Detection of breast cancer with full-field digital mammography and computer-aided detection.

OBJECTIVE The purpose of this study was to evaluate computer-aided detection (CAD) performance with full-field digital mammography (FFDM). MATERIALS AND METHODS CAD (Second Look, version 7.2) was used to evaluate 123 cases of breast cancer detected with FFDM (Senographe DS). Retrospectively, CAD sensitivity was assessed using breast density, mammographic presentation, histopathology results, and lesion size. To determine the case-based false-positive rate, patients with four standard views per case were included in the study group. Eighteen unilateral mammography examinations with nonstandard views were excluded, resulting in a sample of 105 bilateral cases. RESULTS CAD detected 115 (94%) of 123 cancer cases: six of six (100%) in fatty breasts, 63 of 66 (95%) in breasts containing scattered fibroglandular densities, 43 of 46 (93%) in heterogeneously dense breasts, and three of five (60%) in extremely dense breasts. CAD detected 93% (41/44) of cancers manifesting as calcifications, 92% (57/62) as masses, and 100% (17/17) as mixed masses and calcifications. CAD detected 94% of the invasive ductal carcinomas (n = 63), 100% of the invasive lobular carcinomas (n = 7), 91% of the other invasive carcinomas (n = 11), and 93% of the ductal carcinomas in situ (n = 42). CAD sensitivity for cancers 1-10 mm (n = 55) was 89%; 11-20 mm (n = 37), 97%; 21-30 mm (n = 16), 100%; and larger than 30 mm (n = 15), 93%. The CAD false-positive rate was 2.3 marks per four-image case. CONCLUSION CAD with FFDM showed a high sensitivity in identifying cancers manifesting as calcifications and masses. Sensitivity was maintained in cancers with lower mammographic sensitivity, including invasive lobular carcinomas and small neoplasms (1-20 mm). CAD with FFDM should be effective in assisting radiologists with earlier detection of breast cancer. Future studies are needed to assess CAD accuracy in larger populations.