Single reading with computer-aided detection performed by selected radiologists in a breast cancer screening program

• 1-The cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD.
• 2-The cancer detection rate improved at the cost of increasing recall rate.
• 3-CAD, used by breast radiologists, did not help to detect more cancers.

ObjectivesTo assess the impact of shifting from a standard double reading plus arbitration protocol to a single reading by experienced radiologists assisted by computer-aided detection (CAD) in a breast cancer screening program.MethodsThis was a prospective study approved by the ethics committee. Data from 21,321 consecutive screening mammograms in incident rounds (2010–2012) were read following a single reading plus CAD protocol and compared with data from 47,462 consecutive screening mammograms in incident rounds (2004–2010) that were interpreted following a double reading plus arbitration protocol. For the single reading, radiologists were selected on the basis of the appraisement of their previous performance.ResultsPeriod 2010–2012 vs. period 2004–2010: Cancer detection rate (CDR): 6.1‰ (95% confidence interval: 5.1–7.2) vs. 5.25‰; Recall rate (RR): 7.02% (95% confidence interval: 6.7–7.4) vs. 7.24% (selected readers before arbitration) and vs. 3.94 (all readers after arbitration); Predictive positive value of recall: 8.69% vs. 13.32%. Average size of invasive cancers: 14.6 ± 9.5 mm vs. 14.3 ± 9.5 mm. Stage: 0 (22.3/26.1%); I (59.2/50.8%); II (19.2/17.1%); III (3.1/3.3%); IV (0/1.9%). Specialized breast radiologists performed better than general radiologists.ConclusionsThe cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD, at the cost of a moderate increase of the recall rate mainly related to the lack of arbitration.