Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection.

PURPOSE To retrospectively determine the mammographic characteristics of cancers missed at screening mammography and assess the ability of computer-aided detection (CAD) to mark the missed cancers. MATERIALS AND METHODS A multicenter retrospective study accrued 1,083 consecutive cases of breast cancer detected at screening mammography. Prior mammograms were available in 427 cases. Of these, 286 had lesions visible in retrospect. The 286 cases underwent blinded review by panels of radiologists; a majority recommended recall for 112 cases. Two experienced radiologists compared prior mammograms in 110 of these cases with the subsequent screening mammograms (when cancer was detected), noting mammographic characteristics of breast density, lesion type, size, morphology, and subjective reasons for possible miss. The prior mammograms were then analyzed with a CAD program. RESULTS There were 110 patients with 115 cancers. On the prior mammograms with missed cancers, 35 (30%) of the 115 lesions were calcifications, with 17 of 35 (49%) clustered or pleomorphic. Eighty of the 115 (70%) were mass lesions, with 32 of 80 (40%) spiculated or irregular. For calcifications and masses, the most frequently suggested reasons for possible miss were dense breasts (12 of 35; 34%) and distracting lesions (35 of 80; 44%), respectively. CAD marked 30 (86%) of 35 missed calcifications and 58 (73%) of 80 missed masses. CONCLUSION Detection errors affected cases with calcifications and masses. CAD marked most (77%; 88 of 115) cancers missed at screening mammography that radiologists retrospectively judged to merit recall.

[1]  B. Rush,et al.  Interval breast cancer: a more aggressive subset of breast neoplasias. , 1983, Surgery.

[2]  E. Sickles.  Mammographic features of 300 consecutive nonpalpable breast cancers. , 1986, AJR. American journal of roentgenology.

[3]  C J Baines,et al.  The role of the reference radiologist. Estimates of inter-observer agreement and potential delay in cancer detection in the national breast screening study. , 1990, Investigative radiology.

[4]  D. Ikeda,et al.  Interval carcinomas in the Malmö Mammographic Screening Trial: radiographic appearance and prognostic considerations. , 1992, AJR. American journal of roentgenology.

[5]  D R Dance,et al.  The automatic computer detection of subtle calcifications in radiographically dense breasts. , 1992, Physics in medicine and biology.

[6]  R. Bird,et al.  Analysis of cancers missed at screening mammography. , 1992, Radiology.

[7]  L. Tabár,et al.  Update of the Swedish two-county program of mammographic screening for breast cancer. , 1992, Radiologic clinics of North America.

[8]  L. Fajardo,et al.  Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. 1993 ARRS President's Award. , 1993, AJR. American journal of roentgenology.

[9]  Roland Holland,et al.  The current detectability of breast cancer in a mammographic screening program. A review of the previous mammograms of interval and screen‐detected cancers , 1993, Cancer.

[10]  K Doi,et al.  Effect of case selection on the performance of computer-aided detection schemes. , 1994, Medical physics.

[11]  J. M. Pruneda,et al.  Computer-aided mammographic screening for spiculated lesions. , 1994, Radiology.

[12]  K L Lam,et al.  Computer-aided detection of mammographic microcalcifications: pattern recognition with an artificial neural network. , 1995, Medical physics.

[13]  H P Chan,et al.  Automated detection of breast masses on mammograms using adaptive contrast enhancement and texture classification. , 1996, Medical physics.

[14]  L J Yeoman,et al.  Screening interval breast cancers: mammographic features and prognosis factors. , 1996, Radiology.

[15]  C. Nodine,et al.  Nature of expertise in searching mammograms for breast masses , 1996, Medical Imaging.

[16]  G. P. Cohen,et al.  Characteristics of breast carcinomas missed by screening radiologists. , 1997, Radiology.

[17]  S. Feig.  Role and evaluation of mammography and other imaging methods for breast cancer detection, diagnosis, and staging. , 1999, Seminars in nuclear medicine.

[18]  M Kallergi,et al.  Evaluating the performance of detection algorithms in digital mammography. , 1999, Medical physics.

[19]  L. Tabár,et al.  Potential contribution of computer-aided detection to the sensitivity of screening mammography. , 2000, Radiology.