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Computer-aided Detection versus Independent Double Reading of Masses on Mammograms¹

¹ From the Departments of Radiology (N.K.) and Epidemiology and Biostatistics (J.D.M.O., A.L.M.V.) and the National Expert and Training Center for Breast Cancer Screening (J.H.C.L.H., R.H.), University Medical Center Nijmegen, Geert Grooteplein 18, 6525 GA Nijmegen, the Netherlands; and the Department of Public Health, National Evaluation Team for Breast Cancer Screening (J.H.G., H.J.d.K.). From the 2001 RSNA scientific assembly. Received November 30, 2001; revision requested January 10, 2002; final revision received August 5; accepted August 22. Supported by the National Evaluation Team for Breast Cancer Screening. Address correspondence to N.K. (e-mail: n.karssemeijer@rad.umcn.nl).

PURPOSE: To evaluate the use of a computer-aided detection (CAD) system (designed for mammographic mass detection) to help improve mass interpretation and to compare CAD results with independent double-reading results.

MATERIALS AND METHODS: Screening mammograms from 500 cases were collected; 125 of these cases were screening-detected cancers, and 125 were interval cancers. Previously obtained screening mammograms (ie, prior mammograms) were available in all cases. All mammograms were analyzed by a CAD system, which detected mass regions and assigned a level of (cancer) suspicion to each mass. Ten experienced screening radiologists read the prior mammograms. For independent interpretation with CAD, the suspicion rating assigned to each finding by the radiologist was weighted with the CAD output at the area of the finding. CAD markers on areas that were not reported by the radiologist were not used. Independent double reading was implemented by using a rule to combine the levels of suspicion assigned to findings by two radiologists. Results were evaluated by using localized-response receiver operating characteristic analysis.

RESULTS: In a total of 141 cases, there was a visible abnormality at the location of the cancer on the prior mammogram, and 115 of these were classified as mass cases. For prior mammograms that depicted masses, the mean sensitivity of the radiologists, as averaged among the false-positive rates lower than 10%, was 39.4%; this increased by 7.0% with CAD and by 10.5% with double reading. Differences among single, double, and CAD readings were statistically significant (P < .001).

CONCLUSION: Although independent double reading yields the best detection performance, the presence and probability of CAD mass markers can improve mammogram interpretation.

© RSNA, 2003

Index terms: Breast neoplasms, diagnosis, 00.31, 00.32 • Cancer screening, 00.11 • Computers, diagnostic aid

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