乳腺X线影像报告的系统审核对报告质量评估的意义

Significance of audit for assessing the quality of mammography diagnostic reports

目的探讨乳腺X线摄影诊断报告审核对评估诊断报告质量的意义。方法根据美国食品药物监督管理局有关规定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,回顾性分析解放军总医院第五医学中心南院区2017年1月1日至12月31日行诊断性乳腺X线摄影检查患者的影像诊断报告,收集基本数据,计算相关衍生数据,包括:灵敏度、特异度、异常诊断率、乳腺癌检出率、第二类阳性预测值(PPV2)和第三类阳性预测值(PPV3)。将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进行对比,评估乳腺X线摄影诊断报告质量。结果共1309例乳腺X线摄影诊断报告纳入研究,通过收集基本数据,计算出相关衍生数据,敏感度92.00%(115/125),特异度79.65%(943/1184),异常诊断率27.20%(356/1309),乳腺癌检出率9.55%(125/1309),PPV238.21%(115/301),PPV365.65%(115/170)。与参考数据比较,该院乳腺X线摄影诊断报告的特异度较低,异常诊断率略高,PPV3较高,乳腺癌检出率略低。结论由于人种、国情和辅助投照体位应用不足,以及诊断医师对某些征象认识不足,该院医师乳腺X线摄影诊断报告质量与美国指南推荐水平尚有一定差距。

Objective To investigate the significance of mammographic audit for assessing the quality of diagnostic reports.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),the pathological and follow-up results(patients who tested negative)were used as the golden standard.The diagnostic mammographic reports in 2017 were retrospectively analyzed.Primary data was collected and the diagnostic sensitivity,specificity,the rate of abnormal diagnosis,the detection rate of breast cancer,the second positive predictive value(PPV2),and the third positive predictive value(PPV3)were calculated.All the data was compared with the reference data of the United States mammography diagnostic report system.Results A total of 1309 mammography diagnostic reports were analyzed.The sensitivity of diagnosis of malignant breast lesions was 92.00%(115/125),the specificity was 79.65%(943/1184),the abnormal diagnosis rate was 27.20%(356/1309),the detection rate of breast cancer was 9.55%(125/1309),PPV2 was38.21%(115/301),and PPV3 was 65.65%(115/170).Compared with the recommended parameters,the specificity and the detection rate of breast cancer were lower,PPV3 and the abnormal diagnosis rate were higher.Conclusion For various reasons,the quality of mammographic reports in our hospital is lower than the recommended level in the United States.