title: Impact on breast cancer diagnosis in a multidisciplinary unit after the incorporation of mammography digitalization and computer-aided detection systems.
abstract: OBJECTIVE
  The purpose of this article is to evaluate the impact on the diagnosis of breast cancer of implementing full-field digital mammography (FFDM) in a multidisciplinary breast pathology unit and, 1 year later, the addition of a computer-aided detection (CAD) system.
  
  
  METHODS
  A total of 13,453 mammograms performed between January and July of the years 2004, 2006, and 2007 were retrospectively reviewed using conventional mammography, digital mammography, and digital mammography plus CAD techniques. Mammograms were classified into two subsets: screening and diagnosis. Variables analyzed included cancer detection rate, rate of in situ carcinoma, tumor size at detection, biopsy rate, and positive predictive value of biopsy.
  
  
  RESULTS
  FFDM increased the cancer detection rate, albeit not statistically significantly. The detection rate of in situ carcinoma increased significantly using FFDM plus CAD compared with conventional technique (36.8% vs 6.7%; p = 0.05 without Bonferroni statistical correction) for the screening dataset. Relative to conventional mammography, tumor size at detection decreased with digital mammography (T1, 61.5% vs 88%; p = 0.018) and with digital mammography plus CAD (T1, 79.7%; p = 0.03 without Bonferroni statistical correction). Biopsy rates in the general population increased significantly using CAD (10.6/1000 for conventional mammography, 14.7/1000 for digital mammography, and 17.9/1000 for digital mammography plus CAD; p = 0.02). The positive predictive value of biopsy decreased slightly, but not significantly, for both subsets.
  
  
  CONCLUSIONS
  The incorporation of new techniques has improved the performance of the breast unit by increasing the overall detection rates and earlier detection (smaller tumors), both leading to an increase in interventionism.
authors: Unidad de Patología Mamaria, Servicio de Radiología, Hospital Virgen de la Salud, Toledo, Spain.
authors: Cristina
authors: C
authors: Romero
authors: Celia
authors: C
authors: Varela
authors: Enriqueta
authors: E
authors: Muñoz
authors: Asunción
authors: A
authors: Almenar
authors: Jose María
authors: JM
authors: Pinto
authors: Miguel
authors: M
authors: Botella
mesh_terms: D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003936:Diagnosis, Computer-Assisted; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies