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Computer-aided Detection Output on 172 Subtle Findings on Normal Mammograms Previously Obtained in Women with Breast Cancer Detected at Follow-Up Screening Mammography¹

¹ From the Dept of Radiology, Stanford Univ Medical Center, Room S-068A, Rte 1, 300 Pasteur Dr, Stanford, CA 94305-5105 (D.M.I., R.L.B.); R2 Technology, Sunnyvale, Calif (K.F.O.); Dept of Radiology, Univ of California, San Francisco (E.A.S.); Eisenberg Keefer Breast Center, John Wayne Cancer Institute, St John’s Health Center, Santa Monica, Calif (R.J.B.); and Dept of Radiology, Geffen School of Medicine, Univ of California, Los Angeles (R.J.B.). Received February 13, 2003; revision requested May 2; revision received July 15; accepted August 22. Address correspondence to D.M.I.

View larger version (147K): [in a new window]   Figure 1a. Mammograms obtained in 61-year-old woman show a BI-RADS 1 lesion seen at unblinded rereview with CAD output. Normal-appearing (a) craniocaudal and (b) mediolateral-oblique screening mammograms obtained 13 months prior to diagnosis of a 1.2-cm, grade II invasive ductal carcinoma are shown. When the location of the subsequently developing cancer is noted, in retrospect, there is a focal island of normal tissue in the lower part of the right breast that was interpreted as normal by the two breast imaging specialists at unblinded review. (c) Craniocaudal view subsequently obtained at the time of cancer diagnosis shows an oval obscured mass (arrow) in the outer part of the right breast that is denser than the tissue seen in a. (d) Mediolateral oblique view obtained at the time of cancer diagnosis shows the same mass (arrow) in the lower part of the right breast. (e) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. The CAD system marked the focal island of tissue (*) on only the right mediolateral-oblique view (left image on right side) of the prior normal mammograms in a and b. The CAD system also marked benign-appearing calcifications () in the upper part of the right breast on the right mediolateral-oblique view (left image on right side). The CAD system marked skin calcifications () and a region of glandular tissue (*) in the outer part of the left breast on the left craniocaudal view (right image on left side). Note that the finding where cancer later developed is seen on only one view (right mediolateral-oblique) and looks like normal tissue.

View larger version (156K): [in a new window]   Figure 1b. Mammograms obtained in 61-year-old woman show a BI-RADS 1 lesion seen at unblinded rereview with CAD output. Normal-appearing (a) craniocaudal and (b) mediolateral-oblique screening mammograms obtained 13 months prior to diagnosis of a 1.2-cm, grade II invasive ductal carcinoma are shown. When the location of the subsequently developing cancer is noted, in retrospect, there is a focal island of normal tissue in the lower part of the right breast that was interpreted as normal by the two breast imaging specialists at unblinded review. (c) Craniocaudal view subsequently obtained at the time of cancer diagnosis shows an oval obscured mass (arrow) in the outer part of the right breast that is denser than the tissue seen in a. (d) Mediolateral oblique view obtained at the time of cancer diagnosis shows the same mass (arrow) in the lower part of the right breast. (e) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. The CAD system marked the focal island of tissue (*) on only the right mediolateral-oblique view (left image on right side) of the prior normal mammograms in a and b. The CAD system also marked benign-appearing calcifications () in the upper part of the right breast on the right mediolateral-oblique view (left image on right side). The CAD system marked skin calcifications () and a region of glandular tissue (*) in the outer part of the left breast on the left craniocaudal view (right image on left side). Note that the finding where cancer later developed is seen on only one view (right mediolateral-oblique) and looks like normal tissue.

View larger version (150K): [in a new window]   Figure 1c. Mammograms obtained in 61-year-old woman show a BI-RADS 1 lesion seen at unblinded rereview with CAD output. Normal-appearing (a) craniocaudal and (b) mediolateral-oblique screening mammograms obtained 13 months prior to diagnosis of a 1.2-cm, grade II invasive ductal carcinoma are shown. When the location of the subsequently developing cancer is noted, in retrospect, there is a focal island of normal tissue in the lower part of the right breast that was interpreted as normal by the two breast imaging specialists at unblinded review. (c) Craniocaudal view subsequently obtained at the time of cancer diagnosis shows an oval obscured mass (arrow) in the outer part of the right breast that is denser than the tissue seen in a. (d) Mediolateral oblique view obtained at the time of cancer diagnosis shows the same mass (arrow) in the lower part of the right breast. (e) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. The CAD system marked the focal island of tissue (*) on only the right mediolateral-oblique view (left image on right side) of the prior normal mammograms in a and b. The CAD system also marked benign-appearing calcifications () in the upper part of the right breast on the right mediolateral-oblique view (left image on right side). The CAD system marked skin calcifications () and a region of glandular tissue (*) in the outer part of the left breast on the left craniocaudal view (right image on left side). Note that the finding where cancer later developed is seen on only one view (right mediolateral-oblique) and looks like normal tissue.

