CAD Useful in Finding Cancers Missed by Radiologists
by Barbara Kram, Editor | March 27, 2007
Computer aided detection (CAD) increases the breast cancer detection rate and decreases the false negative rate, but it comes at the cost of a higher recall rate, according to a recently released prospective study.
The study included 5,016 screening mammograms. The radiologists detected 43 of the 48 cancers in the study without the use of CAD, said Priscilla Slanetz, MD, an author of the study, now at Boston University Medical Center in Boston, MA. With the addition of CAD, two additional cancers - both ductal carcinoma in situ that presented as microcalcifications -- were detected, she said. The cancers were stage 0 and stage 1 tumors, Dr. Slanetz added. CAD also marked one mass that was dismissed by the radiologist, but later shown to be cancer (categorized as a false negative).
The radiologist alone detected 90% of malignant asymmetry or masses and 89% of microcalcifications. CAD alone marked 67% of asymmetry or masses and 100% of microcalcifications. "CAD is best suited to detect microcalcifications, and in reality faint microcalcifications are the most commonly overlooked finding by most radiologists," Dr. Slanetz said. Neither the radiologist or CAD was perfect, but the false negative rate was reduced when both were employed, she said.
The study examined the recall rate as well and found that the use of CAD resulted in an additional 89 women (from 607 to 696 patients) being recalled. Of those, six women were biopsied; and two had cancers, she said.
'We continue to routinely employ CAD in the interpretation of screening mammograms. The tradeoff of earlier detection for a slight increase in recall rates seems reasonable and is well accepted by most patients,' she added.
CAD is a useful addition to any practice, particularly in light of the ongoing shortage of breast imagers in the U.S., but it cannot and should not replace the radiologist, Dr. Slanetz said. It is important for each radiologist to be aware of what CAD can detect well, and what it tends to miss, she addded.
The study appeared in a recent issue of the American Journal of Roentgenology, which is published by the American Roentgen Ray Society.
The American Journal of Roentgenology (AJR) is a highly respected peer-reviewed monthly radiology journal published by the American Roentgen Ray Society (ARRS). For almost 100 years, the AJR has been recognized as one of the best specialty journals in the world. The ARRS and AJR are named after Wilhelm Röentgen, who discovered the x-ray in 1895. For more information, visit www.arrs.org.
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The study included 5,016 screening mammograms. The radiologists detected 43 of the 48 cancers in the study without the use of CAD, said Priscilla Slanetz, MD, an author of the study, now at Boston University Medical Center in Boston, MA. With the addition of CAD, two additional cancers - both ductal carcinoma in situ that presented as microcalcifications -- were detected, she said. The cancers were stage 0 and stage 1 tumors, Dr. Slanetz added. CAD also marked one mass that was dismissed by the radiologist, but later shown to be cancer (categorized as a false negative).
The radiologist alone detected 90% of malignant asymmetry or masses and 89% of microcalcifications. CAD alone marked 67% of asymmetry or masses and 100% of microcalcifications. "CAD is best suited to detect microcalcifications, and in reality faint microcalcifications are the most commonly overlooked finding by most radiologists," Dr. Slanetz said. Neither the radiologist or CAD was perfect, but the false negative rate was reduced when both were employed, she said.
The study examined the recall rate as well and found that the use of CAD resulted in an additional 89 women (from 607 to 696 patients) being recalled. Of those, six women were biopsied; and two had cancers, she said.
'We continue to routinely employ CAD in the interpretation of screening mammograms. The tradeoff of earlier detection for a slight increase in recall rates seems reasonable and is well accepted by most patients,' she added.
CAD is a useful addition to any practice, particularly in light of the ongoing shortage of breast imagers in the U.S., but it cannot and should not replace the radiologist, Dr. Slanetz said. It is important for each radiologist to be aware of what CAD can detect well, and what it tends to miss, she addded.
The study appeared in a recent issue of the American Journal of Roentgenology, which is published by the American Roentgen Ray Society.
The American Journal of Roentgenology (AJR) is a highly respected peer-reviewed monthly radiology journal published by the American Roentgen Ray Society (ARRS). For almost 100 years, the AJR has been recognized as one of the best specialty journals in the world. The ARRS and AJR are named after Wilhelm Röentgen, who discovered the x-ray in 1895. For more information, visit www.arrs.org.
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