J Breast Cancer.  2013 Sep;16(3):322-328. 10.4048/jbc.2013.16.3.322.

Detection of Breast Cancer in Asymptomatic and Symptomatic Groups Using Computer-Aided Detection with Full-Field Digital Mammography

• Park CS
• Jung NY
• Kim K
• Jung HS
• Sohn KM
• Oh SJ

• KMID: 2286384
• DOI: http://doi.org/10.4048/jbc.2013.16.3.322

Abstract

PURPOSE
We aimed to determine the sensitivity of computer-aided detection (CAD) applied to digital mammography in asymptomatic and symptomatic breast cancer patients.
METHODS
We retrospectively analyzed digital mammography and CAD images from 210 patients diagnosed with breast cancer. The patients were divided into symptomatic and asymptomatic groups. The sensitivity of CAD in both groups was assessed in relation to breast tissue density, histopathological type of breast cancer, and tumor size.
RESULTS
The detection rate of the CAD system was 87.8% in the asymptomatic group. The sensitivity in different tissue densities was 100% in fatty breasts (P1), 88.9% with scattered fibroglandular densities (P2), 94.4% in heterogeneously dense breasts (P3), and 66.7% in extremely dense breasts (P4). The detection rate of the CAD system in the symptomatic group was 87.2%, and the sensitivity was 90.5%, 90%, 86.6%, and 75% in P1-P4 breasts, respectively. In the asymptomatic group, the CAD system detected 90.3% of invasive ductal carcinomas, not otherwise specified (IDC-NOS) and 88.9% of ductal carcinomas in situ (DCIS), but did not detect other types of malignancy. In the symptomatic group, the CAD system detected 88.2% of IDC-NOS, 88.9% of DCIS and 75% of other types of malignancy. When analyzed according to tumor size, the sensitivity of CAD in the asymptomatic and symptomatic groups was 82.6% and 83.3% for tumors <1 cm, 76.5% and 82.4% for tumors between 1 and 2 cm, and 91.7% and 89% in tumors >2 cm.
CONCLUSION
The sensitivity of CAD was low in P4 breasts and high for tumors larger than 2 cm, with no statistically significant differences between the asymptomatic and symptomatic groups for IDC-NOS and DCIS. CAD showed greater sensitivity for other neoplasms in symptomatic patients.

Keyword

Breast neoplasms; Computer-assisted diagnosis; Mammography

MeSH Terms

Breast
Breast Neoplasms
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Diagnosis, Computer-Assisted
Humans
Mammography
Retrospective Studies

Figure

• 

  Figure 1 A 61-year-old asymptomatic woman underwent screening mammography. (A, B) Right mediolateral oblique and craniocaudal views show a spiculated, isodense mass in the upper outer quadrant (arrow). (C) This mass was not marked on the computer-aided detection image. The lesion was diagnosed as an invasive ductal carcinoma.

• 

  Figure 2 A 75-year-old asymptomatic woman underwent breast ultrasonography and digital mammography. (A) Screening breast ultrasonography shows an indistinct hypoechoic nodule in the right upper inner periareolar portion. Thus, we recommended diagnostic mammography after marking the lesion with a round metal marker. (B, C, D) Right mediolateral oblique and craniocaudal views (B and C) show a spiculated, isodense nodule (arrow) unmarked by computer-aided detection (CAD); however, CAD marked another lesion (D-asterisk, '*') in the upper portion and benign vascular calcifications (D-triangle, '▲') in the outer portion. The lesion was confirmed to be an invasive lobular carcinoma.

• 

  Figure 3 A 47-year-old woman underwent diagnostic mammography for a palpable mass in the left breast at the 3 o'clock position (round metal markers). (A, B) Left mediolateral oblique and craniocaudal views show extremely dense breast tissue without a definite abnormality. Computer-aided detection did not mark anything (not shown here). Retrospective review by two radiologists did not find abnormal findings. (C) Breast ultrasonography shows a lobulated, hypoechoic lesion in the area of a palpable mass. This was confirmed to be invasive ductal carcinoma.

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