title: Prevalence scaling: applications to an intelligent workstation for the diagnosis of breast cancer.
abstract: OBJECTIVE
  Our goal was to investigate the effects of changes that the prevalence of cancer in a population have on the probability of malignancy (PM) output and an optimal combination of a true-positive fraction (TPF) and a false-positive fraction (FPF) of a mammographic and sonographic automatic classifier for the diagnosis of breast cancer.
  
  
  METHODS
  We investigate how a prevalence-scaling transformation that is used to change the prevalence inherent in the computer estimates of the PM affects the numerical and histographic output of a previously developed multimodality intelligent workstation. Using Bayes' rule and the binormal model, we study how changes in the prevalence of cancer in the diagnostic breast population affect our computer classifiers' optimal operating points, as defined by maximizing the expected utility.
  
  
  RESULTS
  Prevalence scaling affects the threshold at which a particular TPF and FPF pair is achieved. Tables giving the thresholds on the scaled PM estimates that result in particular pairs of TPF and FPF are presented. Histograms of PMs scaled to reflect clinically relevant prevalence values differ greatly from histograms of laboratory-designed PMs. The optimal pair (TPF, FPF) of our lower performing mammographic classifier is more sensitive to changes in clinical prevalence than that of our higher performing sonographic classifier.
  
  
  CONCLUSIONS
  Prevalence scaling can be used to change computer PM output to reflect clinically more appropriate prevalence. Relatively small changes in clinical prevalence can have large effects on the computer classifier's optimal operating point.
authors.affiliation: Department of Radiology, The University of Chicago, Chicago, IL 60637, USA. kjhorsch@uchicago.edu
authors.forename: Karla
authors.initials: K
authors.lastname: Horsch
authors.forename: Maryellen L
authors.initials: ML
authors.lastname: Giger
authors.forename: Charles E
authors.initials: CE
authors.lastname: Metz
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003936:Diagnosis, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D011336:Probability; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods / Q000706:statistics & numerical data*