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    Computer-Aided Detection Improves Early Breast Cancer Diagnosis

    CAD breast cancer screening courtesy Radiological Society of North America, Inc. CAD, computer-aided detection, is computer software that uses a normal mammogram film or a digital mammogram. The program searches for abnormal areas of density, mass, or calcification that may indicate the presence of cancer. The CAD system highlights these areas on the images, letting the radiologist know that there is a need for further analysis.

    CAD can help radiologists detect breast cancer earlier and pinpoint micro-calcifications that may be early cancer. In one study, CAD correctly identified 71% of cancers missed by two readers. Another study of 18,586 screening mammograms confirmed that by using CAD radiologists are able to identify more cancers earlier.

    "Our study indicates that by using a CAD system there is a potential to increase the pick-up rates of breast cancer earlier," said Stamatia Destounis, M.D., from The Elizabeth Wende Breast Clinic in Rochester, N.Y. and lead author of the study published in the August 2004 issue of the journal Radiology.

    For the study, Dr. Destounis and colleagues reviewed the cases of 519 patients with proven breast cancer. Prior screening mammograms were available for 318 patients and yielded a total of 98 "false-negatives," or missed cancers. Three out of five reviewers identified 52 actionable cancers that, in retrospect, appeared as visible abnormalities on prior screening mammograms, but had been missed by two breast imaging specialists doing a non-blinded, double-read.

    The researchers, retrospectively, then used CAD to scan and analyze the "false-negative" mammograms. CAD correctly marked 37 (or 71 percent) of the 52 visible cancers missed during the double-read.

    "Finding cancer earlier, we believe, is the best chance for longer cancer-free survival, resulting in less surgery, less chemotherapy and less stress on the patient and her family," Dr. Destounis said.

    Computer-aided detection finds breast cancers earlier in both screening and diagnostic patients according to another study done by a private practice radiologist in Santa Barbara, CA. which appeared in the July 2006 issue of the American Journal of Roentgenology

    “Early detection is essential in preventing breast cancer deaths, so as a mammography specialist, I’m always looking for tools to improve cancer detection,” said Judy Dean, MD, and lead author of the study.

    “This study began as acceptance testing for the CAD system I purchased for my mammography practice in 2002. I scanned 50 known cancer cases and 50 normal mammograms to see how the software would perform on films from my own practice and was astounded to find that it marked 90% of the cancers. I was really surprised that a computer program could achieve that level of sensitivity, so I decided to see what effect it would have when put into day-to-day use in my practice,” said Dr. Dean.

    “We collected data until more than a hundred cancers had been found, and then analyzed the results to compare what types of cancers were found with and without CAD assistance,” said Dr. Dean. “We used the CAD system for every mammogram performed during the study, not just screening patients, and even in patients with prior surgery, breast implants, or other findings, CAD was helpful in finding more cancers.”

    During a 28 month period, 9,520 film-screen mammograms were interpreted. According to the study screening-detected cancers increased 13.3% with CAD assistance and 9.5% in diagnostic exams. The greatest impact was on ductal carcinoma in situ (DCIS), the most common type of non-invasive breast cancer in women, for which CAD increased cancer detection by 14.2%.

    “Cancer detections were higher in both screening studies and symptomatic patients. This means that CAD should be used for all mammograms, not just routine screening examinations,” said Dr. Dean. “According to the ACR, there are currently 8,881 accredited mammography facilities in the United States but only 4,000 are using CAD.”

    “The principal barrier with CAD is the cost, and a proposed 50% reduction in Medicare reimbursement will make the technology out of reach for most small and medium sized facilities,” said Dr. Dean. “These may be the very places that need CAD the most, as prior studies have shown that CAD has the most impact for non-specialist radiologists,” she said.

    Computers Significantly Increase Breast Cancer Detection Rate
    Computer Helps Detect Breast Cancer Earlier
    New Technologies to Help Improve Mammography
    Improving Methods for Breast Cancer Detection and Diagnosis
    CAD software improves characterization of suspicious masses on breast ultrasound
    Computers Increase Detection Rate Of Breast Cancer

    August 1, 2006





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