View larger version (157K): [in a new window]   Figure 1d. Mammograms obtained in 61-year-old woman show a BI-RADS 1 lesion seen at unblinded rereview with CAD output. Normal-appearing (a) craniocaudal and (b) mediolateral-oblique screening mammograms obtained 13 months prior to diagnosis of a 1.2-cm, grade II invasive ductal carcinoma are shown. When the location of the subsequently developing cancer is noted, in retrospect, there is a focal island of normal tissue in the lower part of the right breast that was interpreted as normal by the two breast imaging specialists at unblinded review. (c) Craniocaudal view subsequently obtained at the time of cancer diagnosis shows an oval obscured mass (arrow) in the outer part of the right breast that is denser than the tissue seen in a. (d) Mediolateral oblique view obtained at the time of cancer diagnosis shows the same mass (arrow) in the lower part of the right breast. (e) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. The CAD system marked the focal island of tissue (*) on only the right mediolateral-oblique view (left image on right side) of the prior normal mammograms in a and b. The CAD system also marked benign-appearing calcifications () in the upper part of the right breast on the right mediolateral-oblique view (left image on right side). The CAD system marked skin calcifications () and a region of glandular tissue (*) in the outer part of the left breast on the left craniocaudal view (right image on left side). Note that the finding where cancer later developed is seen on only one view (right mediolateral-oblique) and looks like normal tissue.

View larger version (82K): [in a new window]   Figure 1e. Mammograms obtained in 61-year-old woman show a BI-RADS 1 lesion seen at unblinded rereview with CAD output. Normal-appearing (a) craniocaudal and (b) mediolateral-oblique screening mammograms obtained 13 months prior to diagnosis of a 1.2-cm, grade II invasive ductal carcinoma are shown. When the location of the subsequently developing cancer is noted, in retrospect, there is a focal island of normal tissue in the lower part of the right breast that was interpreted as normal by the two breast imaging specialists at unblinded review. (c) Craniocaudal view subsequently obtained at the time of cancer diagnosis shows an oval obscured mass (arrow) in the outer part of the right breast that is denser than the tissue seen in a. (d) Mediolateral oblique view obtained at the time of cancer diagnosis shows the same mass (arrow) in the lower part of the right breast. (e) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. The CAD system marked the focal island of tissue (*) on only the right mediolateral-oblique view (left image on right side) of the prior normal mammograms in a and b. The CAD system also marked benign-appearing calcifications () in the upper part of the right breast on the right mediolateral-oblique view (left image on right side). The CAD system marked skin calcifications () and a region of glandular tissue (*) in the outer part of the left breast on the left craniocaudal view (right image on left side). Note that the finding where cancer later developed is seen on only one view (right mediolateral-oblique) and looks like normal tissue.

View larger version (138K): [in a new window]   Figure 2a. (a) Prior negative and (b) subsequently obtained follow-up screening mammograms obtained in 69-year-old woman. (a) Photographically magnified left craniocaudal view of prior mammogram shows four benign-appearing calcifications (arrow) that were rated as BI-RADS 2 lesions by the unblinded radiologists and recalled by none of the five blinded panel radiologists. (b) Photographically magnified left craniocaudal view obtained 11 months later shows a 4-mm cluster of pleomorphic calcifications (arrow) that developed at the site of the normal-appearing calcifications in a. Biopsy revealed intermediate-grade DCIS. (c) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. On the prior normal mammogram, the CAD system marked the benign-appearing calcifications () and a focal island of normal tissue (*) in the left breast on the craniocaudal (right image on left side) and mediolateral-oblique (right image on right side) views of the left mammogram. The CAD system also marked a few possible calcifications (two triangles) in the lower part of the right breast on the right mediolateral-oblique view (left image on right side).

View larger version (142K): [in a new window]   Figure 2b. (a) Prior negative and (b) subsequently obtained follow-up screening mammograms obtained in 69-year-old woman. (a) Photographically magnified left craniocaudal view of prior mammogram shows four benign-appearing calcifications (arrow) that were rated as BI-RADS 2 lesions by the unblinded radiologists and recalled by none of the five blinded panel radiologists. (b) Photographically magnified left craniocaudal view obtained 11 months later shows a 4-mm cluster of pleomorphic calcifications (arrow) that developed at the site of the normal-appearing calcifications in a. Biopsy revealed intermediate-grade DCIS. (c) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. On the prior normal mammogram, the CAD system marked the benign-appearing calcifications () and a focal island of normal tissue (*) in the left breast on the craniocaudal (right image on left side) and mediolateral-oblique (right image on right side) views of the left mammogram. The CAD system also marked a few possible calcifications (two triangles) in the lower part of the right breast on the right mediolateral-oblique view (left image on right side).

View larger version (70K): [in a new window]   Figure 2c. (a) Prior negative and (b) subsequently obtained follow-up screening mammograms obtained in 69-year-old woman. (a) Photographically magnified left craniocaudal view of prior mammogram shows four benign-appearing calcifications (arrow) that were rated as BI-RADS 2 lesions by the unblinded radiologists and recalled by none of the five blinded panel radiologists. (b) Photographically magnified left craniocaudal view obtained 11 months later shows a 4-mm cluster of pleomorphic calcifications (arrow) that developed at the site of the normal-appearing calcifications in a. Biopsy revealed intermediate-grade DCIS. (c) CAD output shows low-spatial-resolution mammograms (from left to right: right craniocaudal, left craniocaudal, right mediolateral-oblique, left mediolateral-oblique views) and marked findings. On the prior normal mammogram, the CAD system marked the benign-appearing calcifications () and a focal island of normal tissue (*) in the left breast on the craniocaudal (right image on left side) and mediolateral-oblique (right image on right side) views of the left mammogram. The CAD system also marked a few possible calcifications (two triangles) in the lower part of the right breast on the right mediolateral-oblique view (left image on right side).