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

• 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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Keyword

Humans

Female

Breast Neoplasms/diagnosis

Retrospective Studies

Artificial Intelligence

Early Detection of Cancer/methods

Breast/diagnostic imaging

Mammography/methods

Mass Screening/methods

Publication and Content Type

art (subject category)

ref (subject category)