Artificial intelligence-based computer-assisted detection/diagnosis (AI-CAD) for screening mammography: Outcomes of AI-CAD in the mammographic interpretation workflow.

Purpose: To evaluate the stand-alone diagnostic performances of AI-CAD and outcomes of AI-CAD detected abnormalities when applied to the mammographic interpretation workflow. Methods: From January 2016 to December 2017, 6499 screening mammograms of 5228 women were collected from a single screening facility. Historic reads of three radiologists were used as radiologist interpretation. A commercially-available AI-CAD was used for analysis. One radiologist not involved in interpretation had retrospectively reviewed the abnormality features and assessed the significance (negligible vs. need recall) of the AI-CAD marks. Ground truth in terms of cancer, benign or absence of abnormality was confirmed according to histopathologic diagnosis or negative results on the next-round screen. Results: Of the 6499 mammograms, 6282 (96.7%) were in the negative, 189 (2.9%) were in the benign, and 28 (0.4%) were in the cancer group. AI-CAD detected 5 (17.9%, 5 of 28) of the 9 cancers that were intially interpreted as negative. Of the 648 AI-CAD recalls, 89.0% (577 of 648) were marks seen on examinations in the negative group, and 267 (41.2%) of the AI-CAD marks were considered to be negligible. Stand-alone AI-CAD has significantly higher recall rates (10.0% vs. 3.4%, P < 0.001) with comparable sensitivity and cancer detection rates (P = 0.086 and 0.102, respectively) when compared to the radiologists' interpretation. Conclusion: AI-CAD detected 17.9% additional cancers on screening mammography that were initially overlooked by the radiologists. In spite of the additional cancer detection, AI-CAD had significantly higher recall rates in the clinical workflow, in which 89.0% of AI-CAD marks are on negative mammograms.