乳腺X线摄影报告质量评价体系对于评估诊断报告质量的意义

摘要

目的 探讨乳腺X线摄影报告质量的客观评价体系对评估乳腺X线摄影诊断报告质量的意义.方法 根据美国食品及药物管理局颁布的规则及美国放射学会推荐的乳腺X线摄影实践参数,以病理及临床随访(对于阴性检查结果的患者)结果为金标准,回顾性分析2015年11月14日至2016年11月14日于北京大学第一医院行诊断性乳腺X线摄影检查的连续患者的影像诊断报告,计算总体乳腺X线摄影诊断乳腺癌的灵敏度、特异度、第二类阳性预测值(PPV2)、第三类阳性预测值(PPV3).将本研究结果与美国乳腺X线摄影诊断报告质量评估体系中的参考数据对比,评估乳腺X线摄影报告质量.结果 共1 779例乳腺X线摄影诊断报告纳入研究,其中恶性患者137例,良性患者1 642例.乳腺X线摄影诊断乳腺癌的灵敏度为93.4％(128/137),特异度为95.2％(1 563/1 642),诊断阳性率11.6％(207/1 779),PPV2为61.8％(128/207),PPV3为83.1％(128/154).本研究乳腺X线摄影检查的诊断报告与推荐目标值(灵敏度度＞85.0％、特异度＞91.0％、PPV2为25.0％～ 40.0％)对比,除PPV2、PPV3明显偏高,余统计值在推荐范围内.结论 本单位诊断医师的乳腺X线摄影报告质量达到美国指南推荐水平,但建议穿刺活检比例偏低,存在漏诊可能.%Objective To investigate the significance of the objective audit system of mammography diagnostic report in evaluating the diagnostic mammography practice in Peking University First Hospital.Methods According to the regulations issued by the US Food and Drug Administration (FDA 1992) and the mammographic practice parameters recommended by the American College of Radiology (ACR 2013),we retrospectively analyzed the diagnostic mammographic reports in Peking University First Hospital from November 14,2015 to November 14,2016.We calculated the diagnostic sensitivity,specificity,positive predictive value (PPV2),and the third positive predictive value (PPV3).The pathological and follow-up results(the negative patient)were used as the golden standard.All data were compared with the reference data of United States mammography diagnostic report system.Results A total of 1 779 mammography diagnostic reports were analyzed,including 137 malignant cases and 1 642 benign cases.The sensitivity of diagnosis of malignant breast lesions was 93.4％ (128/137),the specificity was 95.2％ (1 563/1 642),PPV2 was 61.8％ (128/207) and PPV3 was 83.1％(128/154).Compared with the recommended target value (sensitivity＞85.0％,specificity＞90.0％,PPV2:25.0％～40.0％),most statistical data were within the recommended range except PPV2 and PPV3,which werehigher.Conclusions The quality of the mammographic report in Peking University First Hospital reached the recommended level in the United States.However,the low proportion of recommendation of biopsy suggested a possibility of missed diagnosis.