性4例），胸片检出9例（3％）（其中恶性3例），均为1期病变。低剂量CT检出叶支气管或段支气管病变9例（3％），其中早期中央型肺癌例（1％），胸片均未检出，胸片、CT对肺癌筛检的敏感度分别为43％、100％，特异度分别为89％、80％。结论 初步筛检结果表明低剂量螺旋CT明显提高了对肺内非钙化小结节及支气管细微病变的检出，可检出早期肺癌。     

CT screening for lung cancer: significance of diagnoses in its baseline cycle

PURPOSE: The aim of this study was to assess the significance of Stage I diagnoses of lung cancer in the baseline cycle of screening for this disease, with special reference to the potential for overdiagnosis. METHODS: We reviewed all 69 cases of Stage I lung cancer diagnosis resulting from our baseline CT screening. Among these 69 cases of lung cancer, 24 presented as solid, 30 as part-solid, and 15 as nonsolid nodules. The extent to which these represented genuine malignancy was assessed by a panel of experts on lung pathology, and the "aggressiveness" of these cases was addressed by the criterion of the tumor's volume doubling time being less than 400 days. RESULTS: The expert panel confirmed all 69 cases as representing genuine malignancy. Among the 69 cases without evidence of metastases, the proportion that satisfied the aggressiveness criterion was 60/69=87%. The corresponding proportions by presentation as solid, part-solid, and nonsolid nodule were 23/24 (96%), 27/30 (90%), and 10/15 (67%), respectively. CONCLUSIONS: In baseline CT screening for lung cancer, overdiagnosis of the disease is uncommon, with cases presenting as a nonsolid nodule a possible exception to this.     

CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans

PURPOSE: To assess the frequency with which a particular, possibly optimal work-up of noncalcified nodules less than 5.0 mm in diameter identified on initial computed tomographic (CT) images at baseline screening leads to a diagnosis of malignancy prior to first annual repeat screening, compared with a possibly optimal work-up of larger nodules. MATERIALS AND METHODS: Two series of baseline CT screenings in high-risk people were retrospectively reviewed. The first series (n = 1,000) was performed in 1993-1998; the second (n = 1,897), in 1999-2002. In each series, cases in which the largest noncalcified nodule detected was less than 5.0 mm in diameter and those in which it was 5.0-9 mm were reviewed to determine whether diagnostic work-up prior to first annual repeat screening showed or would have shown nodule growth and led or would have led to a diagnosis based on biopsy or surgical specimens. RESULTS: The frequency with which malignancy was or could have been diagnosed when the largest noncalcified nodule was less than 5.0 mm in diameter was 0 of 378, whereas when the largest noncalcified nodule was 5.0-9 mm in diameter, the frequency was 13 or 14 of 238. If persons with only nodules smaller than 5.0 mm had merely been referred for first annual repeat screening without immediate further work-up, the referrals for such work-up would have been reduced by 54% (from 817 [28%] to 385 [13%] of 2,897). CONCLUSION: In modern CT screening for lung cancer at baseline, detected noncalcified nodules smaller than 5.0 mm in diameter do not justify immediate work-up but only annual repeat screening to determine whether interim growth has occurred.     

Variations in screening outcome among pairs of screening radiologists at non-blinded double reading of screening mammograms: a population-based study

Objectives

Substantial inter-observer variability in screening mammography interpretation has been reported at single reading. However, screening results of pairs of screening radiologists have not yet been published. We determined variations in screening performances among pairs of screening radiologists at non-blinded double reading.

Methods

We included pairs of screening radiologists with at least 7,500 screening examinations per pair, obtained between 1997 and 2011. During 2-year follow-up, breast imaging reports, surgical reports and pathology results were collected of all referred women and interval cancers. Referral rate, cancer detection rate, positive predictive value and sensitivity were calculated for each pair.

Results

A total of 310,906 screening mammograms, read by 26 pairs of screening radiologists, were included for analysis. The referral rate ranged from 1.0 % (95 % CI 0.8 %–1.2 %) to 1.5 % (95 % CI 1.3 %–1.8 %), the cancer detection rate from 4.0 (95 % CI 2.8–5.2) to 6.3 (95 % CI 4.5–8.0) per 1,000 screens. The programme sensitivity and positive predictive value of referral ranged from 55.1 % (95 % CI 45.1 %–65.1 %) to 81.5 % (95 % CI 73.4 %–89.6 %) and from 28.7 % (95 % CI 20.8 %–36.6 %) to 49.5 % (95 % CI 39.7 %–59.3 %), respectively.

Conclusion

We found significant variations in screening outcomes among pairs of screening radiologists at non-blinded double reading. This stresses the importance of monitoring screening results on a local scale.

Key Points

? Substantial inter-observer variability in screening mammography interpretation is known at single reading ? Population-based study showed significant variations in outcomes among pairs of screening radiologists ? Local monitoring and regular feedback are important to optimise screening outcome     

Single reading with computer-aided detection and double reading of screening mammograms in the United Kingdom National Breast Screening Program

PURPOSE: To retrospectively determine if the use of a computer-aided detection (CAD) system can improve the performance of single reading of screening mammograms to match that of double reading in the United Kingdom. MATERIALS AND METHODS: Local research ethics committee approval was obtained; informed consent was not required. This study included a sample of 10 267 mammograms obtained in women aged 50 years or older who underwent routine screening at one of two breast screening centers in 1996. Mammograms that were double read in 1996 were randomly allocated to be re-read by eight different radiologists using CAD. The cancer detection and recall rates from double reading and single reading with CAD were compared. Statistical significance and confidence intervals were calculated with the McNemar test to account for the matched nature of the data. RESULTS: Single reading with CAD led to a cancer detection rate that was significantly (P = .02) higher than that achieved with double reading: 6.5% more cancers were detected by means of single reading with CAD than by means of double reading. However, the recall rate was higher for single reading with CAD than for double reading (8.6% vs 6.5%, respectively; P < .001). This was equivalent to relative increases of 15% and 32% in the cancer detection and recall rates, respectively. CONCLUSION: Single reading with CAD leads to an improved cancer detection rate and an increased recall rate.