title: Influence of computer-aided detection on performance of screening mammography.
abstract: BACKGROUND
  Computer-aided detection identifies suspicious findings on mammograms to assist radiologists. Since the Food and Drug Administration approved the technology in 1998, it has been disseminated into practice, but its effect on the accuracy of interpretation is unclear.
  
  
  METHODS
  We determined the association between the use of computer-aided detection at mammography facilities and the performance of screening mammography from 1998 through 2002 at 43 facilities in three states. We had complete data for 222,135 women (a total of 429,345 mammograms), including 2351 women who received a diagnosis of breast cancer within 1 year after screening. We calculated the specificity, sensitivity, and positive predictive value of screening mammography with and without computer-aided detection, as well as the rates of biopsy and breast-cancer detection and the overall accuracy, measured as the area under the receiver-operating-characteristic (ROC) curve.
  
  
  RESULTS
  Seven facilities (16%) implemented computer-aided detection during the study period. Diagnostic specificity decreased from 90.2% before implementation to 87.2% after implementation (P<0.001), the positive predictive value decreased from 4.1% to 3.2% (P=0.01), and the rate of biopsy increased by 19.7% (P<0.001). The increase in sensitivity from 80.4% before implementation of computer-aided detection to 84.0% after implementation was not significant (P=0.32). The change in the cancer-detection rate (including invasive breast cancers and ductal carcinomas in situ) was not significant (4.15 cases per 1000 screening mammograms before implementation and 4.20 cases after implementation, P=0.90). Analyses of data from all 43 facilities showed that the use of computer-aided detection was associated with significantly lower overall accuracy than was nonuse (area under the ROC curve, 0.871 vs. 0.919; P=0.005).
  
  
  CONCLUSIONS
  The use of computer-aided detection is associated with reduced accuracy of interpretation of screening mammograms. The increased rate of biopsy with the use of computer-aided detection is not clearly associated with improved detection of invasive breast cancer.
authors.affiliation: University of California, Davis, Sacramento, USA. joshua.fenton@ucdmc.ucdavis.edu
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fenton
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Linn
authors.initials: L
authors.lastname: Abraham
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: Carl
authors.initials: C
authors.lastname: D'Orsi
authors.forename: Eric A
authors.initials: EA
authors.lastname: Berns
authors.forename: Gary
authors.initials: G
authors.lastname: Cutter
authors.forename: R Edward
authors.initials: RE
authors.lastname: Hendrick
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D000328:Adult; D001706:Biopsy / Q000706:statistics & numerical data; D001940:Breast / Q000033:anatomy & histology / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D005189:False Positive Reactions; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012042:Registries; D012680:Sensitivity and Specificity; D014481:United States