Vast majority of CAD prompts are dismissed by interpreting radiologist
False-positive (FP) prompts: CAD-generated prompts in areas where no cancer is present
Computer-aided diagnosis: Computer-generated statistical assessment of imaging findings suggesting likelihood of malignancy based on comparison with large number of similar findings
Double reading: ≥ 2 independent radiologists interpret same group of images
Discordant readings assigned assessment by consensus or arbitration
Consensus: Discussion among interpreting radiologists
Arbitration: 3rd radiologist makes independent decision
↑ perception (sensitivity) and ↑ specificity
May act on all cases indicated as abnormal from either reading
↑ perception (sensitivity) and ↓ specificity
Screening mammography
Asymptomatic standard MLO and CC screening mammograms performed and evaluated for quality assurance by technologists
Women arrive and leave center without waiting for either verbal or written reports, not monitored by physician
Mammograms "batch-read" by radiologist in concentrated and focused setting
Mammograms are either deemed negative, benign (BI-RADS 1, 2), or incomplete (BI-RADS 0)
Women receive via mail or phone call either standard negative report or recommendation to return for additional imaging or biopsy
Recall rate: Percentage of women with recommendation to return for further imaging or biopsy prior to next screening examination
Desired goal (benchmarks) < 10% recall rate
When prior, recent comparisons available, recall rate 30% lower than for baseline (1st mammogram) or no priors
Costs (financial and emotional) related to recall rates must be considered
Most recalled cases do not undergo biopsy: 10% recall → 1-2% biopsy rate; 15-35% PPV of biopsy
IMAGING
General Features
PATHOLOGY
General Pathologic Considerations
CLINICAL ISSUES
Clinical Importance
Expected Performance
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Henriksen EL et al: The efficacy of using computer-aided detection (CAD) for detection of breast cancer in mammography screening: a systematic review. Acta Radiol. 60(1):13-8, 2019
Conant E et al: Improving accuracy and efficiency with concurrent use of artificial intelligence for digital breast tomosynthesis screening. Radiological Society of North America 2018 Scientific Assembly and Annual Meeting, November 26, 2018, Chicago IL (abstr)
Benedikt RA et al: Concurrent computer-aided detection improves reading time of digital breast tomosynthesis and maintains interpretation performance in a multireader multicase study. AJR Am J Roentgenol. 210(3):685-94, 2018
James JJ et al: Evaluation of a computer-aided detection (CAD)-enhanced 2D synthetic mammogram: comparison with standard synthetic 2D mammograms and conventional 2D digital mammography. Clin Radiol. 73(10):886-92, 2018
Katzen J et al: A review of computer aided detection in mammography. Clin Imaging. 52:305-9, 2018
Keen JD et al: Utilization of computer-aided detection for digital screening mammography in the United States, 2008 to 2016. J Am Coll Radiol. 15(1 Pt A):44-8, 2018
Balleyguier C et al: Improving digital breast tomosynthesis reading time: a pilot multi-reader, multi-case study using concurrent Computer-Aided Detection (CAD). Eur J Radiol. 97:83-89, 2017
Cho KR et al: Breast cancer detection in a screening population: comparison of digital mammography, computer-aided detection applied to digital mammography and breast ultrasound. J Breast Cancer. 19(3):316-23, 2016
Lehman CD et al: Diagnostic accuracy of digital screening mammography with and without computer-aided detection. JAMA Intern Med. 175(11):1828-37, 2015
Morra L et al: Breast cancer: computer-aided detection with digital breast tomosynthesis. Radiology. 141959, 2015
Bargalló X et al: Single reading with computer-aided detection performed by selected radiologists in a breast cancer screening program. Eur J Radiol. 83(11):2019-23, 2014
Cole EB et al: Impact of computer-aided detection systems on radiologist accuracy with digital mammography. AJR Am J Roentgenol. 203(4):909-16, 2014
Bargalló X et al: Role of computer-aided detection in very small screening detected invasive breast cancers. J Digit Imaging. 26(3):572-7, 2013
Fenton JJ et al: Short-term outcomes of screening mammography using computer-aided detection: a population-based study of medicare enrollees. Ann Intern Med. 158(8):580-7, 2013
Murakami R et al: Detection of breast cancer with a computer-aided detection applied to full-field digital mammography. J Digit Imaging. 26(4):768-73, 2013
Park CS et al: Detection of breast cancer in asymptomatic and symptomatic groups using computer-aided detection with full-field digital mammography. J Breast Cancer. 16(3):322-8, 2013
