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Prospective Assessment of Computer-Aided Detection in Interpretation of Screening Mammography

Justin M. Ko1, Michael J. Nicholas1,2, Jeffrey B. Mendel1 and Priscilla J. Slanetz1,3

1 Department of Radiology, Caritas St. Elizabeth's Medical Center and Tufts University School of Medicine, Boston, MA.
2 Present address: Department of Radiology, Hospital of Saint Raphael, New Haven, CT.
3 Present address: Department of Radiology, Boston University School of Medicine, Boston Medical Center, 88 East Newton St., Boston, MA 02118.


Figure 1
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  		Fig. 1A —49-year-old woman underwent bilateral screening mammography. Patient presented with palpable mass 5 months after screening mammography. Stage II invasive ductal carcinoma was seen at biopsy. Mediolateral oblique view reveals no suspicious findings.

 

Figure 2
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  		Fig. 1B —49-year-old woman underwent bilateral screening mammography. Patient presented with palpable mass 5 months after screening mammography. Stage II invasive ductal carcinoma was seen at biopsy. Craniocaudal view shows subtle asymmetry.

 

Figure 3
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  		Fig. 1C —49-year-old woman underwent bilateral screening mammography. Patient presented with palpable mass 5 months after screening mammography. Stage II invasive ductal carcinoma was seen at biopsy. Right craniocaudal view at time of screening mammogram.

 

Figure 4
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  		Fig. 1D —49-year-old woman underwent bilateral screening mammography. Patient presented with palpable mass 5 months after screening mammography. Stage II invasive ductal carcinoma was seen at biopsy. Right craniocaudal view 4 months later. Asymmetry was not marked by radiologist but was marked by computer-aided detection (CAD) on screening mammogram craniocaudal view. Mass (arrow) was not marked by CAD when patient returned with palpable mass. Linear markers on images are routinely placed on skin over visible incision sites in women who have previously undergone surgery.

 

Figure 5
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  		Fig. 2A —50-year-old woman underwent bilateral screening mammography. Grade II ductal carcinoma in situ was seen at biopsy. Mediolateral oblique (A) and craniocaudal (B) views show faint calcifications that were marked by computer-aided detection (CAD) on craniocaudal view, as indicated by irregular circle in left breast, outer quadrant, but were not marked by radiologist.

 

Figure 6
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  		Fig. 2B —50-year-old woman underwent bilateral screening mammography. Grade II ductal carcinoma in situ was seen at biopsy. Mediolateral oblique (A) and craniocaudal (B) views show faint calcifications that were marked by computer-aided detection (CAD) on craniocaudal view, as indicated by irregular circle in left breast, outer quadrant, but were not marked by radiologist.

 

Figure 7
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  		Fig. 2C —50-year-old woman underwent bilateral screening mammography. Grade II ductal carcinoma in situ was seen at biopsy. Left craniocaudal film shows calcifications more clearly.

 

Figure 8
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  		Fig. 3A —81-year-old woman underwent bilateral screening mammography. Grade I ductal carcinoma in situ was seen at biopsy. Mediolateral oblique (A) and craniocaudal (B) views show irregular mass that was marked by radiologist (indicated by wax pencil mark) and missed by computer-aided detection (CAD).

 

Figure 9
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  		Fig. 3B —81-year-old woman underwent bilateral screening mammography. Grade I ductal carcinoma in situ was seen at biopsy. Mediolateral oblique (A) and craniocaudal (B) views show irregular mass that was marked by radiologist (indicated by wax pencil mark) and missed by computer-aided detection (CAD).

 

Figure 10
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  		Fig. 3C —81-year-old woman underwent bilateral screening mammography. Grade I ductal carcinoma in situ was seen at biopsy. Right craniocaudal (C) and right mediolateral oblique (D) magnified views from original screening examination show this mass (arrow) more clearly.

 

Figure 11
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  		Fig. 3D —81-year-old woman underwent bilateral screening mammography. Grade I ductal carcinoma in situ was seen at biopsy. Right craniocaudal (C) and right mediolateral oblique (D) magnified views from original screening examination show this mass (arrow) more clearly.

 

Figure 12
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  		Fig. 4A —81-year-old woman underwent bilateral screening mammography. Stage I invasive ductal carcinoma was seen at biopsy. Mediolateral oblique (A) and craniocaudal (B) views show architectural distortion that was marked by radiologist (indicated by wax pencil mark) and missed by computer-aided detection (CAD).

 

Figure 13
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  		Fig. 4B —81-year-old woman underwent bilateral screening mammography. Stage I invasive ductal carcinoma was seen at biopsy. Mediolateral oblique (A) and craniocaudal (B) views show architectural distortion that was marked by radiologist (indicated by wax pencil mark) and missed by computer-aided detection (CAD).

 

Figure 14
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  		Fig. 4C —81-year-old woman underwent bilateral screening mammography. Stage I invasive ductal carcinoma was seen at biopsy. Left craniocaudal (C) and left mediolateral oblique (D) magnified views from original screening examination show architectural distortion more clearly. Arrow indicates location of lesion.

 

Figure 15
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  		Fig. 4D —81-year-old woman underwent bilateral screening mammography. Stage I invasive ductal carcinoma was seen at biopsy. Left craniocaudal (C) and left mediolateral oblique (D) magnified views from original screening examination show architectural distortion more clearly. Arrow indicates location of lesion.

 

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