Reduction of False-Positive Markings on Mammograms: a Retrospective Comparison Study Using an Artificial Intelligence-Based CAD

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Abstract

The aim was to determine whether an artificial intelligence (AI)-based, computer-aided detection (CAD) software can be used to reduce false positive per image (FPPI) on mammograms as compared to an FDA-approved conventional CAD. A retrospective study was performed on a set of 250 full-field digital mammograms between January 1, 2013, and March 31, 2013, and the number of marked regions of interest of two different systems was compared for sensitivity and specificity in cancer detection. The count of false-positive marks per image (FPPI) of the two systems was also evaluated as well as the number of cases that were completely mark-free. All results showed statistically significant reductions in false marks with the use of AI-CAD vs CAD (confidence interval = 95%) with no reduction in sensitivity. There is an overall 69% reduction in FPPI using the AI-based CAD as compared to CAD, consisting of 83% reduction in FPPI for calcifications and 56% reduction for masses. Almost half (48%) of cases showed no AI-CAD markings while only 17% show no conventional CAD marks. There was a significant reduction in FPPI with AI-CAD as compared to CAD for both masses and calcifications at all tissue densities. A 69% decrease in FPPI could result in a 17% decrease in radiologist reading time per case based on prior literature of CAD reading times. Additionally, decreasing false-positive recalls in screening mammography has many direct social and economic benefits.

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Most cited references 15

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Diagnostic Accuracy of Digital Screening Mammography With and Without Computer-Aided Detection.

Constance Lehman, Robert D. Wellman, Diana S M Buist … (2015)

After the US Food and Drug Administration (FDA) approved computer-aided detection (CAD) for mammography in 1998, and the Centers for Medicare and Medicaid Services (CMS) provided increased payment in 2002, CAD technology disseminated rapidly. Despite sparse evidence that CAD improves accuracy of mammographic interpretations and costs over $400 million a year, CAD is currently used for most screening mammograms in the United States.

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Screening mammography with computer-aided detection: prospective study of 12,860 patients in a community breast center.

S T Freer, M J Ulissey (2001)

To prospectively assess the effect of computer-aided detection (CAD) on the interpretation of screening mammograms in a community breast center. Over a 12-month period, 12,860 screening mammograms were interpreted with the assistance of a CAD system. Each mammogram was initially interpreted without the assistance of CAD, followed immediately by a reevaluation of areas marked by the CAD system. Data were recorded to measure the effect of CAD on the recall rate, positive predictive value for biopsy, cancer detection rate, and stage of malignancies at detection. When comparing the radiologist's performance without CAD with that when CAD was used, the authors observed the following: (a) an increase in recall rate from 6.5% to 7.7%, (b) no change in the positive predictive value for biopsy at 38%, (c) a 19.5% increase in the number of cancers detected, and (d) an increase in the proportion of early-stage (0 and I) malignancies detected from 73% to 78%. The use of CAD in the interpretation of screening mammograms can increase the detection of early-stage malignancies without undue effect on the recall rate or positive predictive value for biopsy.

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Systematic review of the psychological consequences of false-positive screening mammograms.

Laura Bond, T Pavey, K Welch … (2013)

