(Radiology Review) Using computer-aided detection (CAD) significantly improved breast cancer detection, according to a study by researchers at George Washington University Medical Center in Washington DC.
Dr. Rachel Brem and colleagues determined that radiologist sensitivity was increased by 21.2% using CAD. Breast screening programs have been shown to reduce mortality by up to 16%. Eighteen clinical centers participated in this study and their research was published in American Journal of Roentgenology.
Three hundred and seventy-seven potentially missed breast cancers were retrospectively investigated. The previous (9-24 months prior to diagnosis) ‘normal’ screening mammograms of these 377 patients with breast cancer were reviewed.
"In 313 cases, study radiologists recommended additional mammographic evaluation," they wrote. "In 177 cases, the area warranting additional work-up precisely correlated with the subsequently diagnosed cancer," according to the authors.
CAD was applied to the ‘normal’ mammograms and the results were compared to the original reports. Because 123 of the 377 cancer cases thought to be ‘normal’ required further evaluation the authors felt that 123 additional cancers could have been diagnosed.
They determined that 65% of the missed cancers could have been diagnosed using a computer-aided system. Initial radiologist sensitivity was 75.4% compared with 91.4% using computer-aided diagnosis.
"The mean tumor size was 1.20 cm, and 76.9% of the tumors were invasive or microinvasive cancers," they reported. Sixty-six percent of the 154 missed cases with known staging were stage T1, 26.6% were carcinoma in situ, and 7.1% were T2, T3 or T4.
Based on their results they concluded, "Therefore, for every 100,000 women with breast cancer identified without the use of computer-aided detection, an estimated additional 21,200 cancers would be found with the use of computer-aided detection."
Improvement in sensitivity of screening mammography with computer-aided detection: A multi-institutional trialBrem, R. F., et, al,
Department of breast imaging and intervention, George Washington University Medical Center, Washington, DC
AJR 2003 September; 181:687-693
By Ultrasound Review
October 13, 2003
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