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Blinded Comparison of Computer-Aided Detection with Human Second Reading in Screening Mammography

¹ Department of Radiology, Breast Imaging, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.
² AVON Breast Center, Boston, MA.
³ Department of Radiology, Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Malignancy detected by human second reviewer in 52-year-old woman with ductal carcinoma in situ (DCIS) who presented with group of three or four punctate calcifications on screening mammograms. At time of screening, these calcifications had arguably been stable for 3 years. Therefore, human second reviewer's motivation to recommend additional views is unknown. At diagnostic visit, radiologist thought that calcifications were stable, but short-interval follow-up was recommended. At that follow-up visit, radiologist thought that calcifications had increased in number since mammograms obtained 3.5 years earlier, although differences in technique were considered, and recommended biopsy. Pathology results were DCIS and calcifications were associated with carcinoma. Mediolateral oblique view. Photographic enlargement shows punctate calcifications (arrows) seen on mammograms obtained 3 years before study mammogram.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Malignancy detected by human second reviewer in 52-year-old woman with ductal carcinoma in situ (DCIS) who presented with group of three or four punctate calcifications on screening mammograms. At time of screening, these calcifications had arguably been stable for 3 years. Therefore, human second reviewer's motivation to recommend additional views is unknown. At diagnostic visit, radiologist thought that calcifications were stable, but short-interval follow-up was recommended. At that follow-up visit, radiologist thought that calcifications had increased in number since mammograms obtained 3.5 years earlier, although differences in technique were considered, and recommended biopsy. Pathology results were DCIS and calcifications were associated with carcinoma. Mediolateral oblique view. Photographic enlargement shows calcifications (arrows) seen at screening; patient was called back by human second reviewer. Diagnostic workup concluded stability, but short-term follow-up was recommended.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Malignancy detected by human second reviewer in 52-year-old woman with ductal carcinoma in situ (DCIS) who presented with group of three or four punctate calcifications on screening mammograms. At time of screening, these calcifications had arguably been stable for 3 years. Therefore, human second reviewer's motivation to recommend additional views is unknown. At diagnostic visit, radiologist thought that calcifications were stable, but short-interval follow-up was recommended. At that follow-up visit, radiologist thought that calcifications had increased in number since mammograms obtained 3.5 years earlier, although differences in technique were considered, and recommended biopsy. Pathology results were DCIS and calcifications were associated with carcinoma. Magnified (x1.8) mediolateral oblique view obtained 6 months after B at time of biopsy that was recommended for same calcifications (arrows).

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Malignancy detected by human second reviewer: 73-year-old woman with ductal carcinoma who was called back by human second reviewer for possible architectural distortion versus summation shadows. Abnormality was suspected on only mediolateral oblique projection of screening mammographic images. Of note is that computer-aided detection (CAD) system had marked this same image, but mark had been dismissed by "CAD reviewer." At time of diagnostic evaluation, many additional views were obtained, and finding was considered to be superimposition of shadows. However, short-term follow-up was recommended in 6 months based only on radiologist's "gut" feeling, even though mammogram was considered to be negative for abnormal findings. At that follow-up, finding was now thought to be architectural distortion in two views but was best seen in craniocaudal projection. Whether this change represented progression in malignancy versus differences in projection is not known. Pathology showed ductal carcinoma in situ. Mediolateral oblique (A) and craniocaudal (B) mammograms. Photographic enlargements show area considered to be overlapping shadows (arrows) after diagnostic workup.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Malignancy detected by human second reviewer: 73-year-old woman with ductal carcinoma who was called back by human second reviewer for possible architectural distortion versus summation shadows. Abnormality was suspected on only mediolateral oblique projection of screening mammographic images. Of note is that computer-aided detection (CAD) system had marked this same image, but mark had been dismissed by "CAD reviewer." At time of diagnostic evaluation, many additional views were obtained, and finding was considered to be superimposition of shadows. However, short-term follow-up was recommended in 6 months based only on radiologist's "gut" feeling, even though mammogram was considered to be negative for abnormal findings. At that follow-up, finding was now thought to be architectural distortion in two views but was best seen in craniocaudal projection. Whether this change represented progression in malignancy versus differences in projection is not known. Pathology showed ductal carcinoma in situ. Mediolateral oblique (A) and craniocaudal (B) mammograms. Photographic enlargements show area considered to be overlapping shadows (arrows) after diagnostic workup.

View larger version (106K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Malignancy detected by human second reviewer: 73-year-old woman with ductal carcinoma who was called back by human second reviewer for possible architectural distortion versus summation shadows. Abnormality was suspected on only mediolateral oblique projection of screening mammographic images. Of note is that computer-aided detection (CAD) system had marked this same image, but mark had been dismissed by "CAD reviewer." At time of diagnostic evaluation, many additional views were obtained, and finding was considered to be superimposition of shadows. However, short-term follow-up was recommended in 6 months based only on radiologist's "gut" feeling, even though mammogram was considered to be negative for abnormal findings. At that follow-up, finding was now thought to be architectural distortion in two views but was best seen in craniocaudal projection. Whether this change represented progression in malignancy versus differences in projection is not known. Pathology showed ductal carcinoma in situ. Craniocaudal (C) and mediolateral oblique (D) mammograms (magnification, x1.8) 6 months later show architectural distortion (arrows) that prompted the radiologist to recommend surgical biopsy.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Malignancy detected by human second reviewer: 73-year-old woman with ductal carcinoma who was called back by human second reviewer for possible architectural distortion versus summation shadows. Abnormality was suspected on only mediolateral oblique projection of screening mammographic images. Of note is that computer-aided detection (CAD) system had marked this same image, but mark had been dismissed by "CAD reviewer." At time of diagnostic evaluation, many additional views were obtained, and finding was considered to be superimposition of shadows. However, short-term follow-up was recommended in 6 months based only on radiologist's "gut" feeling, even though mammogram was considered to be negative for abnormal findings. At that follow-up, finding was now thought to be architectural distortion in two views but was best seen in craniocaudal projection. Whether this change represented progression in malignancy versus differences in projection is not known. Pathology showed ductal carcinoma in situ. Craniocaudal (C) and mediolateral oblique (D) mammograms (magnification, x1.8) 6 months later show architectural distortion (arrows) that prompted the radiologist to recommend surgical biopsy.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —False-negative case for all reviewers: 76-year-old woman with invasive ductal carcinoma. Craniocaudal mammogram obtained 4 years before study in which mass (arrow) was excised and was found to be benign (fibrocystic changes without atypia) at histology.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —False-negative case for all reviewers: 76-year-old woman with invasive ductal carcinoma. Screening mammogram, craniocaudal view, 2 years before study shows postsurgical changes.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —False-negative case for all reviewers: 76-year-old woman with invasive ductal carcinoma. Screening mammogram, craniocaudal view, at time of study in which increase in density at biopsy site was not detected by any of reviewers, although area was marked by computer-aided detection system.

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