Computer-aided detection in full-field digital mammography in a clinical population: performance of radiologist and technologists

Abstract

The purpose of the study was to evaluate the impact of a computer-aided detection (CAD) system on the performance of mammogram readers in interpreting digital mammograms in a clinical population. Furthermore, the ability of a CAD system to detect breast cancer in digital mammography was studied in comparison to the performance of radiologists and technologists as mammogram readers. Digital mammograms of 1,048 consecutive patients were evaluated by a radiologist and three technologists. Abnormalities were recorded and an imaging conclusion was given as a BI-RADS score before and after CAD analysis. Pathology results during 12 months follow up were used as a reference standard for breast cancer. Fifty-one malignancies were found in 50 patients. Sensitivity and specificity were computed before and after CAD analysis and provided with 95% CIs. In order to assess the detection rate of malignancies by CAD and the observers, the pathological locations of these 51 breast cancers were matched with the locations of the CAD marks and the mammographic locations that were considered to be suspicious by the observers. For all observers, the sensitivity rates did not change after application of CAD. A mean sensitivity of 92% was found for all technologists and 84% for the radiologist. For two technologists, the specificity decreased (from 84 to 83% and from 77 to 75%). For the radiologist and one technologist, the application of CAD did not have any impact on the specificity rates (95 and 83%, respectively). CAD detected 78% of all malignancies. Five malignancies were indicated by CAD without being noticed as suspicious by the observers. In conclusion, the results show that systematic application of CAD in a clinical patient population failed to improve the overall sensitivity of mammogram interpretation by the readers and was associated with an increase in false-positive results. However, CAD marked five malignancies that were missed by the different readers.

Impact of Computer-Aided Detection Systems on Radiologist Accuracy With Digital Mammography

“…Our results are similar to those of others who have looked at the sensitivity of CAD with digital mammography [6, 13–16], finding no difference in radiologists’ performance with and without CAD overall. Four of 14 readers (28.6%) achieved significant improvement in sensitivity with the iCAD system, and four of 15 readers (26.7%) achieved significant improvement in sensitivity with the R2 system.…”

“…Although CAD was in widespread use in the United States by 2008, opinions expressed in articles published since remain mixed on the impact of this technology on radiologist performance in the detection of breast cancer [4–6]. Given the low sensitivity to breast cancers on both film-screen (0.41) and digital (0.41) mammography in DMIST [2] and the results of stand-alone assessment of the sensitivity of the two CAD systems, iCAD (0.74) and R2 (0.74), to cancers in DMIST (including interval cancers and those found at 1-year follow-up) [7], we anticipated that application of CAD to the challenging screening cases in DMIST should result in improved radiologist per formance.…”

Comparison of sensitivity of lung nodule detection between radiologists and technologists on low-dose CT lung cancer screening images

“…One study reported the usage of a CAD system for mammogram reading by a radiologist and three technologists, and concluded the CAD system failed to improve performance of either the radiologist or the three technologists [20]. Another study evaluated the efficacy of a CAD system for low-dose CT lung cancer screening, and found the detection accuracy improved significantly for thoracic and general radiologists using the CAD system; however, no statistically significant difference in the diagnostic accuracy obtained with and without the use of CAD was seen for residents [21].…”

Evaluation of breast amorphous calcifications by a computer-aided detection system in full-field digital mammography

“…Logically, the use of CAD systems that have superb sensitivity for the detection of malignant microcalcifications seems to be very attractive in digital mammography. Previous studies [12,[17][18][19] have shown that CAD sensitivity for the detection of breast cancer is similar in fatty breasts and dense breasts in both SFM [17] and FFDM [20][21][22][23]; however, indirect-CAD sensitivity for subgroups of cancers apparent only as microcalcifications has been shown to be higher in dense breasts than the sensitivity for calcifications in fatty breasts [12]. The indirect-CAD sensitivity was markedly lower in cases of malignant amorphous calcifications than in other malignant calcifications [12].…”