Potential usefulness of similar images in the differential diagnosis of clustered microcalcifications on mammograms
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Published on: August 30, 2013
Ryohei Nakayama1, Hiroyuki Abe, Junji Shiraishi
1Kurt Rossmann Laboratories for Radiologic Image Research, Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA. nakayama@clin.medic.mie-u.ac.jp
Purpose:
To evaluate the potential usefulness of images of lesions of a known disease that have a similar appearance to lesions of an unknown disease in distinguishing between benign and malignant clustered microcalcifications on mammograms by removing the unusual cases from the database.
Materials And Methods:
Institutional review board approval for this retrospective HIPAA-compliant study of images from a publicly available database was obtained. Unusual lesions, such as malignant-looking benign lesions and benign-looking malignant lesions, were removed from the database. A total of 20 benign and 20 malignant lesions were selected with a stratified randomization method, and it was these lesions that served as unknown cases in this observer study. For each unknown case, eight similar images of benign lesions and eight similar images of malignant lesions were preselected with a computerized scheme. From these preselected images, a breast radiologist subjectively selected the four most similar images of benign lesions and the four most similar images of malignant lesions. Five attending breast radiologists and three breast-imaging fellows participated in the observer study. Observers provided their confidence level regarding malignancy of the unknown case before and after they viewed the similar images. The results were evaluated with multireader multicase receiver operating characteristic (ROC) analysis.
Results:
For all observers, the areas under the ROC curves (AUCs) were improved when similar images were used. The average AUC for all observers increased from 0.692 without use of similar images to 0.790 with use of similar images (P = .0009).
Conclusion:
The presentation of similar images can improve radiologists' performance in the differential diagnosis of clustered microcalcifications on mammograms.
Insights
Presenting similar mammogram images significantly improved radiologists' ability to differentiate benign from malignant clustered microcalcifications. This method enhances diagnostic accuracy for breast cancer detection.
Area of Science:
- Radiology
- Medical Imaging
- Breast Cancer Diagnosis
Background:
- Mammography is crucial for detecting clustered microcalcifications, a potential sign of breast cancer.
- Distinguishing benign from malignant microcalcifications can be challenging, impacting diagnostic accuracy.
- Unusual lesion presentations can complicate differential diagnosis.
Purpose of the Study:
- To assess if showing similar known cases improves differentiation of benign and malignant clustered microcalcifications.
- To evaluate the impact of removing ambiguous cases on diagnostic performance.
- To enhance the diagnostic accuracy of mammographic interpretation.
Main Methods:
- Retrospective analysis of a public mammogram database after removing unusual lesions.
- Selection of 40 "unknown" clustered microcalcifications (20 benign, 20 malignant).
- Radiologists reviewed unknown cases with and without preselected similar benign and malignant examples, with performance measured using ROC analysis.
Main Results:
- The use of similar images significantly improved diagnostic performance across all observers.
- The average area under the receiver operating characteristic curve (AUC) increased from 0.692 to 0.790 (P = .0009).
- This indicates a substantial enhancement in the ability to correctly classify microcalcifications.
Conclusions:
- Providing similar images aids radiologists in the differential diagnosis of clustered microcalcifications.
- This approach can improve diagnostic confidence and accuracy in mammography.
- The strategy shows promise for enhancing early breast cancer detection.
