Abstract
BackgroundThe computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening. The purpose of this study is to evaluate the diagnostic performance of the CAD system in full-field digital mammography for detecting breast cancer when used by dedicated breast radiologist (BR) and radiology resident (RR), and to reveal who could benefit the most from a CAD application.MethodsWe retrospectively chose 100 image sets from mammographies performed with CAD between June 2008 and June 2010. Thirty masses (15 benign and 15 malignant), 30 microcalcifications (15 benign and 15 malignant), and 40 normal mammography images were included. The participating radiologists consisted of 7 BRs and 13 RRs. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for total, normal plus microcalcification and normal plus mass both with and without CAD use for each reader. We compared the diagnostic performance values obtained with and without CAD use for the BR and RR groups, respectively. The reading time reviewing one set of 100 images and time reduction with CAD use for the BR and RR groups were also evaluated.ResultsThe diagnostic performance was generally higher in the BR group than in the RR group. Sensitivity improved with CAD use in the BR and RR groups (from 81.10 to 84.29% for BR; 75.38 to 77.95% for RR). A tendency for improvement in all diagnostic performance values was observed in the BR group, whereas in the RR group, sensitivity improved but specificity, PPV, and NPV did not. None of the diagnostic performance parameters were significantly different. The mean reading time was shortened with CAD use in both the BR and RR groups (111.6 minutes to 94.3 minutes for BR; 135.5 minutes to 109.8 minutes for RR). The mean time reduction was higher for the RR than that in the BR group.ConclusionsCAD was helpful for dedicated BRs to improve their diagnostic performance and for RRs to improve the sensitivity in a screening setting. CAD could be essential for radiologists by decreasing reading time without decreasing diagnostic performance.
Highlights
The computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening
A tendency for CAD to improve all diagnostic performance values was observed in the breast radiologist (BR) group, whereas in the radiology resident (RR) group sensitivity improved but specificity, positive predictive value (PPV), and negative predictive value (NPV) did not
No significant difference in diagnostic performance was observed in either the BR or RR groups when CAD was applied, but the results showed a tendency for an improvement in sensitivity, specificity, PPV, and NPV in the BR group when the radiologists evaluated microcalcifications but not masses
Summary
The computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening. The purpose of this study is to evaluate the diagnostic performance of the CAD system in full-field digital mammography for detecting breast cancer when used by dedicated breast radiologist (BR) and radiology resident (RR), and to reveal who could benefit the most from a CAD application. To overcome the limitations of human observers and reduce the false negative rate of screening mammograms, double reading by another radiologist has been implemented at many hospitals. Many studies have revealed that CAD can reduce the false negative rate and increase the detection of breast cancer, early breast cancer [2,3,8,9,10] without a significant increase in recall rate [2,8] and false positive rate for biopsy [8,10]. Yang et al reported that the CAD system can correctly mark most asymptomatic breast cancers detected with digital mammographic screening [11], and Bolivar et al demonstrated that improved CAD sensitivity was maintained for small lesions and invasive lobular carcinomas, which have lower mammographic sensitivity [12]
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