Subscribe to RSS
DOI: 10.1055/s-0030-1257160
© Georg Thieme Verlag KG Stuttgart · New York
CAD in der Mammadiagnostik: Einsatz bei Mammografie und MRT
CAD in breast imaging: application in mammography and MR mammographyPublication History
Publication Date:
17 March 2012 (online)

Zusammenfassung
In vielen Bereichen der diagnostischen Radiologie wird zunehmend der Einsatz von computerassistierten Diagnosesystemen (CAD-Systemen) geprüft. In der Mammografie ist dies von besonderem Interesse, da eine Zweitbefundung zeit- und kostenintensiv ist. Aufgrund der hohen Rate an falsch positiven Befunden ist jedoch derzeit der routinemäßige Einsatz der CAD-Systeme noch nicht in den klinischen Alltag eingezogen, sodass das Double Reading auch nicht durch einen Computer aktuell zu ersetzen ist. Es bleibt abzuwarten, ob die Technik in der Zukunft hier Verbesserungen bringt.
Abstract
Computer aided diagnosis systems (CAD-systems) are evaluated in different parts of diagnostic imaging. In breast imaging double reading which is time- and cost spending is necessary. Therefore a lot of studies evaluated the use of CAD-systems in mammography. However the rate of false-positives is too high to implement CAD-systems as double reader in routine work. In the future, improvements in this technique could perhaps change the performance of CAD-systems.
Key words
Computer aided diagnosis systems - diagnostic imaging - mammography
Kernaussagen
-
Zur Qualitätssicherung der mammografischen Befundauswertung schreiben die Richtlinien der European Society of Mastology (EUSOMA) eine Doppelbefundung vor, wodurch die Sensitivität um ca. 15 % gesteigert werden kann.
-
Eine mögliche Alternative zur ärztlichen Zweitbefundung könnten CAD-Systeme darstellen.
-
Neben einer hohen Sensitivität besitzen die CAD-Systeme aber eine geringe Spezifität bei hoher Anzahl an falsch positiven Markierungen. Hier bleibt abzuwarten, ob in der Zukunft eine technische Verbesserung erzielt werden kann.
-
In der MR-Mammografie soll der Radiologe durch die CAD-Systeme bei der Einordnung von Befunden in Benignität oder Malignität unterstützt werden. Auch sollen die Systeme die Kurvenanalyse automatisch in Form einer farbcodierten Analyse erledigen.
-
Damit soll wiederum die Anzahl der falsch positiven Markierungen reduziert und die Zeit für die Interpretation der MR-Mammografie verkürzt werden.
-
Aber auch hier bleibt der Radiologe und seine Erfahrung weiterhin das entscheidende Kriterium.
Literatur
- 1 Blendl C, Hermann K-P, Mertelmeier T. Anwendungen und Prüfverfahren für digitale
Mammografie-Einrichtungen.. Berlin: Beuth Verlag GmbH; 2005
MissingFormLabel
- 2
Eadie L H, Taylor P, Gibson A P.
A systematic review of computer-assisted diagnosis in
diagnostic cancer imaging.
Eur J Radiol.
2012;
81
e70-76
MissingFormLabel
- 3
Jiang Y, Nishikawara R M, Schmidt R A et al.
Potential of computer-aided diagnosis to reduce variability
in radiologists’ interpretations of mammograms depicting
microcalcifications.
Radiology.
2011;
220
787-794
MissingFormLabel
- 4
Malich A, Marx C, Facius M et al.
Tumor detection rate of a new commercially available
computer-aided detection system.
Eur Radiol.
2001;
11
2454-2459
MissingFormLabel
- 5
Sittek H, Perlet C, Helmberger R et al.
Computerassistierte Analyse von Mammografien in der
klinischen Routinediagnostik.
Radiologe.
1998;
38
848-852
MissingFormLabel
- 6
Vyborny C J, Doi T, O’Shaughnessy K et al.
Breast cancer: importance of spiculation in computer-aided
detection.
Radiology.
2000;
215
703-707
MissingFormLabel
- 7
Kegelmeyer W P, Prudeda J M, Bourland P D et al.
Computer-aided mammographic screening for spiculated
lesions.
Radiology.
1994;
191
331-337
MissingFormLabel
- 8
Lehman C D, Peacock S, DeMartini W B, Chen X.
A new automated software system to evaluate breast MR
examinations: improved specificity without decreased sensitivity.
Am J Roentgenol.
2006;
187
51-56
MissingFormLabel
- 9
Williams T C, DeMartini W B, Partridge S C et al.
