Study Finds No Improvement in Diagnostic Accuracy of Digital Screening Mammography With Computer-Aided Detection


Key Points

  • Overall, there was no difference in sensitivity or specificity for mammography with vs without computer-aided detection.
  • No differences in detection rates for overall cancer or invasive cancer were observed, but computer-aided detection was associated with a higher detection rate for ductal carcinoma in situ.

In a study reported in JAMA Internal Medicine, Lehman et al found no difference in the diagnostic accuracy of digital screening mammography with vs without computer-aided detection.

Study Details

The study assessed the accuracy of digital screening mammography interpreted with (n = 495,818) vs without (n = 129,807) computer-aided detection in 323,973 women screened between 2003 and 2009. Mammograms were interpreted by 271 radiologists from 66 sites in the Breast Cancer Surveillance Consortium. A total of 3,159 breast cancers were identified within 1 year of screening through linkage with tumor registries.

Comparative Accuracy

Overall, there was no significant difference in the accuracy of mammography with vs without computer-aided detection. Sensitivity of mammography was 85.3% with vs 87.3% without computer-aided detection, and specificity was 91.6% vs 91.4%. Sensitivity was 82.1% vs 85.0% for invasive cancer and 93.2% vs 94.3% for ductal carcinoma in situ.

The overall cancer detection rate was 4.1 per 1,000 women screened both with and without computer-aided detection, and the invasive cancer detection rate was 2.9 vs 3.0 per 1,000 women. The ductal carcinoma in situ detection rate was higher with computer-aided detection (1.2 vs 0.9 per 1,000; P < .03). Computer-aided detection did not improve intraradiologist performance; sensitivity was reduced for interpretation of mammograms with vs without computer-aided detection among 107 radiologists who interpreted mammograms in both ways (odds ratio = 0.53, 95% confidence interval [CI] = 0.29–0.97).

The investigators concluded: “Computer-aided detection does not improve diagnostic accuracy of mammography. These results suggest that insurers pay more for [computer-aided detection] with no established benefit to women.”

The study was supported by the National Cancer Institute (NCI) and the NCI-funded Breast Cancer Surveillance Consortium.

Constance D. Lehman, MD, PhD, of Massachusetts General Hospital, Avon Foundation Comprehensive Breast Evaluation Center, is the corresponding author of the JAMA Internal Medicine article. 

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