Dedicated computer-aided detection software for automated 3D breast ultrasound; an efficient tool for the radiologist in supplemental screening of women with dense breasts

Eur Radiol. 2018 Jul;28(7):2996-3006. doi: 10.1007/s00330-017-5280-3. Epub 2018 Feb 7.

Abstract

Objectives: To determine the effect of computer-aided-detection (CAD) software for automated breast ultrasound (ABUS) on reading time (RT) and performance in screening for breast cancer.

Material and methods: Unilateral ABUS examinations of 120 women with dense breasts were randomly selected from a multi-institutional archive of cases including 30 malignant (20/30 mammography-occult), 30 benign, and 60 normal cases with histopathological verification or ≥ 2 years of negative follow-up. Eight radiologists read once with (CAD-ABUS) and once without CAD (ABUS) with > 8 weeks between reading sessions. Readers provided a BI-RADS score and a level of suspiciousness (0-100). RT, sensitivity, specificity, PPV and area under the curve (AUC) were compared.

Results: Average RT was significantly shorter using CAD-ABUS (133.4 s/case, 95% CI 129.2-137.6) compared with ABUS (158.3 s/case, 95% CI 153.0-163.3) (p < 0.001). Sensitivity was 0.84 for CAD-ABUS (95% CI 0.79-0.89) and ABUS (95% CI 0.78-0.88) (p = 0.90). Three out of eight readers showed significantly higher specificity using CAD. Pooled specificity (0.71, 95% CI 0.68-0.75 vs. 0.67, 95% CI 0.64-0.70, p = 0.08) and PPV (0.50, 95% CI 0.45-0.55 vs. 0.44, 95% CI 0.39-0.49, p = 0.07) were higher in CAD-ABUS vs. ABUS, respectively, albeit not significantly. Pooled AUC for CAD-ABUS was comparable with ABUS (0.82 vs. 0.83, p = 0.53, respectively).

Conclusion: CAD software for ABUS may decrease the time needed to screen for breast cancer without compromising the screening performance of radiologists.

Key points: • ABUS with CAD software may speed up reading time without compromising radiologists' accuracy. • CAD software for ABUS might prevent non-detection of malignant breast lesions by radiologists. • Radiologists reading ABUS with CAD software might improve their specificity without losing sensitivity.

Keywords: Breast neoplasms; Diagnosis, Computer-assisted; Early detection of cancer; Mammography; Ultrasonography.

MeSH terms

  • Adult
  • Aged
  • Area Under Curve
  • Breast Neoplasms / diagnostic imaging*
  • Early Detection of Cancer / methods
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Imaging, Three-Dimensional / methods
  • Mammography / methods
  • Middle Aged
  • Multimodal Imaging / methods
  • Random Allocation
  • Sensitivity and Specificity
  • Software
  • Time Factors
  • Ultrasonography, Mammary / methods*

Grant support