Stand-Alone Use of Artificial Intelligence for Digital Mammography and Digital Breast Tomosynthesis Screening: A Retrospective Evaluation.

Journal: Radiology
Published Date: Dec 14, 2021

Abstract

Background Use of artificial intelligence (AI) as a stand-alone reader for digital mammography (DM) or digital breast tomosynthesis (DBT) breast screening could ease radiologists' workload while maintaining quality. Purpose To retrospectively evaluate the stand-alone performance of an AI system as an independent reader of DM and DBT screening examinations. Materials and Methods Consecutive screening-paired and independently read DM and DBT images acquired between January 2015 and December 2016 were retrospectively collected from the Tomosynthesis Cordoba Screening Trial. An AI system computed a cancer risk score (range, 1-100) for DM and DBT examinations independently. AI stand-alone performance was measured using the area under the receiver operating characteristic curve (AUC) and sensitivity and recall rate at different operating points selected to have noninferior sensitivity compared with the human readings (noninferiority margin, 5%). The recall rate of AI and the human readings were compared using a McNemar test. Results A total of 15 999 DM and DBT examinations (113 breast cancers, including 98 screen-detected and 15 interval cancers) from 15 998 women (mean age, 58 years ± 6 [standard deviation]) were evaluated. AI achieved an AUC of 0.93 (95% CI: 0.89, 0.96) for DM and 0.94 (95% CI: 0.91, 0.97) for DBT. For DM, AI achieved noninferior sensitivity as a single (58.4%; 66 of 113; 95% CI: 49.2, 67.1) or double (67.3%; 76 of 113; 95% CI: 58.2, 75.2) reader, with a reduction in recall rate ( < .001) of up to 2% (95% CI: -2.4, -1.6). For DBT, AI achieved noninferior sensitivity as a single (77%; 87 of 113; 95% CI: 68.4, 83.8) or double (81.4%; 92 of 113; 95% CI: 73.3, 87.5) reader, but with a higher recall rate ( < .001) of up to 12.3% (95% CI: 11.7, 12.9). Conclusion Artificial intelligence could replace radiologists' readings in breast screening, achieving a noninferior sensitivity, with a lower recall rate for digital mammography but a higher recall rate for digital breast tomosynthesis. Published under a CC BY 4.0 license. See also the editorial by Fuchsjäger and Adelsmayr in this issue.

Authors

  • Sara Romero-Martín
    From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.).
  • Esperanza Elías-Cabot
    From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.).
  • José Luis Raya-Povedano
    From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.).
  • Albert Gubern-Mérida
    Diagnostic Image Analysis Group, Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Alejandro Rodríguez-Ruiz
    From the Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands (A.R.R., I.S., R.M.M.); Department of Radiology & Imaging Sciences, Emory University, Atlanta, Ga (E.K.); ScreenPoint Medical BV, Nijmegen, the Netherlands (J.J.M.); Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital, Boca Raton, Fla (K.S.); Referenzzentrum Mammographie Munich, Brustdiagnostik München and FFB, Munich, Germany (S.H.H.); and Dutch Expert Centre for Screening, Nijmegen, the Netherlands (I.S.).
  • Marina Álvarez-Benito
    From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (J.L.R.P., S.R.M., E.E.C., M.Á.B.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G.M., A.R.R.).

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