title: Computer-aided detection versus independent double reading of masses on mammograms.
abstract: OBJECTIVE
  To evaluate the use of a computer-aided detection (CAD) system (designed for mammographic mass detection) to help improve mass interpretation and to compare CAD results with independent double-reading results.
  
  
  METHODS
  Screening mammograms from 500 cases were collected; 125 of these cases were screening-detected cancers, and 125 were interval cancers. Previously obtained screening mammograms (ie, prior mammograms) were available in all cases. All mammograms were analyzed by a CAD system, which detected mass regions and assigned a level of (cancer) suspicion to each mass. Ten experienced screening radiologists read the prior mammograms. For independent interpretation with CAD, the suspicion rating assigned to each finding by the radiologist was weighted with the CAD output at the area of the finding. CAD markers on areas that were not reported by the radiologist were not used. Independent double reading was implemented by using a rule to combine the levels of suspicion assigned to findings by two radiologists. Results were evaluated by using localized-response receiver operating characteristic analysis.
  
  
  RESULTS
  In a total of 141 cases, there was a visible abnormality at the location of the cancer on the prior mammogram, and 115 of these were classified as mass cases. For prior mammograms that depicted masses, the mean sensitivity of the radiologists, as averaged among the false-positive rates lower than 10%, was 39.4%; this increased by 7.0% with CAD and by 10.5% with double reading. Differences among single, double, and CAD readings were statistically significant (P <.001).
  
  
  CONCLUSIONS
  Although independent double reading yields the best detection performance, the presence and probability of CAD mass markers can improve mammogram interpretation.
authors.affiliation: Department of Radiology, University Medical Center Nijmegen, Geert Grooteplein 18, 6525 GA Nijmegen, The Netherlands. n.karssemeijer@rad.umcn.nl
authors.forename: Nico
authors.initials: N
authors.lastname: Karssemeijer
authors.forename: Johannes D M
authors.initials: JD
authors.lastname: Otten
authors.forename: Andre L M
authors.initials: AL
authors.lastname: Verbeek
authors.forename: Johanna H
authors.initials: JH
authors.lastname: Groenewoud
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Jan H C L
authors.initials: JH
authors.lastname: Hendriks
authors.forename: Roland
authors.initials: R
authors.lastname: Holland
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012680:Sensitivity and Specificity