title: Case-based reasoning computer algorithm that uses mammographic findings for breast biopsy decisions.
abstract: OBJECTIVE
  We present case-based reasoning computer software developed from mammographic findings to provide support for the clinical decision to perform biopsy of the breast.
  
  
  METHODS
  The case-based reasoning system is designed to support the decision to perform biopsy in those patients who have suspicious findings on diagnostic mammography. Currently, between 66% and 90% of biopsies are performed on benign lesions. Our system is designed to help decrease the number of benign biopsies without missing malignancies. Clinicians interpret the mammograms using a standard reporting lexicon. The case-based reasoning system compares these findings with a database of cases with known outcomes (from biopsy) and returns the fraction of similar cases that were malignant. This malignancy fraction is an intuitive response that the clinician can then consider when making the decision regarding biopsy.
  
  
  RESULTS
  The system was evaluated using a round-robin sampling scheme and performed with an area under the receiver operating characteristic curve of 0.83, comparable with the performance of a neural network model. If only the cases returning a malignancy fraction of greater than a threshold of 0.10 are sent to biopsy, no malignancies would be missed, and the number of benign biopsies would be decreased by 25%. At a threshold of 0.21, 98%, of the malignancies would be biopsied, and the number of benign biopsies would be decreased by 41%.
  
  
  CONCLUSIONS
  This preliminary investigation indicates that the case-based reasoning approach to computer-aided diagnosis has the potential to improve the accuracy of breast cancer diagnosis on mammography.
authors.affiliation: Department of Radiology, Duke University Medical Center, Box 2623, Durham, NC 27710, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Floyd
authors.forename: J Y
authors.initials: JY
authors.lastname: Lo
authors.forename: G D
authors.initials: GD
authors.lastname: Tourassi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019540:Area Under Curve; D001185:Artificial Intelligence; D001706:Biopsy; D001941:Breast Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D019992:Databases as Topic; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D016571:Neural Networks, Computer; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012984:Software