Cancer Treatment Today

CAD assists radiologist in interpreting MRIs by color coding areas with differing accumulation of contrast. Its value has not been proven. Computer-aided detection has been used to aid radiologists’ interpretation of contrast-enhanced MRI of the breast, which is sometimes used as an alternative to mammography or other screening and diagnostic tests because of its high sensitivity in detecting breast lesions, even among those in whom mammography is less accurate (e.g., younger women and those with denser breasts).  The BlueCross and BlueShield Association’s Technology Evaluation Center (TEC) Medical Advisory Panel (2006) assessed the evidence on the use of CAD with MRI of the breast by comparing the sensitivity, specificity, and recall rate (percentage of patients asked to come back for further evaluation) of MRI with and without the use of commercially available CAD systems in detecting malignant lesions, evaluating the extent of disease in women with cancer, or gauging the impact of treatment.  According to this assessment, many of the studies on the use of CAD with MRI of the breast mainly reported on the development of CAD systems, or testing new CAD approaches.  The assessment noted that few of them evaluated commercially available CAD systems.  The TEC assessment stated that the literature is unclear on how CAD systems are to be used.  In the case of CAD with mammography, the radiologist reads the original films first, makes a diagnosis, and then reviews the CAD results. Based on the available evidence, the Blue Cross and Blue Shield Association Medical Advisory Panel concluded that there is insufficient evidence to evaluate if the use of CAD systems would maintain or increase the sensitivity, specificity, and recall rates of MRI of the breast.  The TEC assessment concluded that, given the inability to evaluate these intermediate outcomes, it is impossible to evaluate the impact of CAD on health outcomes such as treatment success and survival of patients with breast cancer. As such, the CAD method required farther testing and is investigational.

Bruening W, Launders J, Pinkney N, et al. Effectiveness of noninvasive diagnostic tests for breast abnormalities. Comparative Effectiveness Review No. 2. Prepared by the ECRI Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ). AHRQ Publication No. 06-EHC005-EF. Rockville, MD: AHRQ; February 2006.

Muralidhar GS, Bovik AC, Sampat MP et al. Computer-aided diagnosis in breast magnetic resonance imaging. Mt Sinai J Med. 2011 Mar-Apr; 78(2):280-90. doi: 10.1002.msj.20248.

Dorrius MD, der Weide MC, van Ooijen PM et al. Computer-aided detection in breast MRI: a systematic review and meta-analysis. Eur Radiol. 2011 Aug;21(8):1600-8. Epub 2011 Mar 15

Sung Eun Song et al, Computer-aided detection (CAD) system for breast MRI in assessment of local tumor extent, nodal status, and multifocalit Cancer Imaging201515:1

NCCN, Detection 2018