In the UK, women aged 50-73 years are invited for screening by mammography every 3 years. In 2009-10, more than 2.24 million women in this age group in England were invited to take part in the programme, of whom 73% attended a screening clinic. Of these, 64,104 women were recalled for assessment. Of those recalled, 81% did not have breast cancer; these women are described as having a false-positive mammogram. The aim of this systematic review was to identify the psychological impact on women of false-positive screening mammograms and any evidence for the effectiveness of interventions designed to reduce this impact. We were also looking for evidence of effects in subgroups of women. MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register for Controlled Trials, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination (CRD) Database of Abstracts of Reviews of Effects, CRD Health Technology Assessment (HTA), Cochrane Methodology, Web of Science, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index-Science, Conference Proceeding Citation Index-Social Science and Humanities, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the International Bibliography of the Social Sciences, the British Library's Electronic Table of Contents and others. Initial searches were carried out between 8 October 2010 and 25 January 2011. Update searches were carried out on 26 October 2011 and 23 March 2012. Based on the inclusion criteria, titles and abstracts were screened independently by two reviewers. Retrieved papers were reviewed and selected using the same independent process. Data were extracted by one reviewer and checked by another. Each included study was assessed for risk of bias. Eleven studies were found from 4423 titles and abstracts. Studies that used disease-specific measures found a negative psychological impact lasting up to 3 years. Distress increased with the level of invasiveness of the assessment procedure. Studies using instruments designed to detect clinical levels of morbidity did not find this effect. Women with false-positive mammograms were less likely to return for the next round of screening [relative risk (RR) 0.97; 95% confidence interval (CI) 0.96 to 0.98] than those with normal mammograms, were more likely to have interval cancer [odds ratio (OR) 3.19 (95% CI 2.34 to 4.35)] and were more likely to have cancer detected at the next screening round [OR 2.15 (95% CI 1.55 to 2.98)]. This study was limited to UK research and by the robustness of the included studies, which frequently failed to report quality indicators, for example failure to consider the risk of bias or confounding, or failure to report participants' demographic characteristics. We conclude that the experience of having a false-positive screening mammogram can cause breast cancer-specific psychological distress that may endure for up to 3 years, and reduce the likelihood that women will return for their next round of mammography screening. These results should be treated cautiously owing to inherent weakness of observational designs and weaknesses in reporting. Future research should include a qualitative interview study and observational studies that compare generic and disease-specific measures, collect demographic data and include women from different social and ethnic groups.

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Author and article information

Contributors

Ray Cody Mayo:

ORCID: http://orcid.org/0000-0002-7737-6562

rcmayo@mdanderson.org

Journal

Journal ID (nlm-ta): J Digit Imaging

Journal ID (iso-abbrev): J Digit Imaging

Title: Journal of Digital Imaging

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0897-1889

ISSN (Electronic): 1618-727X

Publication date (Electronic): 8 April 2019

Publication date PMC-release: 8 April 2019

Publication date (Print): August 2019

Volume: 32

Issue: 4

Pages: 618-624

Affiliations

[1 ]ISNI 0000 0000 9206 2401, GRID grid.267308.8, Department of Diagnostic Imaging, Breast Imaging Division, MD Anderson Center, , University of Texas, ; 1515 Holcombe Blvd., Houston, TX 77030 USA

[2 ]Voxel Imaging, Inc., 2711 N. Sepulveda Blvd., #284, Manhattan Beach, CA 90266 USA

[3 ]ISNI 0000 0001 2156 6853, GRID grid.42505.36, Keck School of Medicine, , University of Southern California, ; 1975 Zonal Avenue, Los Angeles, CA 90033 USA

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Ray Cody Mayo http://orcid.org/0000-0002-7737-6562

Article

Publisher ID: 168

DOI: 10.1007/s10278-018-0168-6

PMC ID: 6646646

PubMed ID: 30963339

SO-VID: ad568778-4280-454c-809e-49e1f1a550c2

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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ScienceOpen disciplines: Radiology & Imaging

Keywords: breast imaging,mammogram,computer-aided detection,false-positive exam,artificial intelligence

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ScienceOpen disciplines: Radiology & Imaging

Keywords: breast imaging, mammogram, computer-aided detection, false-positive exam, artificial intelligence

Reduction of False-Positive Markings on Mammograms: a Retrospective Comparison Study Using an Artificial Intelligence-Based CAD

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Most cited references 15

Diagnostic Accuracy of Digital Screening Mammography With and Without Computer-Aided Detection.

Screening mammography with computer-aided detection: prospective study of 12,860 patients in a community breast center.

Systematic review of the psychological consequences of false-positive screening mammograms.

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