Destounis SV et al: CAD may not be necessary for microcalcifications in the digital era, CAD may benefit radiologists for masses. J Clin Imaging Sci. 2:45, 2012
Geller BM et al: Is confidence of mammographic assessment a good predictor of accuracy? AJR Am J Roentgenol. 199(1):W134-41, 2012
Nishikawa RM et al: Clinically missed cancer: how effectively can radiologists use computer-aided detection? AJR Am J Roentgenol. 198(3) :708-16, 2012
Scaranelo AM et al: Evaluation of breast amorphous calcifications by a computer-aided detection system in full-field digital mammography. Br J Radiol. 85:517-22, 2012
Waldmann A et al: Benefits of the quality assured double and arbitration reading of mammograms in the early diagnosis of breast cancer in symptomatic women. Eur Radiol. 22(5):1014-22, 2012
Berlin L: Mammographic CAD markings: archive or discard? AJR Am J Roentgenol. 196:W659, 2011
Fenton JJ et al: Effectiveness of computer-aided detection in community mammography practice. J Natl Cancer Inst. 103(15):1152-61, 2011
Glynn CG et al: Effect of transition to digital mammography on clinical outcomes. Radiology. 260(3):664-70, 2011
Cho N et al: Features of prospectively overlooked computer-aided detection marks on prior screening digital mammograms in women with breast cancer. AJR Am J Roentgenol. 195(5):1276-82, 2010
James JJ et al: Mammographic features of breast cancers at single reading with computer-aided detection and at double reading in a large multicenter prospective trial of computer-aided detection: CADET II. Radiology. 256(2):379-86, 2010
Cawson JN et al: Invasive breast cancers detected by screening mammography: a detailed comparison of computer-aided detection-assisted single reading and double reading. J Med Imaging Radiat Oncol. 53(5):442-9, 2009
Duijm LE et al: Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome. Br J Cancer. 100(6):901-7, 2009
Malich A et al: The performance of computer-aided detection when analyzing prior mammograms of newly detected breast cancers with special focus on the time interval from initial imaging to detection. Eur J Radiol. 69:574-8, 2009
Noble M et al: Computer-aided detection mammography for breast cancer screening: systematic review and meta-analysis. Arch Gynecol Obstet. 279(6):881-90, 2009
Gromet M: Comparison of computer-aided detection to double reading of screening mammograms: review of 231,221 mammograms. AJR Am J Roentgenol. 190(4):854-9, 2008
Kim SJ et al: Computer-aided detection in full-field digital mammography: sensitivity and reproducibility in serial examinations. Radiology. 246(1):71-80, 2008
Fenton JJ et al: Influence of computer-aided detection on performance of screening mammography. N Engl J Med. 356(14):1399-409, 2007
Skaane P et al: Effect of computer-aided detection on independent double reading of paired screen-film and full-field digital screening mammograms. AJR Am J Roentgenol. 188(2):377-84, 2007
Yang SK et al: Screening mammography-detected cancers: sensitivity of a computer-aided detection system applied to full-field digital mammograms. Radiology. 244(1):104-11, 2007
Dean JC et al: Improved cancer detection using computer-aided detection with diagnostic and screening mammography: prospective study of 104 cancers. AJR Am J Roentgenol. 187(1):20-8, 2006
Ko JM et al: Prospective assessment of computer-aided detection in interpretation of screening mammography. AJR Am J Roentgenol. 187(6):1483-91, 2006
Lindfors KK et al: Computer-aided detection of breast cancer: a cost-effectiveness study. Radiology. 239(3):710-7, 2006
Morton MJ et al: Screening mammograms: interpretation with computer-aided detection--prospective evaluation. Radiology. 239(2):375-83, 2006
Birdwell RL et al: Computer-aided detection with screening mammography in a university hospital setting. Radiology. 236(2):451-7, 2005
Burhenne LJW: Proficiency in mammography: interpretive skills, computer-aided detection, and double reading. Breast Imaging: RSNA Categorical Course in Diagnostic Radiology. 93-106, 2005
Cupples TE et al: Impact of computer-aided detection in a regional screening mammography program. AJR Am J Roentgenol. 185(4):944-50, 2005
Khoo LA et al: Computer-aided detection in the United Kingdom National Breast Screening Programme: prospective study. Radiology. 237(2):444-9, 2005
Soo MS et al: Computer-aided detection of amorphous calcifications. AJR Am J Roentgenol. 184(3):887-92, 2005
Destounis SV et al: Can computer-aided detection with double reading of screening mammograms help decrease the false-negative rate? Initial experience. Radiology. 232(2):578-84, 2004
