title: Clinically missed cancer: how effectively can radiologists use computer-aided detection?
abstract: OBJECTIVE
  The purpose of this study was to determine the effectiveness with which radiologists can use computer-aided detection (CADe) to detect cancer missed at screening.
  
  
  METHODS
  An observer study was performed to measure the ability of radiologists to detect breast cancer on mammograms with and without CADe. The images in the study were from 300 analog mammographic examinations. In 234 cases the mammograms were read clinically as normal and free of cancer for at least 2 subsequent years. In the other 66 cases, cancers were missed clinically. In 256 cases, current and previous mammograms were available. Eight radiologists read the dataset and recorded a BI-RADS assessment, the location of the lesion, and their level of confidence that the patient should be recalled for diagnostic workup for each suspicious lesion. Jackknife alternative free-response receiver operating characteristic analysis was used.
  
  
  RESULTS
  The jackknife alternative free-response receiver operating characteristic figure of merit was 0.641 without aid and 0.659 with aid (p = 0.06; 95% CI, -0.001 to 0.036). The sensitivity increased 9.9% (95% CI, 3.4-19%) and the callback rate 12.1% (95% CI, 7.3-20%) with CADe. Both increases were statistically significant (p < 0.001). Radiologists on average ignored 71% of correct computer prompts.
  
  
  CONCLUSIONS
  Use of CADe can increase radiologist sensitivity 10% with a comparable increase in recall rate. There is potential for CADe to have a bigger clinical impact because radiologists failed to recognize a correct computer prompt in 71% of missed cancer cases [corrected].
authors.affiliation: Carl J. Vyborny Translational Laboratory for Breast Cancer Research, Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC-2026, Chicago, IL 60637, USA. r-nishikawa@uchicago.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Nishikawa
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schmidt
authors.forename: Michael N
authors.initials: MN
authors.lastname: Linver
authors.forename: Alexandra V
authors.initials: AV
authors.lastname: Edwards
authors.forename: John
authors.initials: J
authors.lastname: Papaioannou
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Stull
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003936:Diagnosis, Computer-Assisted; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008327:Mammography; D012372:ROC Curve; D012680:Sensitivity and Specificity