title: Computer-aided detection output on 172 subtle findings on normal mammograms previously obtained in women with breast cancer detected at follow-up screening mammography.
abstract: OBJECTIVE
  To evaluate, by using a computer-aided detection (CAD) program, the nonspecific findings on normal screening mammograms obtained in women in whom breast cancer was later detected at follow-up screening mammography.
  
  
  METHODS
  Four hundred ninety-three mammogram pairs-an initial negative screening mammogram and a subsequently obtained screening mammogram showing cancer-were collected. The mean interval between examinations was 14.6 months. In 169 cases, in which 172 cancers were later depicted, findings on the initial mammogram were subtle enough that either none or only one or two of five blinded radiologists recommended screening recall. On the initial negative mammograms, of the 172 areas where cancer later developed, 137 (80%) had subtle nonspecific findings and were retrospectively judged as having a benign or normal appearance. The mammograms with these subtle findings were evaluated with a commercially available CAD program, and the numbers of CAD marks on these nonspecific findings were analyzed.
  
  
  RESULTS
  Of the 172 cancers, 129 (75%) were invasive and 43 (25%) were ductal carcinoma in situ. The CAD program marked 72 (42%) of the 172 findings that subsequently developed into cancer: 24 (29%) of 82 findings recalled by none, 25 (49%) of 51 findings recalled by one, and 23 (59%) of 39 findings recalled by two of the five radiologists. Among the 137 areas with nonspecific normal or benign findings, 41 (30%) areas where cancer subsequently developed were marked by the CAD program.
  
  
  CONCLUSIONS
  A subset of cancers have perceptible but nonspecific mammographic findings that may be marked by a CAD program, even when the findings do not warrant recall as judged at blinded and unblinded radiologist review. The authors believe failure to act on such nonspecific but CAD-marked findings prospectively does not constitute interpretation below a reasonable standard of care.
authors.affiliation: Department of Radiology, Stanford University Medical Center, Room S-068A, Rte 1, 300 Pasteur Dr, Stanford, CA 94305-5105, USA.
authors.forename: Debra M
authors.initials: DM
authors.lastname: Ikeda
authors.forename: Robyn L
authors.initials: RL
authors.lastname: Birdwell
authors.forename: Kathryn F
authors.initials: KF
authors.lastname: O'Shaughnessy
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: R James
authors.initials: RJ
authors.lastname: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D044584:Carcinoma, Ductal / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D019091:Critical Pathways; D003936:Diagnosis, Computer-Assisted; D005188:False Negative Reactions; D005260:Female; D005348:Fibrocystic Breast Disease / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D015588:Observer Variation; D011857:Radiographic Image Interpretation, Computer-Assisted; D012984:Software