imaging aides reduce diagnostic

Imaging Aids Reduce Diagnostic Accuracy

I've sometimes been described as a Luddite because of my resistance to

adopt certain technologies (though my iPod and laptop would beg to

differ). In a recent case of man vs. machine published in the New

England Journal of Medicine compares mammograms subjected to

computer-aided detection (CAD) to those screened without computer

assistance. CAD software, approved for use in 1998, analyzes mammogram

images and marks suspicious areas which are then reviewed by a

radiologist. The NCI sponsored study found that CAD did not increase

cancer-detection rate, in contrast to early studies that showed a

10-15% increase in diagnosis rate - similar to the increase found with

a second human opinion. Instead, this much more comprehensive study

found a significant increase in false positive rate, resulting in more

call-backs and biopsies, and increased burden on the system and

ulitmately an increase in cost for breast screening.

From the NCI press release:

"This study points out the need for the use of other techniques to

find cancer at its earliest stages. NCI is incorporating techniques

for imaging at the molecular level into many of its studies and is

also conducting studies to improve the use of CAD and conventional

mammography," said John E. Niederhuber, M.D., NCI Director. "In the

end, technology facilitates screening. Ultimately, treatment

requires radiologists working with the examining physician and the

responsible surgeon to put everything together. We worry about

false positives, but we certainly don't want to miss any cancers,

either."

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