Breast MR imaging: computer-aided evaluation program for
discriminating benign from malignant lesions.
Radiology.
2007;
244
94-103
MissingFormLabel
- 10
Blieheuvel C, Weigel S, Heindel W.
Mammography Screening: Evidence, History and Current Practice
in Germany and Other European Countries.
Breast Care (Basel).
2011;
6
104-109
MissingFormLabel
- 11
Diekmann S, Diekmann F.
Mammography screening in Germany.
Radiologe.
2008;
1
17-25
MissingFormLabel
- 12
Shapiro S, Strax P, Venet L.
Periodic breast cancer screening in reducing mortality from
breast cancer.
JAMA.
1971;
215
1777-1785
MissingFormLabel
- 13
Tabar L, Fagerberg C J, Gad A et al.
Reduction in mortality from breast cancer after mass
screening with mammography.
Lancet.
1985;
2
829-832
MissingFormLabel
- 14
Thurfjell E L, Lernevall K A, Taube A A.
Benefit of independent double reading in a population-based
mammography screening program.
Radiology.
1994;
1
241-244
MissingFormLabel
- 15
Funovics M, Schamp S, Helbich T H et al.
Evaluation of a computer-assisted diagnosis system in breast
carcinoma.
Fortschr Röntgenstr.
2001;
3
218-223
MissingFormLabel
- 16
Brem R F, Baum J, Lechner M et al.
Improvement in sensitivity of screening mammography with
computer-aided detection: a multiinstitutional trial.
Am J Roentgenol.
2003;
181
687-693
MissingFormLabel
- 17
Bandodkar P, Birdwell R L, Ikeda D M.
Computer aided detection (CAD) with screening mammography in
an academic institution: preliminary findings.
Radiology.
2002;
225
458
MissingFormLabel
- 18
Malich A, Sauner D, Marx C et al.
Influence of breast lesion size and histologic findings on
tumor detection. Rate of a computer-aided detection system.
Radiology.
2003;
228
851-856
MissingFormLabel
- 19
Morton M J, Whaley D H, Brandt K R, Amrami K K.
Screening mammograms: interpretation with computer-aided
detection – prospective evaluation.
Radiology.
2006;
239
375-383
MissingFormLabel
- 20
Obenauer S, Sohns C, Werner C, Grabbe E.
Retrospective analysis of a computer-aided detection (CAD)
system in full-field digital mammography in correlation to tumor
histology.
Fortschr Röntgenstr.
2005;
177
1103-1109
MissingFormLabel
- 21
Obenauer S, Sohns C, Werner C, Grabbe E.
Impact of breast density on computer-aided detection in
full-field digital mammography.
J Dig Imaging.
2006;
19
258-263
MissingFormLabel
- 22
Winsberg F, Elkin M, Macy J et al.
Detection of radiographic abnormalities in mammograms by
means of optical scanning an computer analysis.
Radiology.
1967;
89
211-215
MissingFormLabel
- 23
Bick U.
Computerassistierte Diagnose in der Screening
Mammografie.
Radiologe.
1996;
36
72-80
MissingFormLabel
- 24
Giger M L.
Update on the potential of computer-aided diagnosis for
breast cancer.
Future Oncol.
2010;
6
1-4
MissingFormLabel
- 25
Jiang Y.
Malignant and benign clustered microcalzifications: Automated
feature analysis and classification.
Radiology.
1996;
198
671-678
MissingFormLabel
- 26
Freer T W, Ulissey M J.
Screening mammography with computer-aided detection:
prospective study of 12,860 patients in a community breast center.
Radiology.
2001;
3
781-786
MissingFormLabel
- 27
Cupples T E, Cunningham J E, Reynolds J C.
Impact of computer-aided detection (CAD) in a regional
screening mammography program.
Am J Roentgenol.
2005;
185
944-950
MissingFormLabel
- 28
Quek S T, Thng C H, Khoo J B, Koh W L.
Radiologists detection of mammographic abnormalities with and
without a computer-aided detection system.
Australas Radiol.
2003;
3
257-260
MissingFormLabel
- 29
Chan H P, Doi K, Vyborny C J et al.
Improvement in radiologists detection of clustered
microcalcifications on mammograms. The potential of computer-aided
diagnosis.
Invest Radiol.
1990;
10
1102-1110
MissingFormLabel
- 30
Birdwell R L, Ikeda D M, Shoughnessy K F et al.
