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Computer-aided Detection in Screening Mammography: Variability in Cues¹

¹ From the Departments of Radiology and Biomedical Engineering, Duke University Medical Center, Erwin Rd, Durham, NC 27710. From the 2003 RSNA scientific assembly. Received July 28, 2003; revision requested October 6; revision received January 24, 2004; accepted March 2. Address correspondence to J.A.B. (e-mail: jay.baker@duke.edu).

PURPOSE: To evaluate the variability of true-positive and false-positive cues by using a commercially available computer-aided detection (CAD) system for analysis of 50 malignancies in a screening population.

MATERIALS AND METHODS: Fifty breast cancers detected at screening were analyzed by using a commercially available CAD system. Mean patient age was 62.2 years. Each set of mammograms (craniocaudal and mediolateral oblique views) was digitized and analyzed by the CAD system 10 times. One radiologist compared CAD output with the location of the malignancy at mammography and determined whether each lesion was marked accurately in one mammographic view, both views, or neither. Sensitivity and reproducibility of the CAD system were determined for both case- and image-based analysis.

RESULTS: Overall sensitivity of the CAD system when at least one of the two mammographic views was marked correctly (case-base sensitivity) was 82.4%. Sensitivity when each mammographic view was considered separately (image-based sensitivity) was 61.1%. For case-based analysis, variability in true-positive CAD cues was demonstrated for 14 of 50 (28%) cases. For image-based analysis, inconsistency in CAD output was observed in 33 of 100 (33%) mammographic views that contained malignancies detected at screening. However, the CAD system consistently detected 40–43 of the 50 breast cancers in each of the 10 CAD runs. Variability for false-positive marks was significantly greater than that for true-positive marks.

CONCLUSION: Inconsistency was demonstrated for CAD analysis of breast cancers detected at screening. However, the CAD system was reasonably consistent in the overall number of cancers identified from run to run. Greater variability of the CAD system was also demonstrated for false-positive marks, as compared with true-positive marks.

© RSNA, 2004

Index terms: Breast neoplasms, localization, 08.112, 08.115 • Breast radiography, quality assurance, 08.112, 08.115 • Computers, diagnostic aid

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