分析双读数数字乳腺断层合成 (DBT) 与数字乳腺 X 线摄影 (DM) 的不一致和假阴性，包括奥斯陆断层合成筛选试验 (OTST) 中的读取时间，并在回顾性读者研究中将这些重新分类为漏检、最小征象或比较双读 DBT 与 DM 的前瞻性 OTST 具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 线摄影。八位放射科医生使用 5 分制分批解读图像。自动记录阅读时间。一项由四名放射科医生参与的回顾性读者研究将筛查检测到的癌症（至少有一个假阴性评分）和间隔期癌症的筛查检查分类为阴性、非特异性最小体征、显着最小体征和漏诊；后两组被定义为“可采取行动”。统计数据包括卡方检验、费舍尔精确检验、麦克尼马尔检验和曼惠特尼 U 检验。屏幕检测到的癌症的不一致率（一位读者漏掉的癌症）总体上具有可比性（DBT (31% [71/227]) 和 DM (30 % [52/175]), p = .81)，对于针状癌症，DBT 显着较低（DBT，19% [20/106] vs. DM，36% [38/106]，p = .003），但是对于仅使用 DBT 检测到的刺状癌症，该结果较高（28/49 = 57%，p = 0.001）。读者的阅读时间和敏感度各不相同。仅使用 DBT 检测到的假阴性刺状癌的读取时间比真阴性的读取时间短（46% (13/28)）。回顾性评估将以下 DBT 检查分类为“可采取行动”：两位读者都错过了 3 项检查，两种模式检测到 95% (39/41) 的不一致癌症，所有 30 种仅使用 DBT 不一致的癌症，25% (13/51) 的间期癌症DBT 和 DM 的不一致率总体相当，对于针状癌症，DBT 显着较低，但仅 DBT 检测到的针状病变则较高。大多数假阴性筛查检测到的 DBT 被归类为“可采取行动”。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，大多数不一致和几种间隔癌症可以在筛查时检测到。这凸显了基于现代人工智能的阅读辅助和分诊的潜力，因为大容量筛查是一项艰巨的任务。• 数字乳腺断层合成 (DBT) 筛查比数字乳房 X 线摄影筛查更敏感且具有更高的特异性，但大容量 DBT筛选是一项艰巨的任务，可能会导致读者之间的不一致率很高。 • 独立双读DBT 筛查的总体不一致率与数字乳房X 光检查相当，两种方式中看到的针状肿块较低，而仅在DBT 中看到的小针状癌则较高。 • 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 例中的 72 例）和 25%（51 例中的 13 例）的间期癌症均被回顾性分类为可采取行动，并且可能已被读者检测到。© 2023。作者。

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.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.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.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."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.• 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.© 2023. The Author(s).