title: The usefulness of a computer-aided diagnosis scheme for improving the performance of clinicians to diagnose non-mass lesions on breast ultrasonographic images.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the usefulness of a computer-aided diagnosis (CAD) scheme for improving the performance of clinicians to diagnose non-mass lesions appearing as hypoechoic areas on breast ultrasonographic images.
  
  
  METHODS
  The database included 97 ultrasonographic images with hypoechoic areas: 48 benign cases [benign lesion with benign mammary tissue or fibrocystic disease (n = 20), fibroadenoma (n = 11), and intraductal papilloma (n = 17)] and 49 malignant cases [ductal carcinoma in situ (n = 17) and invasive ductal carcinoma (n = 32)]. Seven clinicians, three expert breast surgeons, and four general surgeons participated in the observer study. They were asked their confidence level concerning the possibility of malignancy in all 97 cases with and without the use of the CAD scheme. Receiver operating characteristic (ROC) analysis was performed to evaluate the usefulness of the CAD scheme.
  
  
  RESULTS
  The areas under the ROC curve (AUC) improved for all observers when they used the CAD scheme and increased from 0.649 to 0.783 (P = 0.0167). Notably, the AUC for the general surgeon group increased from 0.625 to 0.793 (P = 0.045).
  
  
  CONCLUSIONS
  This study showed that the performance of clinicians to diagnose non-mass lesions appearing as hypoechoic areas on breast ultrasonographic images was improved by the use of a CAD scheme.
authors.affiliation: Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan. shibu-m@clin.medic.mie-u.ac.jp.
authors.forename: Mai
authors.initials: M
authors.lastname: Shibusawa
authors.affiliation: Department of Electronic and Computer Engineering, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu City, Shiga, 525-8577, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Nakayama
authors.affiliation: Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Okanami
authors.affiliation: Department of Senology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba City, Ibaraki, 305-8558, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kashikura
authors.affiliation: Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Imai
authors.affiliation: Department of Breast Surgery, Nabari City Hospital, 1-178 Yurigaokanishi, Nabari City, Mie, 518-0481, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Yamashita
authors.affiliation: Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Hanamura
authors.affiliation: Department of Breast Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ogawa
mesh_terms: D001706:Biopsy; D001940:Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D001941:Breast Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D016208:Databases, Factual; D003937:Diagnosis, Differential; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D010820:Physicians; D012372:ROC Curve; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Breast non-mass lesions; Breast ultrasonography; Computer-aided diagnosis