Polyp characteristics correctly annotated by computer-aided detection software but ignored by reporting radiologists during CT colonography.
OBJECTIVE
To retrospectively describe the characteristics of polyps incorrectly dismissed by radiologists despite appropriate computer-aided detection (CAD) prompting during computed tomographic (CT) colonography.


METHODS
Ethics committee approval and patient informed consent were obtained from institutions that provided the data sets used in this HIPAA-compliant study. A total of 111 polyps that had a diameter of at least 6 mm and were detected with CAD were collated from three previous studies in which researchers investigated radiologist performance with and without CAD (total, 25 readers). Two new observers graded each polyp with predefined criteria, including polyp size, morphology, and location; data set quality; ease of visualization; tagging use and polyp coating; colonic curvature; CAD mark obscuration; and number of false-positive findings. The 86 polyps that were missed before CAD (those that were unreported by one or more original readers) were divided into those that remained unreported after CAD (no CAD gain, n = 36) and those that were reported correctly by at least one additional reader (CAD gain, n = 50). Logistic-regression analysis and the Fisher exact and Mann-Whitney tests were used to compare the results of both groups with each other and with a control group of 25 polyps, all of which were detected by readers without CAD.


RESULTS
Before CAD, polyps 10 mm in diameter or larger, those that were rated easy to visualize, and those that were uncoated by tagged fluid were less likely to be missed (72%, 76%, and 80% of control polyps vs 43%, 43%, and 59% of missed polyps, respectively; P < .001, P < .01, and P < .03, respectively). After CAD, the odds of CAD gain decreased with increasing polyp size (odds ratio, 0.92; 95% confidence interval: 0.85, 1.00; P = .04) and irregular morphology (odds ratio, 0.28; 95% confidence interval: 0.08, 0.92; P = .04).


CONCLUSIONS
Larger irregular polyps are a common source of incorrect radiologist dismissal, despite correct CAD prompting.
Department of Specialist X-Ray, University College Hospital, 2F Podium, 235 Euston Rd, London NW1 2BU, England. csytaylor@yahoo.co.uk
Stuart A
SA
Taylor
Charlotte
C
Robinson
Darren
D
Boone
Lesley
L
Honeyfield
Steve
S
Halligan
D002983:Clinical Competence; D003111:Colonic Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D023881:Colonography, Computed Tomographic / Q000379:methods*; D003936:Diagnosis, Computer-Assisted; D003951:Diagnostic Errors; D005189:False Positive Reactions; D006801:Humans; D012189:Retrospective Studies; D018709:Statistics, Nonparametric