目的:分析奥斯陆断层合成筛查试验(OTST)中双读数字乳房断层合成(DBT)与数字乳房X线摄影(DM)的不一致和假阴性,包括阅读时间,并在回顾性读者研究中将其重新分类为遗漏,最小的标志,或真正的底片。
方法:比较双读数DBT与DBT的前瞻性OTSTDM有四个平行臂的配对设计:DM,DM+计算机辅助检测,DBT+DM,和DBT+合成乳房X线照相术。八名放射科医生使用5点量表分批解释图像。自动记录阅读时间。一项回顾性读者研究,包括四名放射科医生,将至少有一个假阴性评分的筛查癌症和间隔癌症的筛查检查分类为阴性,非特定的最小符号,显著的最小标志,并错过;后两组被定义为“可操作”。\“统计数据包括卡方,费希尔的精确,McNemar\'s,和Mann-WhitneyU测试。
结果:屏幕检测到的癌症的不一致率(一个读者错过的癌症)总体相当(DBT(31%[71/227])和DM(30%[52/175]),p=.81),DBT显着降低针状癌症(DBT,19%[20/106]vs.DM,36%[38/106],p=.003),但很高(28/49=57%,p=0.001)用于仅DBT检测到的针状癌症。读者的阅读时间和敏感度各不相同。在46%(13/28)的情况下,仅检测到假阴性DBT的针状癌症的阅读时间短于真阴性。回顾性评估将以下DBT考试分类为“可操作”:两位读者错过了三项,两种模式检测到95%(39/41)的不一致癌症,所有30种不和谐的DBT癌症,25%(13/51)的间隔癌。
结论:DBT和DM的不一致率总体相当,DBT显着降低针状癌症,但对于仅DBT检测到的针状病变较高。大多数假阴性筛查检测到的DBT被归类为“可操作”。\"
结论:对奥斯陆断层合成筛查试验的假阴性解释的回顾性评估表明,在筛查时可以检测到大多数不一致和几种间隔癌症。这突显了现代基于AI的阅读辅助工具和分类的潜力,因为大批量筛查是一项艰巨的任务。
结论:•数字乳腺断层合成(DBT)筛查比数字乳腺摄影筛查更敏感,特异性更高,但是大量DBT筛查是一项艰巨的任务,可能导致读者之间的不一致率很高。•独立双读DBT筛查具有与数字乳腺X线照相术相当的总体不一致率,在两种模式下看到的毛刺性肿块较低,仅在DBT上见的小针状癌更高。•在奥斯陆断层合成筛查试验中,几乎所有不一致的数字乳腺断层合成检测到的癌症(74个中的72个)和25%(51个中的13个)的间隔癌症都被回顾性分类为可行的,并且可以被读者检测到。
OBJECTIVE: To analyze discordant and false-negatives of double reading digital breast tomosynthesis (DBT) versus digital mammography (DM) including reading times in the Oslo Tomosynthesis Screening
Trial (OTST), and reclassify these in a retrospective reader
study as missed, minimal sign, or true-negatives.
METHODS: The prospective OTST comparing double reading DBT vs. DM had paired design with four parallel arms: DM, DM + computer aided detection, DBT + DM, and DBT + synthetic mammography. Eight radiologists interpreted images in batches using a 5-point scale. Reading time was automatically recorded. A retrospective reader
study including four radiologists classified screen-detected cancers with at least one false-negative score and screening examinations of interval cancers as negative, non-specific minimal sign, significant minimal sign, and missed; the two latter groups are defined \"actionable.\" Statistics included chi-square, Fisher\'s exact, McNemar\'s, and Mann-Whitney U tests.
RESULTS: Discordant rate (cancer missed by one reader) for screen-detected cancers was overall comparable (DBT (31% [71/227]) and DM (30% [52/175]), p = .81), significantly lower at DBT for spiculated cancers (DBT, 19% [20/106] vs. DM, 36% [38/106], p = .003), but high (28/49 = 57%, p = 0.001) for DBT-only detected spiculated cancers. Reading time and sensitivity varied among readers. False-negative DBT-only detected spiculated cancers had shorter reading time than true-negatives in 46% (13/28). Retrospective evaluation classified the following DBT exams \"actionable\": three missed by both readers, 95% (39/41) of discordant cancers detected by both modes, all 30 discordant DBT-only cancers, 25% (13/51) of interval cancers.
CONCLUSIONS: Discordant rate was overall comparable for DBT and DM, significantly lower at DBT for spiculated cancers, but high for DBT-only detected spiculated lesions. Most false-negative screen-detected DBT were classified as \"actionable.\"
CONCLUSIONS: Retrospective evaluation of false-negative interpretations from the Oslo Tomosynthesis Screening
Trial shows that most discordant and several interval cancers could have been detected at screening. This underlines the potential for modern AI-based reading aids and triage, as high-volume screening is a demanding task.
CONCLUSIONS: • Digital breast tomosynthesis (DBT) screening is more sensitive and has higher specificity compared to digital mammography screening, but high-volume DBT screening is a demanding task which can result in high discordance rate among readers. • Independent double reading DBT screening had overall comparable discordance rate as digital mammography, lower for spiculated masses seen on both modalities, and higher for small spiculated cancer seen only on DBT. • Almost all discordant digital breast tomosynthesis-detected cancers (72 of 74) and 25% (13 of 51) of the interval cancers in the Oslo Tomosynthesis Screening
Trial were retrospectively classified as actionable and could have been detected by the readers.