Comparisons between artificial intelligence computer-aided detection synthesized mammograms and digital mammograms when used alone and in combination with tomosynthesis images in a virtual screening setting

PURPOSE: To compare the reader performance of artificial intelligence computer-aided detection synthesized mammograms (AI CAD SM) with that of digital mammograms (DM) when used alone or in combination with digital breast tomosynthesis (DBT) images. MATERIALS AND METHODS: This retrospective multireader (n = 4) study compared the reader performances in 388 cases (84 cancer, 83 benign, and 221 normal or benign cases). The overall accuracy of the breast-based assessment was determined by four radiologists using two sequential reading modes: DM followed by DM + DBT; and AI CAD SM followed by AI CAD SM + DBT. Each breast was rated by each reader using five-category ratings, where 3 or higher was considered positive. The area under the receiver-operating characteristic curve (AUC) and reading time were evaluated. RESULTS: The mean AUC values for DM, AI CAD SM, DM + DBT, and AI CAD SM + DBT were 0.863, 0.895, 0.886, and 0.902, respectively. The mean AUC of AI CAD SM was significantly higher (P < 0.0001) than that of DM. The mean AUC of AI CAD SM + DBT was higher than that of DM + DBT (P = 0.094). A significant reduction in the reading time was observed after using AI CAD SM + DBT when compared with that after using DM + DBT (P < 0.001). CONCLUSION: AI CAD SM + DBT might prove more effective than DM + DBT in a screening setting because of its lower radiation dose, noninferiority, and shorter reading time compared to DM + DBT.