Feig SA et al: Re: Changes in breast cancer detection and mammography recall rates after the introduction of a computer-aided detection system. J Natl Cancer Inst. 96(16):1260-1; author reply 1261, 2004
Helvie MA et al: Sensitivity of noncommercial computer-aided detection system for mammographic breast cancer detection: pilot clinical trial. Radiology. 231(1):208-14, 2004
Baker JA et al: Computer-aided detection (CAD) in screening mammography: sensitivity of commercial CAD systems for detecting architectural distortion. AJR Am J Roentgenol. 181(4):1083-8, 2003
Beam CA et al: Association of volume and volume-independent factors with accuracy in screening mammogram interpretation. J Natl Cancer Inst. 95(4):282-90, 2003
Beam CA: Interpretation error in mammography: taxonomy and measurement. Semin Breast Dis. 6:153-5, 2003
Ciatto S et al: Comparison of standard reading and computer aided detection (CAD) on a national proficiency test of screening mammography. Eur J Radiol. 45(2):135-8, 2003
Harvey SC et al: Increase in cancer detection and recall rates with independent double interpretation of screening mammography. AJR Am J Roentgenol. 180(5):1461-7, 2003
Malich A et al: Influence of breast lesion size and histologic findings on tumor detection rate of a computer-aided detection system. Radiology. 228(3):851-6, 2003
Sickles EA et al: Performance parameters for screening and diagnostic mammography: specialist and general radiologists. Radiology. 224(3):861-9, 2002
Brem RF et al: Radiologist detection of microcalcifications with and without computer-aided detection: a comparative study. Clin Radiol. 56(2):150-4, 2001
Freer TW et al: Screening mammography with computer-aided detection: prospective study of 12,860 patients in a community breast center. Radiology. 220(3):781-6, 2001
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Abbreviations
Computer-aided/-assisted detection (CAD)
Distinguish from computer-aided diagnosis
CAD + R: CAD + single reader
Definitions
CAD
Neural network-generated prompts (marks) highlight areas of concern, directing attention of interpreting radiologist
Analog films must be digitized and then processed with a CAD algorithm; digitally acquired images directly interface with the CAD system
CAD marks are displayed on low-resolution workstation images by pushing button or on paper printout
For digital mammography, CAD systems interface directly with workstation on which mammograms are interpreted
CAD engaged by pushing button on workstation console; CAD marks displayed directly over mammographic images
Recognized marks (e.g., asterisks or triangles) project over/near findings recognized by neural network
Interpreting radiologist makes final determination as to assessment
Negative or benign, return to screening interval (BI-RADS 1, 2)
Vast majority of CAD prompts are dismissed by interpreting radiologist
False-positive (FP) prompts: CAD-generated prompts in areas where no cancer is present
Computer-aided diagnosis: Computer-generated statistical assessment of imaging findings suggesting likelihood of malignancy based on comparison with large number of similar findings
Double reading: ≥ 2 independent radiologists interpret same group of images
Discordant readings assigned assessment by consensus or arbitration
Consensus: Discussion among interpreting radiologists
Arbitration: 3rd radiologist makes independent decision
↑ perception (sensitivity) and ↑ specificity
May act on all cases indicated as abnormal from either reading
↑ perception (sensitivity) and ↓ specificity
Screening mammography
Asymptomatic standard MLO and CC screening mammograms performed and evaluated for quality assurance by technologists
Women arrive and leave center without waiting for either verbal or written reports, not monitored by physician
Mammograms "batch-read" by radiologist in concentrated and focused setting
Mammograms are either deemed negative, benign (BI-RADS 1, 2), or incomplete (BI-RADS 0)
Women receive via mail or phone call either standard negative report or recommendation to return for additional imaging or biopsy
Recall rate: Percentage of women with recommendation to return for further imaging or biopsy prior to next screening examination
Desired goal (benchmarks) < 10% recall rate
When prior, recent comparisons available, recall rate 30% lower than for baseline (1st mammogram) or no priors
Costs (financial and emotional) related to recall rates must be considered
Most recalled cases do not undergo biopsy: 10% recall → 1-2% biopsy rate; 15-35% PPV of biopsy
IMAGING
General Features
PATHOLOGY
General Pathologic Considerations
CLINICAL ISSUES
Clinical Importance