Mammographic characteristics of 115 missed cancers later
detected with screening mammography and potential utility of computer-aided
detection.
Radiology.
2001;
219
192-202
MissingFormLabel
- 31
Yang S K, Moon W K, Cho N et al.
Screening mammography detected cancers: sensitivity of a
computer-aided detection system applied to full-field digital mammograms.
Radiology.
2007;
244
104-111
MissingFormLabel
- 32
Dean J C, Ilvento C C.
Improved cancer detection using computer-aided detection with
diagnostic and screening mammography: prospective study of 104 cancers.
Am J Roentgenol.
2006;
187
20-28
MissingFormLabel
- 33
Ko J M, Nickolas M J, Mendel J B.
Prospective assessment of computer-aided detection in
interpretation of screening mammography.
Am J Roentgenol.
2006;
187
1483-1491
MissingFormLabel
- 34
Kim S J, Moon W K, Kim S-Y et al.
Comparison of two software versions of a commercially
available computer-aided detection (CAD) system for detecting breast
cancer.
Acta Radiologica.
2010;
5
482-490
MissingFormLabel
- 35
Fenton J J, Abraham L, Taplin S H et al.
Effectiveness of computer-aided detection in community
mammography practice.
J Natl Cancer Inst.
2011;
103
1152-1161
MissingFormLabel
- 36
Bolivar A V, Gomez S S, Merino S P et al.
Computer-aided detection system applied to full-field digital
mammograms.
Acta Radiologica.
2010;
10
1086-1091
MissingFormLabel
- 37
Ciatto S, Ambrogetti D, Bonardi R et al.
Comparison of two commercial systems for computer-assisted
detection (CAD) as an aid to interpreting screening mammograms.
Radiol Med.
2004;
107
480-488
MissingFormLabel
- 38
Baines C J, Miller A B, Wall C et al.
Sensitivity and specificity of first screen mammography in
the Canadian national breast screen study: A preliminary report from five
centers.
Radiology.
1986;
160
295-298
MissingFormLabel
- 39
Bird R E, Wallace T W, Yankaskas B C.
Analysis of cancers missed at screening mammography.
Radiology.
1992;
3
613-617
MissingFormLabel
- 40
Karssemeijer N, Otten J D, Verbeek A L et al.
Computer-aided detection versus independent double reading of
masses in mammograms.
Radiology.
2003;
227
192-200
MissingFormLabel
- 41
Singh S, Maxwell J, Baker J A et al.
Computer-aided classification of breast masses: performance
and interobserver variability of expert radiologists versus residents.
Radiology.
2011;
258
73-80
MissingFormLabel
- 42
James J J, Gilbert F J, Wallis M G et al.
Mammographic features of breast cancers at single reading
with computer-aided detection and at double reading in a large multicenter
prospective trial of computer-aided detection: CADET II.
Radiology.
2010;
256
379-386
MissingFormLabel
- 43
Guerriero C, Gillan M GC, Cairns J et al.
Is computer aided detection (CAD) cost effective in screening
mammography? A model based on the CADET II study.
BMC Health Services Research.
2011;
11
11
MissingFormLabel
- 44
Elter M, Schulz-Wendtland R, Wittenberg T.
The prediction of breast cancer biopsy outcomes using two CAD
approaches that both emphasize an intelligible decision process.
Med Phys.
2007;
23
4164-4172
MissingFormLabel
- 45
Bluemke D A, Gatsonis C A, Chen M H et al.
Magnetic resonance imaging of the breast prior to
biopsy.
JAMA.
2004;
292
2735-2742
MissingFormLabel
- 46
Lee C H.
Problem solving MR imaging of the breast.
Radiol Clin North Am.
2004;
42
919-934
MissingFormLabel
- 47
Peters N H, Borel Rinkes I H, Zuithoff N P et al.
Meta-analysis of MR imaging in the diagnosis of breast
lesions.
Radiology.
2008;
246
116-124
MissingFormLabel
- 48
Kuhl C K, Schmutzler R K, Leutner C C et al.
Breast MR imaging screening in 192 women proved or suspected
to be carriers of a breast cancer susceptibility gene: preliminary
results.
Radiology.
2000;
215
267-279
MissingFormLabel
- 49
Moy L, Elias K, Patel V et al.
Is breast MRI helpful in the evaluation of inconclusive
mammographic findings?.
Am J Roentgenol.
2009;
193
986-993
MissingFormLabel
- 50
Vassiou K, Kanavou T, Vlychou M et al.
