title: Who could benefit the most from using a computer-aided detection system in full-field digital mammography?
abstract: BACKGROUND
  The computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening. The purpose of this study is to evaluate the diagnostic performance of the CAD system in full-field digital mammography for detecting breast cancer when used by dedicated breast radiologist (BR) and radiology resident (RR), and to reveal who could benefit the most from a CAD application.
  
  
  METHODS
  We retrospectively chose 100 image sets from mammographies performed with CAD between June 2008 and June 2010. Thirty masses (15 benign and 15 malignant), 30 microcalcifications (15 benign and 15 malignant), and 40 normal mammography images were included. The participating radiologists consisted of 7 BRs and 13 RRs. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for total, normal plus microcalcification and normal plus mass both with and without CAD use for each reader. We compared the diagnostic performance values obtained with and without CAD use for the BR and RR groups, respectively. The reading time reviewing one set of 100 images and time reduction with CAD use for the BR and RR groups were also evaluated.
  
  
  RESULTS
  The diagnostic performance was generally higher in the BR group than in the RR group. Sensitivity improved with CAD use in the BR and RR groups (from 81.10 to 84.29% for BR; 75.38 to 77.95% for RR). A tendency for improvement in all diagnostic performance values was observed in the BR group, whereas in the RR group, sensitivity improved but specificity, PPV, and NPV did not. None of the diagnostic performance parameters were significantly different. The mean reading time was shortened with CAD use in both the BR and RR groups (111.6 minutes to 94.3 minutes for BR; 135.5 minutes to 109.8 minutes for RR). The mean time reduction was higher for the RR than that in the BR group.
  
  
  CONCLUSIONS
  CAD was helpful for dedicated BRs to improve their diagnostic performance and for RRs to improve the sensitivity in a screening setting. CAD could be essential for radiologists by decreasing reading time without decreasing diagnostic performance.
authors.forename: Na Young
authors.initials: NY
authors.lastname: Jung
authors.affiliation: Department of Radiology, Seoul St, Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, South Korea. lionmain@catholic.ac.kr.
authors.forename: Bong Joo
authors.initials: BJ
authors.lastname: Kang
authors.forename: Hyeon Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Cha
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Chang Suk
authors.initials: CS
authors.lastname: Park
authors.forename: In Young
authors.initials: IY
authors.lastname: Whang
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Kim
authors.forename: Yeong Yi
authors.initials: YY
authors.lastname: An
authors.forename: Jae Jeong
authors.initials: JJ
authors.lastname: Choi
mesh_terms: D001941:Breast Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003936:Diagnosis, Computer-Assisted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods*; D011379:Prognosis; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012680:Sensitivity and Specificity