Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate

Background: There are two competing methods for improving the accuracy of a radiologist interpreting screening mammograms: computer aids (CAD) or independent second reading. Methods: Bibliographic databases were searched for clinical trials. Meta-analyses estimated impacts of CAD and double reading on odds ratios for cancer detection and recall rates. Sub-group analyses considered double reading with arbitration. Results: Ten studies compared single reading with CAD to single reading. Seventeen compared double to single reading. Double reading increases cancer detection and recall rates. Double reading with arbitration increases detection rate (CI: 1.02-1.15) and decreases recall rate (CI: 0.92-0.96). CAD does not have a significant effect on cancer detection rate (CI: 0.96-1.13) and increases recall rate (95% CI: 1.09-1.12). However, there is considerable heterogeneity in the impact on recall rate in both sets of studies. Conclusion: The evidence that double reading with arbitration enhances screening is stronger than that for single reading with CAD

Use of computer-aided detection (CAD) tools in screening mammography: a multidisciplinary investigation

We summarise a set of analyses and studies conducted to assess the effects of the use of a computer-aided detection (CAD) tool in breast screening. We have used an interdisciplinary approach that combines: (a) statistical analyses inspired by reliability modelling in engineering; (b) experimental studies of decisions of mammography experts using the tool, interpreted in the light of human factors psychology; and (c) ethnographic observations of the use of the tool both in trial conditions and in everyday screening practice. Our investigations have shown patterns of human behaviour and effects of computer-based advice that would not have been revealed by a standard clinical trial approach. For example, we found that the negligible measured effect of CAD could be explained by a range of effects on experts' decisions, beneficial in some cases and detrimental in others. There is some evidence of the latter effects being due to the experts using the computer tool differently from the intentions of the developers. We integrate insights from the different pieces of evidence and highlight their implications for the design, evaluation and deployment of this sort of computer tool

Can high-frequency ultrasound predict metastatic lymph nodes in patients with invasive breast cancer?

Aim To determine whether high-frequency ultrasound can predict the presence of metastatic axillary lymph nodes, with a high specificity and positive predictive value, in patients with invasive breast cancer. The clinical aim is to identify patients with axillary disease requiring surgery who would not normally, on clinical grounds, have an axillary dissection, so potentially improving outcome and survival rates. Materials and methods The ipsilateral and contralateral axillae of 42 consecutive patients with invasive breast cancer were scanned prior to treatment using a B-mode frequency of 13 MHz and a Power Doppler frequency of 7 MHz. The presence or absence of an echogenic centre for each lymph node detected was recorded, and measurements were also taken to determine the L/S ratio and the widest and narrowest part of the cortex. Power Doppler was also used to determine vascularity. The contralateral axilla was used as a control for each patient. Results In this study of patients with invasive breast cancer, ipsilateral lymph nodes with a cortical bulge ≥3 mm and/or at least two lymph nodes with absent echogenic centres indicated the presence of metastatic axillary lymph nodes (10 patients). The sensitivity and specificity were 52.6% and 100%, respectively, positive and negative predictive values were 100% and 71.9%, respectively, the P value was 0.001 and the Kappa score was 0.55.\ud Conclusion This would indicate that high-frequency ultrasound can be used to accurately predict metastatic lymph nodes in a proportion of patients with invasive breast cancer, which may alter patient management

CAD in mammography: lesion-level versus case-level analysis of the effects of prompts on human decisions

Object: To understand decision processes in CAD-supported breast screening by analysing how prompts affect readers’ judgements of individual mammographic features (lesions). To this end we analysed hitherto unexamined details of reports completed by mammogram readers in an earlier evaluation of a CAD tool. Material and methods: Assessments of lesions were extracted from 5,839 reports for 59 cancer cases. Statistical analyses of these data focused on what features readers considered when recalling a cancer case and how readers reacted to CAD prompts. Results: About 13.5% of recall decisions were found to be caused by responses to features other than those indicating actual cancer. Effects of CAD: lesions were more likely to be examined if prompted; the presence of a prompt on a cancer increased the probability of both detection and recall especially for less accurate readers in subtler cases; lack of prompts made cancer features less likely to be detected; false prompts made non-cancer features more likely to be classified as cancer. Conclusion: The apparent lack of impact reported for CAD in some studies is plausibly due to CAD systematically affecting readers’ identification of individual features, in a beneficial way for certain combinations of readers and features and a damaging way for others. Mammogram readers do not ignore prompts. Methodologically, assessing CAD by numbers of recalled cancer cases may be misleading

Effects of incorrect computer-aided detection (CAD) output on human decision-making in mammography

To investigate the effects of incorrect computer output on the reliability of the decisions of human users. This work followed an independent UK clinical trial that evaluated the impact of computer-aided detection(CAD) in breast screening. The aim was to use data from this trial to feed into probabilistic models (similar to those used in "reliability engineering") which would detect and assess possible ways of improving the human-CAD interaction. Some analyses required extra data; therefore, two supplementary studies were conducted. Study 1 was designed to elucidate the effects of computer failure on human performance. Study 2 was conducted to clarify unexpected findings from Study 1

Breast Cancer: Modelling and Detection

This paper reviews a number of the mathematical models used in cancer modelling and then chooses a specific cancer, breast carcinoma, to illustrate how the modelling can be used in aiding detection. We then discuss mathematical models that underpin mammographic image analysis, which complements models of tumour growth and facilitates diagnosis and treatment of cancer. Mammographic images are notoriously difficult to interpret, and we give an overview of the primary image enhancement technologies that have been introduced, before focusing on a more detailed description of some of our own recent work on the use of physics-based modelling in mammography. This theoretical approach to image analysis yields a wealth of information that could be incorporated into the mathematical models, and we conclude by describing how current mathematical models might be enhanced by use of this information, and how these models in turn will help to meet some of the major challenges in cancer detection

A New Computer-Aided Diagnosis System with Modified Genetic Feature Selection for BI-RADS Classification of Breast Masses in Mammograms

Mammography remains the most prevalent imaging tool for early breast cancer screening. The language used to describe abnormalities in mammographic reports is based on the breast Imaging Reporting and Data System (BI-RADS). Assigning a correct BI-RADS category to each examined mammogram is a strenuous and challenging task for even experts. This paper proposes a new and effective computer-aided diagnosis (CAD) system to classify mammographic masses into four assessment categories in BI-RADS. The mass regions are first enhanced by means of histogram equalization and then semiautomatically segmented based on the region growing technique. A total of 130 handcrafted BI-RADS features are then extrcated from the shape, margin, and density of each mass, together with the mass size and the patient's age, as mentioned in BI-RADS mammography. Then, a modified feature selection method based on the genetic algorithm (GA) is proposed to select the most clinically significant BI-RADS features. Finally, a back-propagation neural network (BPN) is employed for classification, and its accuracy is used as the fitness in GA. A set of 500 mammogram images from the digital database of screening mammography (DDSM) is used for evaluation. Our system achieves classification accuracy, positive predictive value, negative predictive value, and Matthews correlation coefficient of 84.5%, 84.4%, 94.8%, and 79.3%, respectively. To our best knowledge, this is the best current result for BI-RADS classification of breast masses in mammography, which makes the proposed system promising to support radiologists for deciding proper patient management based on the automatically assigned BI-RADS categories