2004 Computer-Aided Detection in Screening Mammography: Variability in Cues Authors: Jay A. Baker, Joseph Y. Lo, David M. Delong, and Carey E. Floyd Published: Radiology 2004; 233:411-417. PURPOSE: To evaluate the variability of true-positive and false-positive cues by using a commercially available computer-aided detection (CAD) system for analysis of 50 malignancies in a screening population. RESULTS: Each set of mammograms (CC and MLO views) was digitized and analyzed by the CAD system 10 times. Overall CAD sensitivity when at least one of the two mammographic views was marked correctly was 82.4%; and, variability in true-positive CAD cues was demonstrated for 14 of 50 (28%) cases. However, the CAD system consistently detected 40–43 of the 50 breast cancers in each of the 10 CAD runs. Variability for false-positive marks was significantly greater than that for true-positive marks.   Computer-Aided Detection Performance in Mammographic Examination of Masses: Assessment Authors: David Gur, Jennifer S. Stalder, Lara A. Hardesty et.al. Published: Radiology 2004; 233:418-423. PURPOSE: To compare performance of two computer-aided detection (CAD) systems and an in-house scheme applied to five groups of sequentially acquired screening mammograms.   Can Computer-Aided Detection with Double Reading of Screening Mammograms Help Decrease the False-Negative Rate? Initial Experience Authors: Destounis SV, DiNitto P, Logan-Young W, et al Published: Radiology 2004; 232:578-584. PURPOSE: To retrospectively evaluate the role of computer-aided detection (CAD) in reducing the rate of false-negative (FN) findings on screening mammograms considered normal at initial double reading. RESULTS: Of 71 visible cancers seen in retrospect, 52 (73%) were considered actionable. The CAD system correctly marked 37 (71%) of these 52 cancers on the prior screening mammograms which had been double read as negative in the previous screening years. CONCLUSION: -CAD has the potential to decrease the FN rate at double reading by more than one-third (from 31% to 19%).   Changes in Breast Cancer Detection and Mammography Recall Rates After the Introduction of a Computer-Aided Detection System Authors: Gur D, Sumkin JH, Rockette HE et al. Published: J Natl Cancer Inst 2004; 96: 185–90. PURPOSE: Assessment of changes in mammography recall and cancer detection rates after the introduction of a computer-aided detection system into a clinical radiology practice in an academic setting. CONCLUSION: The authors concluded that the introduction of computer-aided detection into this practice was not associated with statistically significant changes in recall and breast cancer detection rates, both for the entire group of radiologists and for the subset of radiologists who interpreted high volumes of mammograms. (See below Letter to the Editor)   Letter to the Editor: Re: Changes in Breast Cancer Detection and Mammography Recall Rates After the Introduction of a Computer-Aided Detection System Authors: Stephen A. Feig, Edward A. Sickles, W. Phil Evans, Michael N. Linver Published: J Natl Cancer Inst 2004: 96:1260-1261. In this Letter to the Editor, Feig, Sickles, Evans and Linver pointed out that:      Use of computer-aided detection by the low-volume radiologists was associated with a 19.7% increase in their detection rate (from 3.05 cancers per 1000 mammograms without computer-aided detection to 3.65 cancers per 1000 mammograms with computer-aided detection).      Thus, use of computer-aided detection allowed the low-volume radiologists to increase their collective detection rate to a rate equal to that of the high-volume radiologists Further, there had been no correction for the approximate decrease from 40% to 30% of the women who had been screened for the first time, which could obscure any evidence of benefit from CAD.   Computer-Aided Detection Output On 172 Subtle Findings On Normal Mammograms Previously Obtained In Women With Breast Cancer Detected At Follow-Up Screening Mammography Authors: Ikeda DM, Birdwell RL, O’Shaughnessy KF, Sickles EA, and Brenner RJ Published: Radiology 2004; 230: 811-819. PURPOSE: To evaluate, by using a computer-aided detection (CAD) program, the nonspecific findings on normal screening mammograms obtained in women in whom breast cancer was later detected at follow-up screening mammography. In 169 cases, in which 172 cancers were later depicted, findings on the initial mammogram were subtle enough that either none or only one or two of five blinded radiologists recommended screening recall. CONCLUSION: Although the CAD program marked 72 (42%) of the 172 findings that subsequently developed into cancer. The authors believed that there were a subset of cancers that display perceptible but nonspecific mammographic findings that do not warrant recall, as judged by both a majority of blinded radiologists and by unblinded reviewers. Failure to act on these nonspecific findings prospectively was felt to not necessarily constitute interpretation below a reasonable standard of care.   Computer-Aided Detection in Diagnostic Mammography: Detection of Clinically Unsuspected Cancers Authors: Butler SA, Gabbay RJ, Kass DA, Siedler DE, O’Shaughnessy KF, Castellino RA Published: AJR 2004; 183: 1511-1515. OBJECTIVE: To (a) determine the percentage of women presenting with clinical findings whose diagnostic mammogram led to detection of a breast cancer at a site distant from the original clinical complaint and to (b) assess the performance of computer aided detection (CAD) on diagnostic mammography. RESULTS: There were 212 biopsy-proven cancers in 197 patients. Two separate cancers were found in 7.6% (15/197) of the cases. In another 7.6% (15/197) of the cases, the single diagnosed cancer was not at the location of the specific clinical finding. The CAD system correctly marked 87% (26/30) of those cancers that were clinically unsuspected (i.e., not at the location of the clinical finding) and may therefore be useful as a detection aid to the radiologist when interpreting diagnostic mammograms. This modified abstract is displayed and reprinted here with permission from the American Roentgen Ray Society. www.ajronline.org