title: Improved cancer detection in automated breast ultrasound by radiologists using Computer Aided Detection.
abstract: OBJECTIVE
  To investigate the effect of dedicated Computer Aided Detection (CAD) software for automated breast ultrasound (ABUS) on the performance of radiologists screening for breast cancer.
  
  
  METHODS
  90 ABUS views of 90 patients were randomly selected from a multi-institutional archive of cases collected between 2010 and 2013. This dataset included normal cases (n=40) with >1year of follow up, benign (n=30) lesions that were either biopsied or remained stable, and malignant lesions (n=20). Six readers evaluated all cases with and without CAD in two sessions. CAD-software included conventional CAD-marks and an intelligent minimum intensity projection of the breast tissue. Readers reported using a likelihood-of-malignancy scale from 0 to 100. Alternative free-response ROC analysis was used to measure the performance.
  
  
  RESULTS
  Without CAD, the average area-under-the-curve (AUC) of the readers was 0.77 and significantly improved with CAD to 0.84 (p=0.001). Sensitivity of all readers improved (range 5.2-10.6%) by using CAD but specificity decreased in four out of six readers (range 1.4-5.7%). No significant difference was observed in the AUC between experienced radiologists and residents both with and without CAD.
  
  
  CONCLUSIONS
  Dedicated CAD-software for ABUS has the potential to improve the cancer detection rates of radiologists screening for breast cancer.
authors.affiliation: Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands. Electronic address: Jan.vanZelst@radboudumc.nl.
authors.forename: J C M
authors.initials: JCM
authors.lastname: van Zelst
authors.affiliation: Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Tan
authors.affiliation: Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Platel
authors.affiliation: Jeroen Bosch Medical Centre, Department of Radiology, 's-Hertogenbosch, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Jong
authors.affiliation: Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Steenbakkers
authors.affiliation: Jeroen Bosch Medical Centre, Department of Radiology, 's-Hertogenbosch, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Mourits
authors.affiliation: Jules Bordet Institute, Department of Radiology, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Grivegnee
authors.affiliation: Catholic University of the Sacred Heart, Department of Radiological Sciences, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Borelli
authors.affiliation: Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Karssemeijer
authors.affiliation: Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Mann
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001940:Breast / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011336:Probability; D012372:ROC Curve; D000072177:Radiologists; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Automated breast ultrasound; Breast cancer; Computer Aided Detection; Detection; Screening; Ultrasound