***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Mammography is the basic imaging modality for early detection of breast cancer . The aim of this prospect i ve study was to evaluate the impact of different mammogram reading strategies on the diagnostic yield in a consecutive patient population referred for digital mammography to a hospital . First , the effect of using computer‐aided detection ( CAD ) software on the performance of mammogram readers was studied . Furthermore , the impact of employing technologists as either prereaders or double readers was assessed , as compared to the conventional strategy of single reading by a radiologist . Digital mammograms of 1,048 consecutive patients were evaluated by a radiologist and 3 technologists with and without the use of CAD software . ROC analysis was used to study the effects of the different strategies . In the conventional strategy , an overall area under the curve ( AUC ) of 0.92 was found , corresponding to a sensitivity of 84 % and specificity of 94 % . When applying CAD software , the AUCs were similar before and after CAD for all readers ( mean of 0.95 ) . Employing technologists in prereading and double reading of mammograms result ed in a mean AUC of 0.91 and 0.96 , respectively . In the prereading strategy , the corresponding sensitivity and specificity were 81 and 96 % ; in the double reading strategy they were 96 and 79 % , respectively . Concluding , in this clinical population , systematic application of CAD software by either radiologist or technologists failed to improve the diagnostic yield . Furthermore , employing technologists as double readers of mammograms was the most effective strategy in improving breast cancer detection in daily clinical practice . © 2009 OBJECTIVE The purpose of our study was to perform a prospect i ve assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years . MATERIAL S AND METHODS Our study was carried out on a population of 21,855 asymptomatic women ( 45 - 65 years ) .  Mammograms were processed in a CAD system and independently interpreted by one of six radiologists . We analyzed the following parameters : sensitivity of radiologist 's interpretation ( without and  with CAD ) , detection increase , recall rate and positive predictive value of biopsy , CAD 's marks , radiologist 's false negatives and comparative analysis of carcinomas detected and non-detected by CAD . RESULTS Detection rate was 4.3‰. CAD supposed an increase of 0.1‰ in detection rate and 1 % in the total number of cases ( p<0.005 ) . The impact on recall rate was not significant ( 0.4 % ) and PPV of percutaneous biopsy was unchanged by CAD ( 20.23 % ) . CAD 's marks were 2.7 per case and 0.7 per view . Radiologist 's false negatives were 13 lesions which were initially considered as CAD 's false positives . CONCLUSIONS CAD supposed a significant increase in detection , without modifications in recall rates and PPV of biopsy . However , better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted The aim of this study was to determine the tumour detection rate and false positive rate of a new mammographic computer-aided detection system ( CAD ) in order to assess its clinical usefulness . The craniocaudal and oblique images of 150 suspicious mammograms from 150 patients that were histologically proven to be malignant were analysed using the Second Look CAD ( CADx Medical Systems , Quebec , Canada ) . Cases were selected r and omly using the clinic 's internal tumour case sample r. Correct marking of the malignant lesion in at least one view was scored as a true positive . Marks not at the location of the malignant lesion were scored as false positives . In addition , mammograms with histologically proven benign masses ( n=50 ) and microcalcifications ( n=50 ) , as well as 100 non-suspicious mammograms , were scanned in order to determine the value of false-positive marks per image . The 150 mammograms included 94 lesions that were suspicious due to masses , 26 due to microcalcifications and 30 showed both signs of malignancy . The overall sensitivity was 90.0 % ( 135 of 150 ) . Sensitivity on subsets of the data was 88.7 % ( 110 of 124 ) for suspicious masses ( MA ) and 98.2 % ( 55 of 56 ) for microcalcifications . Eight of 14 false-negative cases were large lesions . The overall false-positive rate was observed as 0.28 and 0.97 marks per image of microcalcifications and masses , respectively . The lowest false-positive rates for microcalcifications and MA were observed in the cancer subgroup , whereas the highest false-positive rates were