Authors' objectives:

The objective of this study was to determine the value of computer-aided detection (CAD) for breast cancer screening. The impact of the R2 ImageChecker (R) on the sensitivity and specificity of radiologists and film-reading radiographers was assessed in two experiments, referred to here as study 1 and study 2, and the resulting data were used in an economic evaluation.

Authors' results and conclusions: No significant difference was found for readers sensitivity or specificity between the prompted and unprompted conditions in study 1 [95% confidence index (CI) for sensitivity with and without CAD is 0.76 to 0.80, for specificity it is 0.81 to 0.86 without CAD and 0.81 to 0.87 with CAD]. No statistically significant difference was found between the sensitivity and specificity of different groups of film reader (95% CI for unprompted sensitivity of radiologists was 0.75 to 0.81, for radiographers it was 0.71 to 0.81, prompted sensitivity was 0.76 to 0.81 for radiologists and 0.69 to 0.79 for radiographers). Thirty-five readers participated in study 2. Sensitivity was improved in the prompted condition (0.81 from 0.78) but the difference was slightly below the threshold for statistical significance (95% CI for the difference 0.003 to 0.064). Specificity also improved (0.87 from 0.86); again, the difference was not significant at 0.05 (95% CI 0.003 to 0.034). A cost-effectiveness analysis showed that computer prompting increases cost.

Authors' recommendations: No significant improvement in film readers sensitivity or specificity or gain in cost-effectiveness was established in either study. This may be due to the systems low specificity, its relatively poor sensitivity for subtle cancers or the fact the prompts cannot serve as aids to decision-making. Readers may have been better able to make use of the prompts after becoming more accustomed to working with them. Prompts may have an impact in routine use that is not detectable in an experimental setting. Although the case for CAD as an element of the NHS Breast Screening Programme is not made here, further research is required. Evaluations of new CAD tools in routine use are underway and their results should be given careful attention.

Authors' methods: Trial

Project Status: Completed

URL for project: http://www.hta.ac.uk/1183

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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