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Blinded Review of Retrospectively Visible Unreported Breast Cancers: An Eye-Position Analysis¹

¹ From the Pendergrass Laboratory (C.F.N., C.M.T., H.L.K.) and Department of Breast Imaging (S.P.W., E.F.C., R.E.H.S., S.E.R., J.A.B.), University of Pennsylvania, Philadelphia. From the 2000 RSNA scientific assembly. Received September 8, 2000; revision requested October 26; final revision received January 31, 2001; accepted February 15. C.F.N. supported in part by DAMD17-97-1-7130 grant. Address correspondence to C.F.N., Department of Radiology, 3600 Market St, Suite 370, Rm 103, Philadelphia, PA 19104-2647 (e-mail: nodine@oasis.rad.upenn.edu).

PURPOSE: To determine whether unreported retrospectively identified cancers on mammograms receive prolonged visual attention and can be reliably detected in a blinded review.

MATERIALS AND METHODS: Four experienced mammographers performed a blinded review of a test set of 20 retrospective cases where the cancer was not detected until the next mammographic evaluation, 10 prospective cases where the cancer was initially detected, and 10 cancer-free cases. Two views were digitized and displayed on a workstation. The experiment consisted of an initial impression, during which eye position was monitored, and a final impression, during which viewers zoomed on regions of interest and localized suspicious lesions. Eye-position data were analyzed to determine whether retrospectively visible cancers attracted attention to the same degree as prospectively visible cancers. The initial impression used 1,000 msec as the eye-fixation dwell criterion for detecting a lesion.

RESULTS: Initially, 70% of retrospective cancers and 50% of prospective cancers did not attract prolonged visual attention. In prospective cases, detailed examination significantly improved the mean receiver operating characteristic area, from .73 to .88 (P < .01), but in retrospective cases, the mean receiver operating characteristic area barely increased, from .60 to .68, due to a high true-positive–to–false-positive ratio.

CONCLUSION: At blinded review, detection of retrospectively visible cancers was significantly inferior to that of prospective cancers. It cannot be assumed that retrospectively identified cancers are intrinsically detectable, because they do not draw prolonged visual attention during visual search for breast cancers.

Index terms: Breast neoplasms, diagnosis, 00.125, 00.32 • Cancer screening, 00.125, 00.32 • Diagnostic radiology, observer performance, 00.125 • Radiology and radiologists

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