Detection of the abnormal gist in the prior mammograms even with no overt sign of breast cancer

摘要

Can radiologists distinguish prior mammograms with no overt signs of cancer from women who were later diagnosed with breast cancer from the prior mammograms of women reported as normal and subsequently confirmed to be cancer-free? Twenty-three radiologists and breast physicians viewed 200 craniocaudial mammograms for a half-second and rated whether the woman would be recalled on a scale of 0 (clearly normal) to 100 (clearly abnormal). The dataset included five categories of mammograms, with each category containing 40 cases. The categories were Cancer (current cancer-containing mammograms), Prior-Vis (prior mammograms with visible cancer signs), Contra (current 'normal' mammograms contralateral to the cancer), Prior-Invis (priors without visible cancer signs), and Normal (priors of normal cases). For each radiologist, four pairs of analyses were performed to evaluate whether the radiologists could distinguish mammograms in each category from the normal mammograms: Cancer vs Normal, Prior-Vis vs Normal, Contra vs Normal, and Prior-Invis vs Normal. The Area under Receiver Operating Characteristic curves (AUC) was calculated for each paired grouping and each radiologist. Wilcoxon Signed Rank test showed the AUC values were above-chance for all comparisons: Cancer (z=4.20, P<0.00l); Prior-Vis (z=4.11, P<0.00l); Contra (z=4.17, P<0.00l); Prior-Invis (z=3.71, P<0.00l). The results suggest that radiologists can distinguish patients who were diagnosed with cancer from individuals without breast cancer at an above-chance level based on a half-second glimpse of mammogram even before the lesion becomes apparently visible (Prior-Invis). Apparently, something about the breast parenchyma can look abnormal before the appearance of a localized lesion.