Computerized "Second Opinions" for Mammograms

According to a new study by a team of Texas researchers, the use of computer-aided detection (CAD) programs to interpret mammograms can significantly enhance the ability of radiologists to detect cancers that might otherwise be missed.

Drs. Timothy Freer and Michael Ulissey of the Women's Diagnostic Breast Health Center in Plano, Texas evaluated mammograms from 12,860 patients over a 12-month period. The mammograms were initially reviewed by radiologists without the assistance of a computer-aided detection program. The CAD system was then used to re-evaluate each mammogram, which was then reviewed a second time by the radiologist.

Importantly, the CAD-assisted review by the radiologist resulted in "a 19.5 percent increase in the number of cancers detected," they wrote in the journal Radiology, "and an increase in the proportion of early-stage (stage 0 and 1) malignancies detected from 73 percent to 78 percent."

The researchers said that even the most experienced radiologists can overlook extremely subtle signs of breast cancer that the CAD program is designed to highlight. Furthermore, many radiologists do not specialize in breast cancer detection, which can dramatically increase the potential for missing early cancers.

"The use of CAD in the interpretation of screening mammograms can increase the detection of early-stage malignancies," they concluded, "without undue effect on the recall rate or positive predictive value for biopsy." They suggested that the CAD technology may soon revolutionize screening mammography, calling it "the greatest single advance in breast cancer detection in the last 20 years."

SOURCE:
Radiology, September 2001; 220:781-786

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