Concurrent Computer-Aided Detection Improves Reading Time of Digital Breast Tomosynthesis and Maintains Interpretation Performance in a Multireader Multicase Study

Digital breast tomosynthesis (DBT) is more accurate than full-field digital mammography alone but requires a longer reading time. A radiologist reader study evaluated the use of concurrent computer-aided detection (CAD) to shorten the reading time while maintaining interpretation performance. A CAD system was developed to detect suspicious soft-tissue densities in DBT planes. Abnormalities are extracted from the plane in which they are detected and blended into the corresponding synthetic image. The study used an enriched sample of 240 DBT cases with 68 malignancies in 61 patients. Twenty radiologists retrospectively reviewed all 240 cases in a multireader multicase crossover design to compare reading time and performance with and without CAD. The performance of CAD alone was also evaluated. Reading time improved by 29.2% with CAD (95% CI, 21.1-36.5%; p < 0.01). Reader performance, measured by ROC AUC, was noninferior with CAD (p < 0.01). The mean AUC increased from 0.841 without to 0.850 with CAD (95% CI, -0.012 to 0.030). Mean sensitivity increased from 0.847 without to 0.871 with CAD (difference 95% CI, -0.005 to 0.055), showing a 0.033 increase in sensitivity for cases with soft-tissue densities (95% CI, -0.002 to 0.068). Mean specificity decreased from 0.527 without to 0.509 with CAD (difference 95% CI, -0.041 to 0.005), and mean recall rate for noncancers slightly increased from 0.474 without to 0.492 with CAD (difference 95% CI, -0.006 to 0.041). Concurrent use of CAD with DBT resulted in 29.2% faster reading time, while maintaining reader interpretation performance.