Lay Summary: CAD is still investigational for breast MRI.
The use of computer-aided detection (CAD) is proposed to supplement radiologists’ interpretation of contrast-enhanced magnetic resonance imaging (MRI) of the breast. MRI of the breast 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 women—for example, younger women and those with denser breasts—in whom mammography is less accurate. However, MRI has a high false-positive rate because of the difficulty in distinguishing between benign and malignant lesions. It is also used to look for more extensive disease in women diagnosed with breast cancer and to gauge the impact of treatment. Unfortunately, the literature on the use of CAD with MRI of the breast was sparse overall, and few studies addressed the specific situations in which CAD with MRI is used in a clinical setting. A recent TEC Asessment by BCBS found it to be experimental.
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.
Deurloo EE, Peterse JL, Rutgers EJ et al. Additional breast lesions in patients eligible for breast-conserving therapy by MRI: impact on preoperative management and potential benefit of computerized analysis. Eur J Cancer 2005;41(10):1393-401
DeMartini WB, Lehman CD, Peacock S et al. Computer-aided detection applied to breast MRI: assessment of CAD-generated enhancement and tumor size in breast cancers before and after neoadjuvant chemotherapy. Acad Radiol 2005;12(7):806-14