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CAD mammography fails to improve diagnostic accuracy.


Augmenting digital screening mammography with computer-aided detection (CAD) failed to improve diagnostic accuracy in every performance measure and every subgroup of women studied in a series of 625,625 exams performed across the United States during a 7-year period, according to a report published in JAMA Internal Medicine.

"CAD is a technology that does not seem to warrant added compensation beyond coverage of the mammographic examination," wrote Dr. Constance D. Lehman of the department of radiology, Massachusetts General Hospital and the Avon Comprehensive Breast Evaluation Center, both in Boston. "The results of our comprehensive study lend no support for continued reimbursement for CAD as a method to increase mammography performance or improve patient outcomes."

Measuring the real-world impact of CAD on mammographic accuracy has been difficult and has yielded inconsistent and contradictory findings. In this study, the investigators pooled data from five mammographic registries, included a demographically diverse population of women aged 40-89 years, and excluded the first year of CAD use for every radiologist in the study.

They assessed outcomes after routine screening mammography with CAD (495,818) or without CAD (129,807).

The overall sensitivity of mammography was 85.3% with CAD and 87.3% without it; sensitivity for invasive cancer was 82.1% with CAD and 85.0% without it, all of which are nonsignificant differences. Also similar were mammography's specificity, at 91.6% with CAD and 91.4% without CAD. The overall cancer detection rate was exactly the same regardless of the use of CAD, at 4.1 cancers per 1,000 women screened (doi:10.1001/jamainternmed.2015.5231).

Diagnostic accuracy was the same with or without CAD regardless of patient age, ethnicity, breast density, patient menopausal status, family history, or interval since the last mammogram.

The study was supported by the National Cancer Institute, the Breast Cancer Surveillance Consortium, several state public health departments, and U.S. cancer registries. Dr. Lehman reported receiving grant support from General Electric Healthcare.

Caption: DR. LEHMAN


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Title Annotation:GYNECOLOGY
Author:Moon, Mary Ann
Publication:OB GYN News
Date:Nov 1, 2015
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