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Evaluation of Combined Artificial Intelligence and Radiologist Assessment to Interpret Screening Mammograms
Open accessAbstract
Importance: Mammography screening currently relies on subjective human interpretation. Artificial intelligence (AI) advances could be used to increase mammography screening accuracy by reducing missed cancers and false positives. Objective: To evaluate whether AI can overcome human mammography interpretation limitations with a rigorous, unbiased evaluation of machine learning algorithms. Design, Setting, and Participants: In this diagnostic accuracy study conducted between September 2016 and November 2017, an international, crowdsourced challenge was hosted to foster AI algorithm development focused on interpreting screening mammography. More than 1100 participants comprising 126 teams from 44 countries participated. Analysis began November 18, 2016. Main Outcomes and Measurements: Algorithms used images alone (challenge 1) or combined images, previous examinations (if available), and clinical and demographic risk factor data (challenge 2) and output a score that translated to cancer yes/no within 12 months. Algorithm accuracy for breast cancer detection was evaluated using area under the curve and algorithm specificity compared with radiologists' specificity with radiologists' sensitivity set at 85.9% (United States) and 83.9% (Sweden). An ensemble method aggregating top-performing AI algorithms and radiologists' recall assessment was developed and evaluated. Results: Overall, 144 231 screening mammograms from 85 580 US women (952 cancer positive ≤12 months from screening) were used for algorithm training and validation. A second independent validation cohort included 166 578 examinations from 68 008 Swedish women (780 cancer positive). The top-performing algorithm achieved an area under the curve of 0.858 (United States) and 0.903 (Sweden) and 66.2% (United States) and 81.2% (Sweden) specificity at the radiologists' sensitivity, lower than community-practice radiologists' specificity of 90.5% (United States) and 98.5% (Sweden). Combining top-performing algorithms and US radiologist assessments resulted in a higher area under the curve of 0.942 and achieved a significantly improved specificity (92.0%) at the same sensitivity. Conclusions and Relevance: While no single AI algorithm outperformed radiologists, an ensemble of AI algorithms combined with radiologist assessment in a single-reader screening environment improved overall accuracy. This study underscores the potential of using machine learning methods for enhancing mammography screening interpretation.
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“An early catalyst in this space was the Digital Mammography DREAM Challenge, an open AI competition where groups were able to benchmark and compare different AI approaches (8).”
From Artificial Intelligence in Oncology: Current Landscape, Challenges, and Future Directions (2024) · cites this paper as [8]
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Metadata
- Authors
- Schaffter, T., Buist, D. S. M., Lee, C. I., Nikulin, Y., Ribli, D., Guan, Y., Lotter, W., Jie, Z., Du, H., Wang, S., Feng, J., Feng, M., Kim, H.-E., Albiol, F., Albiol, A., Morrell, S., Wojna, Z., Ahsen, M. E., Asif, U., Jimeno Yepes, A., Yohanandan, S., Rabinovici-Cohen, S., Yi, D., Hoff, B., Yu, T., Chaibub Neto, E., Rubin, D. L., Lindholm, P., Margolies, L. R., McBride, R. B., Rothstein, J. H., Sieh, W., Ben-Ari, R., Harrer, S., Trister, A., Friend, S., Norman, T., Sahiner, B., Strand, F., Guinney, J., Stolovitzky, G., and the DM DREAM Consortium, Mackey, L., Cahoon, J., Shen, L., Sohn, J. H., Trivedi, H., Shen, Y., Buturovic, L., Pereira, J. C., Cardoso, J. S., Castro, E., Kalleberg, K. T., Pelka, O., Nedjar, I., Geras, K. J., Nensa, F., Goan, E., Koitka, S., Caballero, L., Cox, D. D., Krishnaswamy, P., Pandey, G., Friedrich, C. M., Perrin, D., Fookes, C., Shi, B., Cardoso Negrie, G., Kawczynski, M., Cho, K., Khoo, C. S., Lo, J. Y., Sorensen, A. G., & Jung, H.
