Influence of computer-aided detection on performance of screening mammography.
Background: Computer-aided detection identifies suspicious findings on mammograms to assist radiologists. Since the Food and Drug Administration approved the technology in 1998, it has been disseminated into practice, but its effect on the accuracy of interpretation is unclear.Methods: We determined...
| Published in: | New England Journal of Medicine Vol. 356; no. 14; pp. 1399 - 1414 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , |
| Format: | CEU exam questions research tables/charts Journal Article |
| Published: |
New England Journal of Medicine
4/5/2007
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106286500&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106286500 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00284793 NEJ jtl: New England Journal of Medicine issn: 00284793 maglogo: N pubinfo: dt: 4/5/2007 vid: 356 iid: 14 pid: 388 pub: New England Journal of Medicine place: Waltham, Massachusetts artinfo: ui: 106286500 106286500 NLM17409321 2009550255 NLM17409321 PMC3182841 106286500 ppf: 1399 ppct: 15 formats: tig: atl: Influence of computer-aided detection on performance of screening mammography. aug: au: Fenton JJ Taplin SH Carney PA Abraham L Sickles EA D'Orsi C Berns EA Cutter G Hendrick RE Barlow WE Elmore JG Fenton, Joshua J Taplin, Stephen H Carney, Patricia A Abraham, Linn Sickles, Edward A D'Orsi, Carl Berns, Eric A Cutter, Gary Hendrick, R Edward affil: University of California, Davis, Sacramento, USA sug: subj: Breast Neoplasms Diagnosis Diagnosis, Computer Assisted Mammography Methods Adult Aged Breast Neoplasms Physiopathology Cancer Screening Chi Square Test Confidence Intervals Descriptive Research Diagnosis, Computer Assisted Evaluation Diagnosis, Computer Assisted Utilization Education, Continuing (Credit) Female Funding Source Logistic Regression Middle Age Neoplasm Invasiveness Odds Ratio Predictive Value of Tests ROC Curve Sensitivity and Specificity Surveys Validity Human Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female ab: Background: Computer-aided detection identifies suspicious findings on mammograms to assist radiologists. Since the Food and Drug Administration approved the technology in 1998, it has been disseminated into practice, but its effect on the accuracy of interpretation is unclear.Methods: We determined the association between the use of computer-aided detection at mammography facilities and the performance of screening mammography from 1998 through 2002 at 43 facilities in three states. We had complete data for 222,135 women (a total of 429,345 mammograms), including 2351 women who received a diagnosis of breast cancer within 1 year after screening. We calculated the specificity, sensitivity, and positive predictive value of screening mammography with and without computer-aided detection, as well as the rates of biopsy and breast-cancer detection and the overall accuracy, measured as the area under the receiver-operating-characteristic (ROC) curve.Results: Seven facilities (16%) implemented computer-aided detection during the study period. Diagnostic specificity decreased from 90.2% before implementation to 87.2% after implementation (P<0.001), the positive predictive value decreased from 4.1% to 3.2% (P=0.01), and the rate of biopsy increased by 19.7% (P<0.001). The increase in sensitivity from 80.4% before implementation of computer-aided detection to 84.0% after implementation was not significant (P=0.32). The change in the cancer-detection rate (including invasive breast cancers and ductal carcinomas in situ) was not significant (4.15 cases per 1000 screening mammograms before implementation and 4.20 cases after implementation, P=0.90). Analyses of data from all 43 facilities showed that the use of computer-aided detection was associated with significantly lower overall accuracy than was nonuse (area under the ROC curve, 0.871 vs. 0.919; P=0.005).Conclusions: The use of computer-aided detection is associated with reduced accuracy of interpretation of screening mammograms. The increased rate of biopsy with the use of computer-aided detection is not clearly associated with improved detection of invasive breast cancer. pubtype: Academic Journal doctype: CEU exam questions research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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