Mammographic features in screening mammograms with high AI scores but a true-negative screening result

Abstract

Background

The use of artificial intelligence (AI) in screen-reading of mammograms has shown promising results for cancer detection. However, less attention has been paid to the false positives generated by AI.

Purpose

To investigate mammographic features in screening mammograms with high AI scores but a true-negative screening result.

Material and Methods

In this retrospective study, 54,662 screening examinations from BreastScreen Norway 2010–2022 were analyzed with a commercially available AI system (Transpara v. 2.0.0). An AI score of 1–10 indicated the suspiciousness of malignancy. We selected examinations with an AI score of 10, with a true-negative screening result, followed by two consecutive true-negative screening examinations. Of the 2,124 examinations matching these criteria, 382 random examinations underwent blinded consensus review by three experienced breast radiologists. The examinations were classified according to mammographic features, radiologist interpretation score (1–5), and mammographic breast density (BI-RADS 5th ed. a–d).

Results

The reviews classified 91.1% (348/382) of the examinations as negative (interpretation score 1). All examinations (26/26) categorized as BI-RADS d were given an interpretation score of 1. Classification of mammographic features: asymmetry = 30.6% (117/382); calcifications = 30.1% (115/382); asymmetry with calcifications = 29.3% (112/382); mass = 8.9% (34/382); distortion = 0.8% (3/382); spiculated mass = 0.3% (1/382). For examinations with calcifications, 79.1% (91/115) were classified with benign morphology.

Conclusion

The majority of false-positive screening examinations generated by AI were classified as non-suspicious in a retrospective blinded consensus review and would likely not have been recalled for further assessment in a real screening setting using AI as a decision support.