title: Evaluation of the effect of computer-aided classification of benign and malignant lesions on reader performance in automated three-dimensional breast ultrasound.
abstract: OBJECTIVE
  To investigate the effect of a newly developed computer-aided diagnosis (CAD) system on reader interpretation of breast lesions in automated three-dimensional (3D) breast ultrasound.
  
  
  METHODS
  A CAD system was developed to differentiate malignant lesions from benign lesions including automated lesion segmentation in three dimensions; extraction of lesion features such as spiculation, margin contrast, and posterior acoustic behavior; and a classification stage. Eighty-eight patients with breast lesions were included for an observer study: 47 lesions were malignant and 41 were benign. Eleven readers (seven radiologists and four residents) read the cases with and without CAD. We compared the performance of readers with and without CAD using receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  The CAD system had an area under the ROC curve (AUC) of 0.92 for discriminating benign and malignant lesions, whereas the unaided reader AUC ranged from 0.77 to 0.92. Mean performance of inexperienced readers improved when CAD was used (AUC = 0.85 versus 0.90; P = .007), whereas mean performance of experienced readers did not change with CAD (AUC = 0.89).
  
  
  CONCLUSIONS
  By using the CAD system for classification of lesions in automated 3D breast ultrasound, which on its own performed as good as the best readers, the performance of inexperienced readers improved while that of experienced readers remained unaffected.
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, Netherlands. Electronic address: t.tan@rad.umcn.nl.
authors.forename: Tao
authors.initials: T
authors.lastname: Tan
authors.forename: Bram
authors.initials: B
authors.lastname: Platel
authors.forename: Thorsten
authors.initials: T
authors.lastname: Twellmann
authors.forename: Guido
authors.initials: G
authors.lastname: van Schie
authors.forename: Roel
authors.initials: R
authors.lastname: Mus
authors.forename: André
authors.initials: A
authors.lastname: Grivegnée
authors.forename: Ritse M
authors.initials: RM
authors.lastname: Mann
authors.forename: Nico
authors.initials: N
authors.lastname: Karssemeijer
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D012372:ROC Curve; D015203:Reproducibility of Results; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Ultrasound; breast cancer; computer-assisted diagnosis; image interpretation