AI for reading screening mammograms: the need for circumspection

AI is viewed as an emerging technology for reading screening mammograms. However, most studies done so far have adopted retrospective designs that cannot fully appreciate the added value and limitations of AI technologies (Autier et al, Eur Radiol 2020, Apr 21). For instance, these studies cannot inform on numbers and results of biopsies that would have been done following a positive result at AI reading but negative at radiology reading. Hence, the specificity of AI reading is overestimated while amounts of excess cancers associated with AI is underestimated. The McKinney et al study (Nature, 2020) suggests that AI would miss significantly (p=0.01 [our computation]) less large size invasive breast cancers than radiologists, but how this would translate into lower incidence rates of large size cancers in female populations is unknown. Real-world evidence (RWE) is mandatory for appraising the pros and cons of AI technologies. RWE means studies on AI reading embedded within the routine breast screening workflow. These studies need to have a prospective (preferably randomised) design. Because the primary goal of cancer screening is to prevent advanced-stage cancer, the main outcomes should be rates of large size or of advanced-stage breast cancer, and rates of interval breast cancer. In this regard, all size or all stage breast cancer detection rates should no longer represent the main outcome for screening effectiveness. Finally, interpretation of results should be based on tables displaying clinical decisions and outcomes after at least two screening rounds followed by a 2-year interval.

Key points

  • The studies on AI reading of screening mammograms have methodological limitations that undermine the conclusion that AI could do better than radiologists.
  • These studies do not inform on numbers of extra breast cancers found by AI that could represent overdiagnosis.
  • The ability of AI to detect breast cancers is overestimated because there is no result on biopsy procedures that should be performed when mammograms are positive at AI reading but not at radiology reading.

Article: AI for reading screening mammograms: the need for circumspection

Authors: Philippe Autier, Jean-Benoît Burrion & André-Robert Grivegnée

WRITTEN BY

  • Philippe Autier

    University of Strathclyde Institute of Global Public Health at iPRI, International Prevention Research Institute, Dardilly, France

Latest posts

Become A Member Today!

You will have access to a wide range of benefits that can help you advance your career and stay up-to-date with the latest developments in the field of radiology. These benefits include access to educational resources, networking opportunities with other professionals in the field, opportunities to participate in research projects and clinical trials, and access to the latest technologies and techniques. 

Check out our different membership options.

If you don’t find a fitting membership send us an email here.

Membership

for radiologists, radiology residents, professionals of allied sciences (including radiographers/radiological technologists, nuclear medicine physicians, medical physicists, and data scientists) & professionals of allied sciences in training residing within the boundaries of Europe

  • Reduced registration fees for ECR 1
  • Reduced fees for the European School of Radiology (ESOR) 2
  • Exclusive option to participate in the European Diploma. 3
  • Free electronic access to the journal European Radiology 4
  • Content e-mails for all ESR journals
  • Updates on offers & events through our newsletters
  • Exclusive access to the ESR feed in Juisci

€ 11 /year

Yes! That is less than €1 per month.

Free membership

for radiologists, radiology residents or professionals of allied sciences engaged in practice, teaching or research residing outside Europe as well as individual qualified professionals with an interest in radiology and medical imaging who do not fulfil individual or all requirements for any other ESR membership category & former full members who have retired from all clinical practice
  • Reduced registration fees for ECR 1
  • Free electronic access to the journal European Radiology
  • Content e-mails for all 3 ESR journals 4
  • Updates on offers & events through our newsletters
  • Exclusive access to the ESR feed in Juisci

€ 0

The best things in life are free.

ESR Friends

For students, company representatives or hospital managers etc.

  • Content e-mails for all 3 ESR journals 4
  • Updates on offers & events through our newsletters

€ 0

Friendship doesn’t cost a thing.

The membership type best fitting for you will be selected automatically during the application process.

Footnotes:

01

Reduced registration fees for ECR 2024:
Provided that ESR 2023 membership is activated and approved by August 31, 2023.

Reduced registration fees for ECR 2025:
Provided that ESR 2024 membership is activated and approved by August 31, 2024.

02
Not all activities included
03
Examination based on the ESR European Training Curriculum (radiologists or radiology residents).
04
European Radiology, Insights into Imaging, European Radiology Experimental.