Screening mammograms: Interpretation with computer-aided detection - Prospective evaluation

Purpose: To prospectively determine the effect of a commercially available computer-aided detection (CAD) system on interpretations of screening mammograms. Materials and Methods: Institutional review board approval was granted; informed consent and HIPAA compliance were waived. A total of 21 349 screening mammograms obtained in 18 096 women were interpreted first without and then with review of CAD images to determine the effect of CAD analysis on the screening breast cancer detection rate, recall rate, and positive predictive value (PPV) for biopsy. The percentage of total cancers detected by the radiologists independent of CAD and the percentage correctly marked by the CAD system were determined. Results: On the basis of pre-CAD interpretations, 2101 patients were recalled for diagnostic evaluation, 256 biopsies were performed, and 105 breast cancers were diagnosed. The breast cancer detection rate per 1000 screening mammograms was 4.92 (105 of 21 349 mammograms), the recall rate was 9.84% (2101 of 21 349 mammograms), and the PPV for biopsy was 41.0% (105 of 256 biopsies). After CAD image review, 199 additional patients were recalled, 21 additional biopsies were performed, and eight additional cancers were detected. The effect was a 7.62% (eight of 105) increase in the number of breast cancers detected, an increase in the recall rate to 10.77% (2300 of 21 349 mammograms), and a slight decrease in the PPV to 40.8% (113 of 277 biopsies). Radiologists detected 92.9% (105 of 113 cancers) of the total cancers, and CAD correctly marked 76.1% (86 of 113 cancers). Conclusion: The use of CAD improved the detection of breast cancer, with an acceptable increase in the recall rate and a minimal increase in the number of biopsies with benign results.