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Published online before print June 26, 2006, 10.1148/radiol.2401042099
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Breast Masses: Computer-aided Diagnosis with Serial Mammograms1

Lubomir Hadjiiski, PhD, Berkman Sahiner, PhD, Mark A. Helvie, MD, Heang-Ping Chan, PhD, Marilyn A. Roubidoux, MD, Chintana Paramagul, MD, Caroline Blane, MD, Nicholas Petrick, PhD, Janet Bailey, MD, Katherine Klein, MD, Michelle Foster, MD, Stephanie K. Patterson, MD, Dorit Adler, MD, Alexis V. Nees, MD and Joseph Shen, MD

1 From the Department of Radiology, University of Michigan Medical Center, CGC B2102, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0904 (L.H., B.S., M.A.H., H.P.C., M.A.R., C.P., C.B., J.B., K.K., M.F., S.K.P., D.A., A.V.N., J.S.); and Center for Devices and Radiological Health, U.S. Food and Drug Administration, Rockville, Md (N.P.). Received December 10, 2004; revision requested February 3, 2005; revision received May 5; accepted June 13; final version accepted September 12. Supported by USAMRMC grants DAMD17-98-1-8211, DAMD17-02-1-0489, and DAMD17–02-1-0214 and USPHS grant CA95153. Address correspondence to L.H. (e-mail: lhadjisk{at}umich.edu).


Figure 1
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  		Figure 1: Bar graph shows temporal interval between current and prior mammograms for 90 two-view temporal pairs, of which 47 were malignant and 43 were benign.

 

Figure 2
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  		Figure 2: Two-view (CC and MLO) temporal pairs of mammographic images displayed by graphical user interface in observer study. Left: Views of prior mass. Right: Views of current mass. Radiologist provided two ratings: estimate of the likelihood of malignancy (range, 1 = benign to 100 = high likelihood of malignancy) and BI-RADS category (range, 1 = negative to 5 = highly suggestive of malignancy), which are displayed at upper right of the interface. When reading in sequential mode with computer aid, computer rating (gray box with number 7) and fitted distributions (in which white curve represents likelihood that mass is benign and black curve represents likelihood that it is malignant) are both displayed in the lower right of the interface. In sequential mode, the radiologist first evaluated the mass without CAD and could change the likelihood of malignancy and/or BI-RADS category after considering the computer's rating.

 

Figure 3
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  		Figure 3: Average ROC curves for two-view observer study for three reading modes: independent (No CAD- Ind) (Az = 0.83), sequential without CAD (No CAD-Seq) (Az = 0.82), and sequential with CAD (With CAD-Seq) (Az = 0.87). The difference was significant for sequential with CAD mode versus independent mode (P = .03, Student paired t test; P < .05, Dorfman-Berbaum-Metz method) and for sequential with CAD mode versus sequential without CAD mode (P < .01, Student paired t test; P < .01, Dorfman-Berbaum-Metz method). Dashed line at true-positive fraction of 0.90 shows threshold above which Az(0.90) was calculated. For the two-view observer study, Az(0.90) was 0.35 for independent mode, 0.30 for sequential without CAD mode, and 0.49 for sequential with CAD mode. The difference was significant for sequential with CAD mode versus sequential without CAD mode (P < .01, Student paired t test).

 

Figure 4
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  		Figure 4: Average ROC curves for two-view and single-view observer studies for two reading modes. Az was 0.87 for sequential reading of two-view mammograms with CAD (With CAD-Seq 2V) and 0.83 for independent reading of two-view mammograms (No CAD-Ind 2V) (P = .03, Student paired t test; P < .05, Dorfman-Berbaum-Metz method). Az was 0.83 for sequential reading of single-view mammograms with CAD (With CAD-Seq 1V) and 0.78 for independent reading of single-view mammograms (No CAD-Ind 1V) (P < .02, Student paired t test; P < .02, Dorfman-Berbaum-Metz method). Dashed line at true-positive fraction of 0.90 shows threshold above which Az(0.90) was calculated. Az(0.90) was 0.49 for sequential reading of two-view mammograms with CAD, 0.35 for independent reading of two-view mammograms (P = .11, Student paired t test), 0.36 for sequential reading of single-view mammograms with CAD, and 0.21 for independent reading of single-view mammograms (P < .02, Student paired t test).

 




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