Background: Postoperative mammograms present interpretive challenges due to postoperative distortion and hematomas. The application of digital breast tomosynthesis (DBT) and artificial intelligence-based computer-aided detection (AI-CAD) after breast concerving therapy (BCT) has not been widely investigated.
Objective: To assess the impact of additional DBT or AI-CAD on recall rate and diagnostic performance in women undergoing mammographic surveillance after BCT.
Methods: This retrospective study included 314 women (mean age 53.2±10.6 years; 4 with bilateral breast cancer) who underwent BCT followed by DBT (mean interval from surgery to DBT of 15.2±15.4 months). Three breast radiologists independently reviewed images in three sessions: digital mammography (DM), DM with DBT (DM+DBT), and DM with AI-CAD (DM+AI-CAD). Recall rates and diagnostic performance were compared between DM, DM+DBT, and DM+AI-CAD, using readers' mean results.
Results: Of the 314 women, 6 breast recurrences (3 ipsilateral, 3 contralateral) developed at the time of surveillance mammography. Ipsilateral breast recall rate was lower for DM+AI-CAD (1.9%) than for DM (11.2%) or DM+DBT (4.1%) (p<.001). Contralateral breast recall rate was lower for DM+AI-CAD (1.5%, p<.001) than for DM (6.6%) but not DM+DBT (2.7%, p=.08). In ipsilateral breast, accuracy was higher for DM+AI-CAD (97.0%) than for DM (88.5%) or DM+DBT (94.8%) (p<.05); specificity was higher for DM+AICAD (98.3%) than for DM (89.3%) or DM+DBT (96.1%) (p<.05); sensitivity was lower for DM+AI-CAD (22.2%) than for DM (66.7%, p=.03) but not DM+DBT (22.2%, p>.99). In contralateral breast, accuracy was higher for DM+AI-CAD (97.1%) than for DM (92.5%, p<.001) but not DM+DBT (96.1%, p=.25); specificity was higher for DM+AI-CAD (98.6%) than for DM (93.7%, p<.001) but not DM+DBT (97.5%) (p=.09); sensitivity was not different between DM (33.3%), DM+DBT (22.2%), and DM+AI-CAD (11.1%) (p>.05).
Conclusion: After BCT, adjunct DBT or AI-CAD reduced recall rates and improved accuracy in the ipsilateral and contralateral breasts compared with DM. In the ipsilateral breast, addition of AI-CAD resulted in lower recall rate and higher accuracy than addition of DBT.
Clinical Impact: AI-CAD may help address the challenges of post-BCT surveillance mammograms.
Jung Hyun Yoon, MD, PhD1, Eun-Kyung Kim, MD, PhD2, Ga Ram Kim, MD, PhD1, Kyunghwa Han, PhD3 and Hee Jung Moon, MD, PhD4
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