RESUMO
Deep neural networks have demonstrated promising performance in screening mammography with recent studies reporting performance at or above the level of trained radiologists on internal datasets. However, it remains unclear whether the performance of these trained models is robust and replicates across external datasets. In this study, we evaluate four state-of-the-art publicly available models using four publicly available mammography datasets (CBIS-DDSM, INbreast, CMMD, OMI-DB). Where test data was available, published results were replicated. The best-performing model, which achieved an area under the ROC curve (AUC) of 0.88 on internal data from NYU, achieved here an AUC of 0.9 on the external CMMD dataset (N = 826 exams). On the larger OMI-DB dataset (N = 11,440 exams), it achieved an AUC of 0.84 but did not match the performance of individual radiologists (at a specificity of 0.92, the sensitivity was 0.97 for the radiologist and 0.53 for the network for a 1-year follow-up). The network showed higher performance for in situ cancers, as opposed to invasive cancers. Among invasive cancers, it was relatively weaker at identifying asymmetries and was relatively stronger at identifying masses. The three other trained models that we evaluated all performed poorly on external datasets. Independent validation of trained models is an essential step to ensure safe and reliable use. Future progress in AI for mammography may depend on a concerted effort to make larger datasets publicly available that span multiple clinical sites.