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Computer-aided Detection with Screening Mammography in a University Hospital Setting¹

¹ From the Department of Radiology, S092, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105 (R.L.B., D.M.I.); and Radiology Residency Program, Loma Linda University Medical Center, Loma Linda, Calif (P.B.). Received May 14, 2004; revision requested August 3; revision received September 22; accepted October 22. Address correspondence to R.L.B. (e-mail: rbirdwell{at}partners.org).

View larger version (132K): [in a new window]   Figure 1a. Bilateral screening mammograms in a 60-year-old woman. (a) Mediolateral oblique and (b) craniocaudal mammograms show scattered fibroglandular tissue. Linear markers on images are routinely placed on the skin over visible incision sites in women who have previously undergone surgery. (c) On magnified craniocaudal view, calcifications (arrows) were present in left upper outer quadrant and were seen by the radiologist. These were not marked by CAD (radiologist-only finding). High-grade ductal carcinoma in situ, 1.6 cm in extent, was seen at biopsy.

View larger version (148K): [in a new window]   Figure 1b. Bilateral screening mammograms in a 60-year-old woman. (a) Mediolateral oblique and (b) craniocaudal mammograms show scattered fibroglandular tissue. Linear markers on images are routinely placed on the skin over visible incision sites in women who have previously undergone surgery. (c) On magnified craniocaudal view, calcifications (arrows) were present in left upper outer quadrant and were seen by the radiologist. These were not marked by CAD (radiologist-only finding). High-grade ductal carcinoma in situ, 1.6 cm in extent, was seen at biopsy.

View larger version (149K): [in a new window]   Figure 1c. Bilateral screening mammograms in a 60-year-old woman. (a) Mediolateral oblique and (b) craniocaudal mammograms show scattered fibroglandular tissue. Linear markers on images are routinely placed on the skin over visible incision sites in women who have previously undergone surgery. (c) On magnified craniocaudal view, calcifications (arrows) were present in left upper outer quadrant and were seen by the radiologist. These were not marked by CAD (radiologist-only finding). High-grade ductal carcinoma in situ, 1.6 cm in extent, was seen at biopsy.

View larger version (78K): [in a new window]   Figure 2a. Screening mammograms in a 58-year-old woman who underwent left breast mastectomy and right breast lumpectomy and radiation therapy for breast cancer 13 years earlier. Linear markers on images are routinely placed on the skin over visible incision sites in women who have previously undergone surgery. (a) Mediolateral oblique and (b) craniocaudal mammograms of the right breast. A density (arrow) seen only on a was detected by the radiologist but not marked at CAD (radiologist-only finding). (c) Mammogram obtained with spot compression shows the density (arrow), in the upper part of the breast, to better advantage. A 0.7-cm infiltrating ductal carcinoma, grade II, was diagnosed at biopsy.

View larger version (69K): [in a new window]   Figure 2b. Screening mammograms in a 58-year-old woman who underwent left breast mastectomy and right breast lumpectomy and radiation therapy for breast cancer 13 years earlier. Linear markers on images are routinely placed on the skin over visible incision sites in women who have previously undergone surgery. (a) Mediolateral oblique and (b) craniocaudal mammograms of the right breast. A density (arrow) seen only on a was detected by the radiologist but not marked at CAD (radiologist-only finding). (c) Mammogram obtained with spot compression shows the density (arrow), in the upper part of the breast, to better advantage. A 0.7-cm infiltrating ductal carcinoma, grade II, was diagnosed at biopsy.

View larger version (126K): [in a new window]   Figure 2c. Screening mammograms in a 58-year-old woman who underwent left breast mastectomy and right breast lumpectomy and radiation therapy for breast cancer 13 years earlier. Linear markers on images are routinely placed on the skin over visible incision sites in women who have previously undergone surgery. (a) Mediolateral oblique and (b) craniocaudal mammograms of the right breast. A density (arrow) seen only on a was detected by the radiologist but not marked at CAD (radiologist-only finding). (c) Mammogram obtained with spot compression shows the density (arrow), in the upper part of the breast, to better advantage. A 0.7-cm infiltrating ductal carcinoma, grade II, was diagnosed at biopsy.

View larger version (53K): [in a new window]   Figure 3a. Images in a 49-year-old nulliparous woman. (a) Mediolateral oblique mammogram shows a density (arrow) in the upper part of the left breast. (b) Craniocaudal mammogram shows that although this lesion was found to be medial in location, the density (arrowheads) was actually anterior to the mass and represented noncompressed breast tissue. The lesion was marked at CAD on a, and the radiologist "looked again" and recommended recall (CAD-only finding). (c) Sonogram obtained at the 2 o'clock position reveals an irregular hypoechoic mass (arrows) suspicious for carcinoma. Results of biopsy showed a 5-mm grade I infiltrating ductal carcinoma.

View larger version (46K): [in a new window]   Figure 3b. Images in a 49-year-old nulliparous woman. (a) Mediolateral oblique mammogram shows a density (arrow) in the upper part of the left breast. (b) Craniocaudal mammogram shows that although this lesion was found to be medial in location, the density (arrowheads) was actually anterior to the mass and represented noncompressed breast tissue. The lesion was marked at CAD on a, and the radiologist "looked again" and recommended recall (CAD-only finding). (c) Sonogram obtained at the 2 o'clock position reveals an irregular hypoechoic mass (arrows) suspicious for carcinoma. Results of biopsy showed a 5-mm grade I infiltrating ductal carcinoma.

View larger version (143K): [in a new window]   Figure 3c. Images in a 49-year-old nulliparous woman. (a) Mediolateral oblique mammogram shows a density (arrow) in the upper part of the left breast. (b) Craniocaudal mammogram shows that although this lesion was found to be medial in location, the density (arrowheads) was actually anterior to the mass and represented noncompressed breast tissue. The lesion was marked at CAD on a, and the radiologist "looked again" and recommended recall (CAD-only finding). (c) Sonogram obtained at the 2 o'clock position reveals an irregular hypoechoic mass (arrows) suspicious for carcinoma. Results of biopsy showed a 5-mm grade I infiltrating ductal carcinoma.