Depiction of breast cancers on digital mammograms by artificial intelligence-based computer-assisted diagnosis according to cancer characteristics

ObjectiveTo evaluate how breast cancers are depicted by artificial intelligence–based computer-assisted diagnosis (AI-CAD) according to clinical, radiological, and pathological factors.Materials and methodsFrom January 2017 to December 2017, 896 patients diagnosed with 930 breast cancers were enrolled in this retrospective study. Commercial AI-CAD was applied to digital mammograms and abnormality scores were obtained. We evaluated the abnormality score according to clinical, radiological, and pathological characteristics. False-negative results were defined by abnormality scores less than 10.ResultsThe median abnormality score of 930 breasts was 87.4 (range 0–99). The false-negative rate of AI-CAD was 19.4% (180/930). Cancers with an abnormality score of more than 90 showed a high proportion of palpable lesions, BI-RADS 4c and 5 lesions, cancers presenting as mass with or without microcalcifications and invasive cancers compared with low-scored cancers (all p < 0.001). False-negative cancers were more likely to develop in asymptomatic patients and extremely dense breasts and to be diagnosed as occult breast cancers and DCIS compared to detected cancers.ConclusionBreast cancers depicted with high abnormality scores by AI-CAD are associated with higher BI-RADS category, invasive pathology, and higher cancer stage.Key Points• High-scored cancers by AI-CAD included a high proportion of BI-RADS 4c and 5 lesions, masses with or without microcalcifications, and cancers with invasive pathology.• Among invasive cancers, cancers with higher T and N stage and HER2-enriched subtype were depicted with higher abnormality scores by AI-CAD.• Cancers missed by AI-CAD tended to be in asymptomatic patients and extremely dense breasts and to be diagnosed as occult breast cancers by radiologists.