scored in the benign but mammographically suspicious subgroups , respectively . The new CAD system shows a high tumour detection rate , with approximately 1.3 false positive marks per image . These results suggest that this system might be clinical ly useful as a second reader of mammograms . The system performance was particularly useful for detecting microcalcifications OBJECTIVE The purpose of this study was to prospect ively assess the usefulness of computer-aided detection ( CAD ) in the interpretation of screening mammography and to provide the true sensitivity and specificity of this technique in a clinical setting . SUBJECTS AND METHODS Over a 26-month period , 5,016 screening mammograms  were interpreted without , and subsequently with , the assistance of the iCAD MammoReader detection system . Data collected for actionable findings included dominant feature ( calcification , mass , asymmetry , architectural distortion ) , detection method ( radiologist only , CAD only , or both radiologist and CAD ) , BI-RADS assessment code , associated histopathology for those undergoing biopsy , and tumor stage for malignant lesions . The study population was cross-checked against an independent reference st and ard to identify false-negative cases . RESULTS Of the 5,016 cases , the recall rate increased from 12 % to 14 % with the addition of CAD . Of the 107 ( 2 % ) patients who underwent biopsy , 101 ( 94 % ) were prompted by the radiologist and six ( 6 % ) were prompted by CAD . Of the 124 biopsies performed on actionable findings in the 107 patients , findings in 79 ( 64 % ) were benign and in 45 ( 36 % ) were in situ or invasive carcinoma . Three study participants who were not recalled by the radiologist with the assistance of CAD developed cancer within 1 year of the screening mammogram and were considered to be false-negative cases . The radiologist detected 43 ( 90 % ) of the 48 total malignancies and 45 ( 94 % ) of the 48 malignancies with the assistance of CAD . CAD missed eight cancers that were detected by the radiologist , which presented as architectural distortions ( n = 3 ) , irregular masses ( n = 4 ) , and a circumscribed mass ( n = 1 ) . CAD detected two in situ cancers as a faint cluster of calcifications that had not been perceived by the radiologist and one mass that was dismissed by the radiologist , accounting for at least a 4.7 % increase in cancer detection rate . Sensitivity of screening mammography with the use of CAD ( 94 % ) represented an absolute and relative 4 % increase over the sensitivity of the radiologist alone ( 90 % ) . Specificity of screening mammography with and without the use of CAD was 99 % . CONCLUSION Routine use of CAD while interpreting screening mammograms significantly increases recall rates , has no significant effect on positive predictive value for biopsy , and can increase cancer detection rate by at least 4.7 % and sensitivity by at least 4 % . This study provides " true " values for sensitivity and specificity for use of CAD in interpretation of screening mammography as measured prospect ively in the context of a working clinical setting In March 1981 a r and omized single-view mammographic screening for breast cancer was started in the south of Stockholm . The screened population in the first round numbered 40,318 women , and 20,000 women served as a well-defined control group . The age groups represented were 40–64 years , and 80.7 % of the invited women participated in the study . The first round disclosed 128 breast cancers ( 113 invasive and 15 noninvasive ) , or 4.0 per 1,000 women . Mean tumour size was 14.1 mm and axillary lymph node metastases were found in 21.8 % . Fifty-five per cent of the tumours were small ( ⩽10 mm ) or non-invasive , and 71 % were stage I.Participation rates are high in all Swedish trials . The present results differ only slightly from other screening programs ; the percentages of patients with axillary metastases and stage II tumours are similar in the Stockholm , Malmö and Kopparberg/Östergötl and studies . Comparisons of cancer prevalence in the various Swedish screening trials show that , in comparable age groups , there are some differences , even when the differences in the natural cancer incidence are taken into account . A decreased mortality was found recently in a Swedish trial in ages above 50 years but not below . In the Stockholm study more than one-third of the participants were aged 40–49 years OBJECTIVE This study prospect ively evaluated a computer-aided detection ( CAD ) device used with diagnostic and screening