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Potential of Computer-aided Diagnosis to Reduce Variability in Radiologists’ Interpretations of Mammograms Depicting Microcalcifications¹

¹ From the Kurt Rossmann Laboratories for Radiologic Image Research, Dept of Radiology (Y.J., R.M.N., R.A.S., K.D.), and the Depts of Anesthesia and Critical Care (A.Y.T.) and Health Studies (A.Y.T.), Univ of Chicago, 5841 S Maryland Ave, MC2026, Chicago, IL 60637. Received Jul 13, 2000; revision requested Aug 21; final revision received Jan 15, 2001; accepted Feb 15. Supported in part by NIH grant CA 60187. Address correspondence to Y.J. (e-mail: y-jiang@uchicago.edu).

PURPOSE: To evaluate whether computer-aided diagnosis can reduce interobserver variability in the interpretation of mammograms.

MATERIALS AND METHODS: Ten radiologists interpreted mammograms showing clustered microcalcifications in 104 patients. Decisions for biopsy or follow-up were made with and without a computer aid, and these decisions were compared. The computer was used to estimate the likelihood that a microcalcification cluster was due to a malignancy. Variability in the radiologists’ recommendations for biopsy versus follow-up was then analyzed.

RESULTS: Variation in the radiologists’ accuracy, as measured with the SD of the area under the receiver operating characteristic curve, was reduced by 46% with computer aid. Access to the computer aid increased the agreement among all observers from 13% to 32% of the total cases (P < .001), while the value increased from 0.19 to 0.41 (P < .05). Use of computer aid eliminated two-thirds of the substantial disagreements in which two radiologists recommended biopsy and routine screening in the same patient (P < .05).

CONCLUSION: In addition to its demonstrated potential to improve diagnostic accuracy, computer-aided diagnosis has the potential to reduce the variability among radiologists in the interpretation of mammograms.

Index terms: Breast neoplasms, calcification, 00.81 • Breast neoplasms, diagnosis, 00.30 • Computers, diagnostic aid • Diagnostic radiology, observer performance

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