Expected Performance
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Henriksen EL et al: The efficacy of using computer-aided detection (CAD) for detection of breast cancer in mammography screening: a systematic review. Acta Radiol. 60(1):13-8, 2019
Conant E et al: Improving accuracy and efficiency with concurrent use of artificial intelligence for digital breast tomosynthesis screening. Radiological Society of North America 2018 Scientific Assembly and Annual Meeting, November 26, 2018, Chicago IL (abstr)
Benedikt RA et al: Concurrent computer-aided detection improves reading time of digital breast tomosynthesis and maintains interpretation performance in a multireader multicase study. AJR Am J Roentgenol. 210(3):685-94, 2018
James JJ et al: Evaluation of a computer-aided detection (CAD)-enhanced 2D synthetic mammogram: comparison with standard synthetic 2D mammograms and conventional 2D digital mammography. Clin Radiol. 73(10):886-92, 2018
Katzen J et al: A review of computer aided detection in mammography. Clin Imaging. 52:305-9, 2018
Keen JD et al: Utilization of computer-aided detection for digital screening mammography in the United States, 2008 to 2016. J Am Coll Radiol. 15(1 Pt A):44-8, 2018
Balleyguier C et al: Improving digital breast tomosynthesis reading time: a pilot multi-reader, multi-case study using concurrent Computer-Aided Detection (CAD). Eur J Radiol. 97:83-89, 2017
Cho KR et al: Breast cancer detection in a screening population: comparison of digital mammography, computer-aided detection applied to digital mammography and breast ultrasound. J Breast Cancer. 19(3):316-23, 2016
Lehman CD et al: Diagnostic accuracy of digital screening mammography with and without computer-aided detection. JAMA Intern Med. 175(11):1828-37, 2015
Morra L et al: Breast cancer: computer-aided detection with digital breast tomosynthesis. Radiology. 141959, 2015
Bargalló X et al: Single reading with computer-aided detection performed by selected radiologists in a breast cancer screening program. Eur J Radiol. 83(11):2019-23, 2014
Cole EB et al: Impact of computer-aided detection systems on radiologist accuracy with digital mammography. AJR Am J Roentgenol. 203(4):909-16, 2014
Bargalló X et al: Role of computer-aided detection in very small screening detected invasive breast cancers. J Digit Imaging. 26(3):572-7, 2013
Fenton JJ et al: Short-term outcomes of screening mammography using computer-aided detection: a population-based study of medicare enrollees. Ann Intern Med. 158(8):580-7, 2013
Murakami R et al: Detection of breast cancer with a computer-aided detection applied to full-field digital mammography. J Digit Imaging. 26(4):768-73, 2013
Park CS et al: Detection of breast cancer in asymptomatic and symptomatic groups using computer-aided detection with full-field digital mammography. J Breast Cancer. 16(3):322-8, 2013
Destounis SV et al: CAD may not be necessary for microcalcifications in the digital era, CAD may benefit radiologists for masses. J Clin Imaging Sci. 2:45, 2012
Geller BM et al: Is confidence of mammographic assessment a good predictor of accuracy? AJR Am J Roentgenol. 199(1):W134-41, 2012
Nishikawa RM et al: Clinically missed cancer: how effectively can radiologists use computer-aided detection? AJR Am J Roentgenol. 198(3) :708-16, 2012
Scaranelo AM et al: Evaluation of breast amorphous calcifications by a computer-aided detection system in full-field digital mammography. Br J Radiol. 85:517-22, 2012
Waldmann A et al: Benefits of the quality assured double and arbitration reading of mammograms in the early diagnosis of breast cancer in symptomatic women. Eur Radiol. 22(5):1014-22, 2012
Berlin L: Mammographic CAD markings: archive or discard? AJR Am J Roentgenol. 196:W659, 2011
Fenton JJ et al: Effectiveness of computer-aided detection in community mammography practice. J Natl Cancer Inst. 103(15):1152-61, 2011
Glynn CG et al: Effect of transition to digital mammography on clinical outcomes. Radiology. 260(3):664-70, 2011
Cho N et al: Features of prospectively overlooked computer-aided detection marks on prior screening digital mammograms in women with breast cancer. AJR Am J Roentgenol. 195(5):1276-82, 2010
James JJ et al: Mammographic features of breast cancers at single reading with computer-aided detection and at double reading in a large multicenter prospective trial of computer-aided detection: CADET II. Radiology. 256(2):379-86, 2010
Cawson JN et al: Invasive breast cancers detected by screening mammography: a detailed comparison of computer-aided detection-assisted single reading and double reading. J Med Imaging Radiat Oncol. 53(5):442-9, 2009
