title: Single reading with computer-aided detection performed by selected radiologists in a breast cancer screening program.
abstract: OBJECTIVE
  To assess the impact of shifting from a standard double reading plus arbitration protocol to a single reading by experienced radiologists assisted by computer-aided detection (CAD) in a breast cancer screening program.
  
  
  METHODS
  This was a prospective study approved by the ethics committee. Data from 21,321 consecutive screening mammograms in incident rounds (2010-2012) were read following a single reading plus CAD protocol and compared with data from 47,462 consecutive screening mammograms in incident rounds (2004-2010) that were interpreted following a double reading plus arbitration protocol. For the single reading, radiologists were selected on the basis of the appraisement of their previous performance.
  
  
  RESULTS
  Period 2010-2012 vs. period 2004-2010: Cancer detection rate (CDR): 6.1‰ (95% confidence interval: 5.1-7.2) vs. 5.25‰; Recall rate (RR): 7.02% (95% confidence interval: 6.7-7.4) vs. 7.24% (selected readers before arbitration) and vs. 3.94 (all readers after arbitration); Predictive positive value of recall: 8.69% vs. 13.32%. Average size of invasive cancers: 14.6±9.5mm vs. 14.3±9.5mm. Stage: 0 (22.3/26.1%); I (59.2/50.8%); II (19.2/17.1%); III (3.1/3.3%); IV (0/1.9%). Specialized breast radiologists performed better than general radiologists.
  
  
  CONCLUSIONS
  The cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD, at the cost of a moderate increase of the recall rate mainly related to the lack of arbitration.
authors.affiliation: Department of Radiology (CDIC), Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain. Electronic address: xbarga@clinic.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bargalló
authors.affiliation: Department of Radiology (CDIC), Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Gorane
authors.initials: G
authors.lastname: Santamaría
authors.affiliation: Department of Radiology (CDIC), Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Del Amo
authors.affiliation: Department of Radiology (CDIC), Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Arguis
authors.affiliation: Biostatistics and Data Management Core Facility, IDIBAPS, (Hospital Clinic) C/ Mallorca, 183. Floor -1. Office #60. 08036 Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Ríos
authors.affiliation: Preventive Medicine and Epidemiology Unit, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Grau
authors.affiliation: Department of Radiology (CDIC), Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Burrel
authors.affiliation: Department of Radiology (CDIC), Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Cores
authors.affiliation: Department of Radiology (CDIC), Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Martín
authors.initials: M
authors.lastname: Velasco
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008403:Mass Screening / Q000379:methods; D015588:Observer Variation; D010363:Pattern Recognition, Automated; D015397:Program Evaluation; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D011871:Radiology / Q000592:standards; D015203:Reproducibility of Results
keywords: Breast; Breast neoplasms; Breast screening; Computer-assisted diagnosis; Mammography