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Mammographic Characteristics of 115 Missed Cancers Later Detected with Screening Mammography and the Potential Utility of Computer-aided Detection¹

¹ From the Department of Radiology (H-1307), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105 (R.L.B., D.M.I.); R2 Technology, Inc, Los Altos, Calif (K.F.O.); and the Department of Radiology, University of California, San Francisco (E.A.S.). From the 1999 RSNA scientific assembly. Received February 25, 2000; revision requested April 9; revision received August 14; accepted September 6. Address correspondence to R.L.B. (e-mail: birdwell@leland.stanford.edu).

PURPOSE: To retrospectively determine the mammographic characteristics of cancers missed at screening mammography and assess the ability of computer-aided detection (CAD) to mark the missed cancers.

MATERIALS AND METHODS: A multicenter retrospective study accrued 1,083 consecutive cases of breast cancer detected at screening mammography. Prior mammograms were available in 427 cases. Of these, 286 had lesions visible in retrospect. The 286 cases underwent blinded review by panels of radiologists; a majority recommended recall for 112 cases. Two experienced radiologists compared prior mammograms in 110 of these cases with the subsequent screening mammograms (when cancer was detected), noting mammographic characteristics of breast density, lesion type, size, morphology, and subjective reasons for possible miss. The prior mammograms were then analyzed with a CAD program.

RESULTS: There were 110 patients with 115 cancers. On the prior mammograms with missed cancers, 35 (30%) of the 115 lesions were calcifications, with 17 of 35 (49%) clustered or pleomorphic. Eighty of the 115 (70%) were mass lesions, with 32 of 80 (40%) spiculated or irregular. For calcifications and masses, the most frequently suggested reasons for possible miss were dense breasts (12 of 35; 34%) and distracting lesions (35 of 80; 44%), respectively. CAD marked 30 (86%) of 35 missed calcifications and 58 (73%) of 80 missed masses.

CONCLUSION: Detection errors affected cases with calcifications and masses. CAD marked most (77%; 88 of 115) cancers missed at screening mammography that radiologists retrospectively judged to merit recall.

Index terms: Breast neoplasms, diagnosis, 00.32, 00.812 • Cancer screening, 00.32, 00.812 • Computers, diagnostic aid, 00.32, 00.812

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