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Computer-aided Detection Performance in Mammographic Examination of Masses: Assessment¹

¹ From the Departments of Radiology (D.G., J.S.S., L.A.H., B.Z, J.H.S., D.M.C., B.E.S) and Biostatistics (H.E.R.) and Magee-Womens Hospital (D.G., L.A.H., J.H.S., D.M.C., B.E.S.), University of Pittsburgh, 300 Halket St, Suite 4200, Pittsburgh, PA 15213-3180. Received February 16, 2004; revision requested April 20; revision received May 5; accepted May 24. Supported in part by grants CA77850 and CA84241 from the National Cancer Institute, National Institutes of Health, and also by the U.S. Army Medical Research Acquisition Center under contract DAMD17-00-1-0410. Address correspondence to D.G. (e-mail: gurd@upmc.edu).

PURPOSE: To compare performance of two computer-aided detection (CAD) systems and an in-house scheme applied to five groups of sequentially acquired screening mammograms.

MATERIALS AND METHODS: Two hundred nineteen film-based mammographic examinations, classified into five groups, were included in this study. Group 1 included 58 examinations in which verified malignant masses were detected during screening; group 2, 39 in which all available latest examinations were performed prior to diagnosis of these malignant masses (subset of 39 women from group 1); group 3, 22 in which findings were interpreted as negative but were verified as cancer within 1 year from the negative interpretation (missed cancers); group 4, 50 in which findings were negative and patients were not recalled for additional procedures; and group 5, 50 in which patients were recalled for additional procedures and findings were negative for cancer. In all examinations, images were processed with two Food and Drug Administration–approved commercially available CAD systems and an in-house scheme. Performance levels in terms of true-positive detection rates and number of false-positive identifications per image and per examination were compared.

RESULTS: Mass detection rates in positive examinations (group 1) were 67%–72%. Detection rates among three systems were not significantly different (P > .05). In 50 negative screening examinations (group 4), false-positive rates ranged from 1.08 to 1.68 per four-view examination. Performance level differences among systems were significant for false-positive rates (P = .008). Performance of all systems was at levels lower than publicly suggested in some retrospective studies. False-positive CAD cueing rates were significantly higher for negative examinations in which patients were recalled (group 5) than they were for those in which patients were not recalled (group 4) (P .002).

CONCLUSION: Performance of CAD systems for mass detection at mammography varies significantly, depending on examination and system used. Actual performance of all systems in clinical environment can be improved.

© RSNA, 2004

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

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