mammography  by assessing cancers detected ; tumor sizes , histology , and stage ; positive predictive value ( PPV ) of biopsy recommendation ; and recall rates before and after CAD introduction . SUBJECTS AND METHODS Interpretations of 9,520 consecutive mammograms were recorded without and then with CAD for a 28-month period . Cancer detections based on initial radiologist review and additional detections based on CAD findings were noted . Recall rates , tumor size and histology , and PPV of biopsy recommendation before and after the introduction of CAD were compared . RESULTS Cancers detected only with CAD assistance were 9.6 % of all cancers ( 10 of 104 ) ; screening-detected cancers increased 13.3 % with CAD assistance ( four in addition to 30 screening-detected cancers ) . The 95 % one-sided confidence boundary using binomial distribution is consistent with at least 5.3 % for all cancers and 5.1 % for nonpalpable cancers . The greatest impact was on ductal carcinoma in situ , for which CAD increased cancer detection by 14.2 % ( three added to 21 ) . Similar percentages of cancers were detected only with CAD assistance in both screening ( 11.4 % ; 4 of 35 ) and diagnostic ( 9.5 % ; six of 63 ) studies . Additional cancers were detected using CAD in patients with implants and previous lumpectomy . The additional cancers detected with CAD were smaller ( p = 0.01 for all cancers , p = 0.03 for nonpalpable invasive cancer ) . The screening recall rate increased from 6.2 % to 7.8 % after CAD , with a decrease in the biopsy rate and a nonsignificant increase in the biopsy PPV from 21.9 % to 26.3 % . CONCLUSION CAD result ed in detection of more cancers in screening and diagnostic patients , with an increased recall rate but no deterioration in PPV of biopsy . Additional cancers detected were significantly smaller BACKGROUND The sensitivity of screening mammography for the detection of small breast cancers is higher when the mammogram is read by two readers rather than by a single reader . We conducted a trial to determine whether the performance of a single reader using a computer-aided detection system would match the performance achieved by two readers . METHODS The trial was design ed as an equivalence trial , with matched-pair comparisons between the cancer-detection rates achieved by single reading with computer-aided detection and those achieved by double reading . We r and omly assigned 31,057 women undergoing routine screening by film mammography at three centers in Engl and to double reading , single reading with computer-aided detection , or both double reading and single reading with computer-aided detection , at a ratio of 1:1:28 . The primary outcome measures were the proportion of cancers detected according to regimen and the recall rates within the group receiving both reading regimens . RESULTS The proportion of cancers detected was 199 of 227 ( 87.7 % ) for double reading and 198 of 227 ( 87.2 % ) for single reading with computer-aided detection ( P=0.89 ) . The overall recall rates were 3.4 % for double reading and 3.9 % for single reading with computer-aided detection ; the difference between the rates was small but significant ( P<0.001 ) . The estimated sensitivity , specificity , and positive predictive value for single reading with computer-aided detection were 87.2 % , 96.9 % , and 18.0 % , respectively . The corresponding values for double reading were 87.7 % , 97.4 % , and 21.1 % . There were no significant differences between the pathological attributes of tumors detected by single reading with computer-aided detection alone and those of tumors detected by double reading alone . CONCLUSIONS Single reading with computer-aided detection could be an alternative to double reading and could improve the rate of detection of cancer from screening mammograms read by a single reader . ( Clinical Trials.gov number , NCT00450359 . PURPOSE To prospect ively determine the effect of a commercially available computer-aided detection ( CAD ) system on interpretations of screening mammograms . MATERIAL S AND METHODS Institutional review board approval was granted ; informed consent and HIPAA compliance were waived . A total of 21 349 screening mammograms obtained in 18 096 women were interpreted 
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Conclusions The scientific evidence is insufficient to determine whether the accuracy of single reading + CAD is at least equivalent to that obtained in st and ard practice , i.e. double reading where two breast radiologists independently read the mammographic images