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Breast Imaging |
1 From the Department of Radiology, University of Michigan Health Systems, 1500 E Medical Center Dr, TC 2910, Ann Arbor, MI 48109-0326 (M.A.H., L.H., H.P.C., N.P., B.S., D.A., J.B., C.B., D.H., K.H., L.J., K.K., C.P., S.K.P., M.R.); and Department of Radiology, Georgetown University Hospital, Washington, DC (E.M., S.C.B.L., M.F.). From the 2002 RSNA scientific assembly. Received March 25, 2003; revision requested June 18; revision received August 19; accepted October 3. Supported by U.S. Army grant DAMD 17-96-1-6254 and U.S. Public Health Service grant CA48129. Address correspondence to M.A.H.
PURPOSE: To evaluate a noncommercial computer-aided detection (CAD) program for breast cancer detection with screening mammography.
MATERIALS AND METHODS: A CAD program was developed for mammographic breast cancer detection. The program was applied to 2,389 patients’ screening mammograms at two geographically remote academic institutions (institutions A and B). Thirteen radiologists who specialized in breast imaging participated in this pilot study. For each case, the individual radiologist performed a prospective Breast Imaging Reporting and Data System (BI-RADS) assessment after viewing of the screening mammogram. Subsequently, the radiologist was shown CAD results and rendered a second BI-RADS assessment by using knowledge of both mammographic appearance and CAD results. Outcome analysis of results of examination in patients recalled for a repeat examination, of biopsy, and of 1-year follow-up examination was recorded. Correct detection with CAD included a computer-generated mark indicating a possible malignancy on craniocaudal or mediolateral oblique views or both.
RESULTS: Eleven (0.46%) of 2,389 patients had mammographically detected nonpalpable breast cancers. Ten (91%) of 11 (95% CI: 74%, 100%) cancers were correctly identified with CAD. Radiologist sensitivity without CAD was 91% (10 of 11; 95% CI: 74%, 100%). In 1,077 patients, follow-up findings were documented at 1 year. Five (0.46%) patients developed cancers, which were found on subsequent screening mammograms. The area where the cancers developed in two (40%) of these five patients was marked (true-positive finding) by the computer in the preceding year. Because of CAD results, a 9.7% increase in recall rate from 14.4% (344 of 2,389) to 15.8% (378 of 2,389) occurred. Radiologists’ recall rate of study patients prior to use of CAD was 31% higher than the average rate for nonstudy cases (10.3%) during the same time period at institution A.
CONCLUSION: Performance of the CAD program had a very high sensitivity of 91% (95% CI: 74%, 100%).
© RSNA, 2004
Index terms: Breast neoplasms, diagnosis, 00.30 • Cancer screening • Computers, diagnostic aid • Diagnostic radiology, observer performance
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