NEW YORK (Reuters Health) – In evaluating screening mammograms for breast cancer, a single reader with computer assistance can perform just as well as two readers, the results of a new study suggest.

In the study, reported in The New England Journal of Medicine for October 16 and released ahead of print, the sensitivity, specificity, and positive predictive value for the two reading protocols was nearly the same.

Prior research has already established that the sensitivity of screening mammography is significantly improved with two readers rather than one. The researchers note that double reading is standard practice in many European countries but is not widely used in the US.

It has been unclear whether single reading with a computer-aided detection system, which relies of various algorithms to analyze digital images, could match the performance of double reading.

To investigate, Dr. Fiona J. Gilbert, from the University of Aberdeen in the UK, and colleagues conducted a randomized controlled trial comparing single reading plus computer-aided detection with double reading. Screening mammograms from 31,057 women were included in the analysis.

Double reading detected 87.7% of cancers and single reading with computer assistance detected 87.2%, the report shows. With double reading, 3.4% of women were recalled for further assessment, whereas with single reading plus computer assistance, the rate was slightly but significantly higher at 3.9%.

The sensitivity, specificity, and positive predictive value with single reading plus computer-aided detection were 87.2%, 96.9%, and 18.0%, respectively. The corresponding values with double reading were 87.7%, 97.4%, and 21.1%.

The pathological features of the tumors detected with the two methods were not significantly different, the investigators note.

“Double reading, which is recognized as the best method for the detection of small invasive cancers, is often difficult to achieve in practice because of costs and the need for two readers,” the authors state. “Where single reading is standard practice, computer-aided detection has the potential to improve cancer-detection rates to the level achieved by double reading.”

Reference:
N Engl J Med 2008;359:1675-1684.