Duijm LE et al: Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome. Br J Cancer. 100(6):901-7, 2009
Malich A et al: The performance of computer-aided detection when analyzing prior mammograms of newly detected breast cancers with special focus on the time interval from initial imaging to detection. Eur J Radiol. 69:574-8, 2009
Noble M et al: Computer-aided detection mammography for breast cancer screening: systematic review and meta-analysis. Arch Gynecol Obstet. 279(6):881-90, 2009
Gromet M: Comparison of computer-aided detection to double reading of screening mammograms: review of 231,221 mammograms. AJR Am J Roentgenol. 190(4):854-9, 2008
Kim SJ et al: Computer-aided detection in full-field digital mammography: sensitivity and reproducibility in serial examinations. Radiology. 246(1):71-80, 2008
Fenton JJ et al: Influence of computer-aided detection on performance of screening mammography. N Engl J Med. 356(14):1399-409, 2007
Skaane P et al: Effect of computer-aided detection on independent double reading of paired screen-film and full-field digital screening mammograms. AJR Am J Roentgenol. 188(2):377-84, 2007
Yang SK et al: Screening mammography-detected cancers: sensitivity of a computer-aided detection system applied to full-field digital mammograms. Radiology. 244(1):104-11, 2007
Dean JC et al: Improved cancer detection using computer-aided detection with diagnostic and screening mammography: prospective study of 104 cancers. AJR Am J Roentgenol. 187(1):20-8, 2006
Ko JM et al: Prospective assessment of computer-aided detection in interpretation of screening mammography. AJR Am J Roentgenol. 187(6):1483-91, 2006
Lindfors KK et al: Computer-aided detection of breast cancer: a cost-effectiveness study. Radiology. 239(3):710-7, 2006
Morton MJ et al: Screening mammograms: interpretation with computer-aided detection--prospective evaluation. Radiology. 239(2):375-83, 2006
Birdwell RL et al: Computer-aided detection with screening mammography in a university hospital setting. Radiology. 236(2):451-7, 2005
Burhenne LJW: Proficiency in mammography: interpretive skills, computer-aided detection, and double reading. Breast Imaging: RSNA Categorical Course in Diagnostic Radiology. 93-106, 2005
Cupples TE et al: Impact of computer-aided detection in a regional screening mammography program. AJR Am J Roentgenol. 185(4):944-50, 2005
Khoo LA et al: Computer-aided detection in the United Kingdom National Breast Screening Programme: prospective study. Radiology. 237(2):444-9, 2005
Soo MS et al: Computer-aided detection of amorphous calcifications. AJR Am J Roentgenol. 184(3):887-92, 2005
Destounis SV et al: Can computer-aided detection with double reading of screening mammograms help decrease the false-negative rate? Initial experience. Radiology. 232(2):578-84, 2004
Feig SA et al: Re: Changes in breast cancer detection and mammography recall rates after the introduction of a computer-aided detection system. J Natl Cancer Inst. 96(16):1260-1; author reply 1261, 2004
Helvie MA et al: Sensitivity of noncommercial computer-aided detection system for mammographic breast cancer detection: pilot clinical trial. Radiology. 231(1):208-14, 2004
Baker JA et al: Computer-aided detection (CAD) in screening mammography: sensitivity of commercial CAD systems for detecting architectural distortion. AJR Am J Roentgenol. 181(4):1083-8, 2003
Beam CA et al: Association of volume and volume-independent factors with accuracy in screening mammogram interpretation. J Natl Cancer Inst. 95(4):282-90, 2003
Beam CA: Interpretation error in mammography: taxonomy and measurement. Semin Breast Dis. 6:153-5, 2003
Ciatto S et al: Comparison of standard reading and computer aided detection (CAD) on a national proficiency test of screening mammography. Eur J Radiol. 45(2):135-8, 2003
Harvey SC et al: Increase in cancer detection and recall rates with independent double interpretation of screening mammography. AJR Am J Roentgenol. 180(5):1461-7, 2003
Malich A et al: Influence of breast lesion size and histologic findings on tumor detection rate of a computer-aided detection system. Radiology. 228(3):851-6, 2003
Sickles EA et al: Performance parameters for screening and diagnostic mammography: specialist and general radiologists. Radiology. 224(3):861-9, 2002
Brem RF et al: Radiologist detection of microcalcifications with and without computer-aided detection: a comparative study. Clin Radiol. 56(2):150-4, 2001
Freer TW et al: Screening mammography with computer-aided detection: prospective study of 12,860 patients in a community breast center. Radiology. 220(3):781-6, 2001
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