- Affiliations
- Sage Bionetworks (US)
- Kaiser Permanente Washington Health Research Institute (US)
- University of Washington (US)
- Therapixel, Paris, France
- Department of Physics of Complex Systems, ELTE Eötvös Loránd University, Budapest, Hungary
- University of Michigan (US)
- IBM (United States) (US)
- Tencent (China) (CN)
- National University of Singapore (SG)
- Synapxe (SG)
- National University Health System (SG)
- Lunit Inc, Seoul, Korea
- Consejo Superior de Investigaciones Científicas (ES)
- Universitat Politècnica de València (ES)
- University College London (GB)
- NortonLifeLock (United States) (US)
- University of Illinois Urbana-Champaign (US)
- IBM Research - Australia (AU)
- IBM Research Australia, Melbourne, Australia
- IBM Research Haifa, Haifa University Campus, Mount Carmel, Haifa, Israel
- Stanford University (US)
- Computational Oncology, Sage Bionetworks, Seattle, Washington
- Karolinska Institutet (SE)
- Icahn School of Medicine at Mount Sinai (US)
- Fred Hutch Cancer Center (US)
- Gates Foundation (US)
- United States Food and Drug Administration (US)
- Karolinska University Hospital (SE)
- IBM Research - Thomas J. Watson Research Center (US)
- Microsoft (United States) (US)
- North Carolina State University (US)
- University of California, San Francisco (US)
- Emory University (US)
- New York University (US)
- Clinical Persona, East Palo Alto, California
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
- INESC TEC (PT)
- KolibriFX, Oslo, Norway
- Dortmund University of Applied Sciences and Arts (DE)
- University of Abou Bekr Belkaïd (DZ)
- NYU Langone Health (US)
- Essen University Hospital (DE)
- Queensland University of Technology (AU)
- MIT-IBM Computing Research Lab (US)
- Agency for Science, Technology and Research (SG)
- Duke University (US)
- Satalia, London, United Kingdom
- Korea University (KR)
- Corresponding author
- Stolovitzky, Gustavo
- ORCID
- Schaffter, Thomas
- Buist, Diana S. M.
- Lee, Christoph I.
- Nikulin, Yaroslav
- Guan, Yuanfang
- Lotter, William
- Jie, Zequn
- Du, Hao
- Wang, Sijia
- Feng, Jiashi
- Feng, Mengling
- Albiol, Francisco
- Albiol, Alberto
- Morrell, Stephen
- Wojna, Zbigniew
- Ahsen, Mehmet Eren
- Asif, Umar
- Yi, Darvin
- Hoff, Bruce
- Yu, Thomas
- Rubin, Daniel L.
- Lindholm, Peter
- Margolies, Laurie R.
- McBride, Russell Bailey
- Rothstein, Joseph H.
- Sieh, Weiva
- Harrer, Stefan
- Trister, Andrew
- Friend, Stephen
- Norman, Thea
- Sahiner, Berkman
- Strand, Fredrik
- Guinney, Justin
- Stolovitzky, Gustavo
- Mackey, Lester
- Cahoon, Joyce
- Shen, Li
- Sohn, Jae Ho
- Trivedi, Hari
- Shen, Yiqiu
- Cardoso, Jaime S.
- Castro, Eduardo
- Kalleberg, Karl Trygve
- Pelka, Obioma
- Nedjar, Imane
- Geras, Krzysztof J.
- Nensa, Felix
- Goan, Ethan
- Koitka, Sven
- Caballero, Luis
- Cox, David D.
- Krishnaswamy, Pavitra
- Pandey, Gaurav
- Friedrich, Christoph M.
- Perrin, Dimitri
- Fookes, Clinton
- Shi, Bibo
- Cho, Kyunghyun
- Lo, Joseph Y.
- Sorensen, A. Gregory
- Jung, Hwejin
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2020-03-02
- Volume
- 3
- Issue
- 3
- Pages
- e200265
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC7052735
- OpenAlex
- W3009692632
- Cited by
- 409
- References
- 32
- Citations by year
- 2026: 29 · 2025: 55 · 2024: 92 · 2023: 74 · 2022: 71 · 2021: 66 · 2020: 21
- FWCI
- 22.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (acceptedVersion, other-oa)
- QUT ePrints (Queensland University of Technology) (submittedVersion)
- National University of Singapore (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Funders
- Engineering and Physical Sciences Research Council (1482827)
- National Cancer Institute (P01CA154292, R37CA240403)
- National Institute of General Medical Sciences (R35GM133346)
- National Institute of Biomedical Imaging and Bioengineering (P41EB017183)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Digital Radiography and Breast Imaging
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- mammography screening, breast cancer detection, artificial intelligence, radiologist interpretation, ensemble learning, false positives, breast cancer risk factors
- MeSH terms
- Radiologists, Deep Learning, Adult, Aged, Algorithms, Artificial Intelligence, Breast Neoplasms, Female, Humans, Image Interpretation, Computer-Assisted, Mammography, Middle Aged, Radiology, Sensitivity and Specificity, Sweden, United States, Early Detection of Cancer
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