Single reader with CAD more efficient, yields fewer false positives, and possibly more sensitive

Single reading of screening mammograms with computer-aided detection (CAD) is more efficient than double reading and yields a higher sensitivity than the first reader in a double reading program, according to a study conducted by researchers at Charlotte Radiology in Charlotte, NC. In addition, the readings with CAD had a significantly lower recall rate than double reading.

The double reading method consisted of the mammogram being first read by sub-specialized mammographers, with the second reading performed by either a specialist or a general radiologist who is certified in mammography. Single reading with CAD was performed by sub-specialized mammographers.

The study compared the recall rate, sensitivity, positive predictive value (PPV), and cancer detection rate of single reading with CAD to double reading and to the first reader in the double reading program in 231,221 mammograms from 2001-2005. The study shows that single reading with CAD was as effective at finding cancers as double reading and had a lower recall rate.

“Because double reading is time consuming and not generally reimbursed, CAD has become increasingly popular in the United States as an alternative way to increase sensitivity,” said Matthew Gromet, JD, MD, author of the study.

According to the study, statistically significant results included a lower recall rate with CAD compared to double reading (10.6% vs. 11.9%), increased sensitivity with CAD compared to the first reader (90.4% vs. 81.4%), and increased recall rate with CAD compared with the first reader (10.6% vs. 10.2%). The sensitivity of single reading with CAD was slightly higher than double reading (90.4% vs. 88.0%), although this difference did not reach statistical significance.

“With manpower and cost constraints limiting the use of double reading, CAD appears to be an effective and more widely accessible alternative that provides a lower recall rate and equal or possibly higher sensitivity,” said Dr. Gromet.

The full results of this study will appear in the April 2008 issue of the American Journal of Roentgenology.