Characterization of breast lesions with CE-MR multimodal
morphological and kinetic analysis: comparison with conventional mammography
and high-resolution ultrasound.
Eur J Radiol.
2009;
70
69-76
MissingFormLabel
- 51
Hrung J M, Sonnad S S, Schwartz J S, Langlotz C P.
Accuracy of MR imaging in the work-up of suspicious breast
lesions: a diagnostic meta-analysis.
Acad Radiol.
1999;
6
387-397
MissingFormLabel
- 52
Wood C.
Computer Aided Detection (CAD) for breast MRI.
Technol Cancer Res Treat.
2005;
4
49-53
MissingFormLabel
- 53
Dorrius M D, Jansen-van der Weide M C, van Ooijen P MA et al.
Computer-aided detection in breast MRI: a systematic review
and meta-analysis.
Eur Radiol.
2011;
21
1600-1608
MissingFormLabel
- 54
Renz D M, Baltzer P A, Kullnig P E et al.
Clinical value of computer-assisted analysis in MR
mammography. A comparison between two systems and three observers with
different levels of experience.
Fortschr Röntgenstr.
2008;
180
968-976
MissingFormLabel
- 55
Meyer-Baese A, Schlossbauer T, Lange O, Wismueller A.
Small lesions evaluation based on unsupervised cluster
analysis of signal-intensity time courses in dynamic breast MRI.
Int J Biomed Imaging.
2009;
Article ID 326 924
MissingFormLabel
- 56
Baltzer P A, Renz D M, Kullnig P E et al.
Application of computer-aided diagnosis (CAD) in
MR-mammography (MRM): do we really need whole lesion time curve distribution
analysis?.
Acad Radiol.
2009;
16
435-442
MissingFormLabel
- 57
Baltzer P A, Freiberg C, Beger S et al.
Clinical MR-mammography: are computer-assisted methods
superior to visual or manual measurements for curve type analysis? A systematic
approach.
Acad Radiol.
2009;
16
1070-1076
MissingFormLabel
- 58
Baltzer P A, Dietzel M, Vag T et al.
Can Color-Coded Parametric Maps Improve Dynamic Enhancement
Pattern Analysis in MR Mammography?.
Fortschr Röntgenstr.
2010;
182
254-260
MissingFormLabel
- 59
Kurz K D, Steinhaus D, Klar V et al.
Assessment of three different software systems in the
evaluation of dynamic MRI of the breast.
Eur J Radiol.
2009;
69
300-307
MissingFormLabel
- 60
Cho N, Kim S M, Park J S et al.
Contralateral lesions detected by preoperative MRI in
patients with recently diagnosed breast cancer: application of MR CAD in
differentiation of benign and malignant lesions.
Eur J Radiol.
2011;
DOI: 10.1016/j.ejrad.2011.03.060
MissingFormLabel
- 61
Arazi-Kleinman T, Causer P A, Jong R A et al.
Can breast MRI computer-aided detection (CAD) improve
radiologist accuracy for lesions detected at MRI screening and recommended for
biopsy in a high-risk population?.
Clin Radiol.
2009;
64
1166-1174
MissingFormLabel
- 62
Hauth E A, Jaeger H, Maderwald S et al.
Quantitative parametric analysis of contrast enhanced lesions
in dynamic MR mammography.
Radiologe.
2008;
48
593-600
MissingFormLabel
- 63
Kelcz F, Furman-Haran E, Grobgeld D, Degani H.
Clinical testing of high-spatial-resolution parametric
contrast enhanced MR imaging of the breast.
Am J Roentgenol.
2002;
179
1485-1492
MissingFormLabel
- 64
Meeuwis C, van de Ven S M, Stapper G et al.
Computer aided detection (CAD) for breast MRI: evaluation of
efficacy at 3.0 T.
Eur Radiol.
2009;
20
522-528
MissingFormLabel
- 65
Veltman J, Mann R M, Meijer F J et al.
The additional value of three time point color coding in
dynamic contrast-enhanced MRI of the breast for inexperienced and experienced
readers.
Eur J Radiol.
2010;
74
514-518
MissingFormLabel
Prof. Dr. Silvia Obenauer
Leiterin Bereich
Frauenklinik
Heinrich-Heine-Universität Düsseldorf
Medizinische Fakultät
Institut für Diagnostische und
Interventionelle Radiologie
Moorenstraße 5
40225 Düsseldorf
Phone: 0211 811-6466
Fax: 0211 811-7522
Email: silvia.obenauer@med.uni-duesseldorf.de