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Sophia Zackrisson, MD, PhD. Photo.

Sophia Zackrisson

Manager

Sophia Zackrisson, MD, PhD. Photo.

Breast cancer screening with digital breast tomosynthesis : comparison of different reading strategies implementing artificial intelligence

Author

  • Victor Dahlblom
  • Magnus Dustler
  • Anders Tingberg
  • Sophia Zackrisson

Summary, in English

OBJECTIVES: Digital breast tomosynthesis (DBT) can detect more cancers than the current standard breast screening method, digital mammography (DM); however, it can substantially increase the reading workload and thus hinder implementation in screening. Artificial intelligence (AI) might be a solution. The aim of this study was to retrospectively test different ways of using AI in a screening workflow.

METHODS: An AI system was used to analyse 14,772 double-read single-view DBT examinations from a screening trial with paired DM double reading. Three scenarios were studied: if AI can identify normal cases that can be excluded from human reading; if AI can replace the second reader; if AI can replace both readers. The number of detected cancers and false positives was compared with DM or DBT double reading.

RESULTS: By excluding normal cases and only reading 50.5% (7460/14,772) of all examinations, 95% (121/127) of the DBT double reading detected cancers could be detected. Compared to DM screening, 27% (26/95) more cancers could be detected (p < 0.001) while keeping recall rates at the same level. With AI replacing the second reader, 95% (120/127) of the DBT double reading detected cancers could be detected-26% (25/95) more than DM screening (p < 0.001)-while increasing recall rates by 53%. AI alone with DBT has a sensitivity similar to DM double reading (p = 0.689).

CONCLUSION: AI can open up possibilities for implementing DBT screening and detecting more cancers with the total reading workload unchanged. Considering the potential legal and psychological implications, replacing the second reader with AI would probably be most the feasible approach.

KEY POINTS: • Breast cancer screening with digital breast tomosynthesis and artificial intelligence can detect more cancers than mammography screening without increasing screen-reading workload. • Artificial intelligence can either exclude low-risk cases from double reading or replace the second reader. • Retrospective study based on paired mammography and digital breast tomosynthesis screening data.

Department/s

  • LUCC: Lund University Cancer Centre
  • Radiology Diagnostics, Malmö
  • Medical Radiation Physics, Malmö
  • LU Profile Area: Light and Materials
  • LTH Profile Area: Photon Science and Technology
  • EpiHealth: Epidemiology for Health

Publishing year

2023-05

Language

English

Pages

3754-3765

Publication/Series

European Radiology

Volume

33

Issue

5

Document type

Journal article

Publisher

Springer

Topic

  • Radiology, Nuclear Medicine and Medical Imaging
  • Cancer and Oncology

Keywords

  • Humans
  • Female
  • Breast Neoplasms/diagnosis
  • Retrospective Studies
  • Artificial Intelligence
  • Early Detection of Cancer/methods
  • Breast/diagnostic imaging
  • Mammography/methods
  • Mass Screening/methods

Status

Published

Research group

  • Radiology Diagnostics, Malmö
  • Medical Radiation Physics, Malmö

ISBN/ISSN/Other

  • ISSN: 0938-7994