Suspicious Findings at Digital Breast Tomosynthesis Occult to Conventional Digital Mammography: Imaging Features and Pathology Findings

To review the imaging and pathologic features of a series of lesions detected at digital breast tomosynthesis (DBT), which are occult to conventional digital mammography (DM). We retrospectively reviewed 268 consecutive breast imaging reporting and data system 4 and 5 lesions imaged with both DM and DBT at our facility from July 2012 through April 2013. For each lesion, we recorded the mammographic finding, breast density, mode of biopsy, and pathology results. A total of 19 lesions were identified at DBT that were occult to DM. Sixty three percent (12/19) of these lesions were identified in dense breasts. Architectural distortion was seen in 74% (14/19) of cases and spiculated masses accounted for the remaining 26% (5/19). The positive predictive value of biopsy was 53% (10/19). Seven cases were infiltrating ductal carcinomas and three were infiltrating lobular carcinomas. High‐risk lesions accounted for 47% (9/19) of the lesions, the majority of which were radial scars 67% (6/9). Eighty four percent (16/19) of the lesions underwent ultrasound guided core biopsy while the remainder underwent magnetic resonance imaging guided core biopsy. DBT may demonstrate suspicious lesions that are occult to DM, particularly in women with dense breasts. Such lesions have a high likelihood of malignancy and warrant biopsy.     

Stereotactic Vacuum‐Assisted Biopsies on a Digital Breast 3D‐Tomosynthesis System

The purpose of this study was to describe our operating process and to report results of 118 stereotactic vacuum‐assisted biopsies performed on a digital breast 3D‐tomosynthesis system. From October 2009 to December 2010, 118 stereotactic vacuum assisted biopsies have been performed on a digital breast 3D‐tomosynthesis system. Informed consent was obtained for all patients. A total of 106 patients had a lesion, six had two lesions. Sixty‐one lesions were clusters of micro‐calcifications, 54 were masses and three were architectural distortions. Patients were in lateral decubitus position to allow shortest skin‐target approach (or sitting). Specific compression paddle, adapted on the system, performed, and graduated, allowing localization in X‐Y. Tomosynthesis views define the depth of lesion. Graduated Coaxial localization kit determines the beginning of the biopsy window. Biopsies were performed with an ATEC‐Suros, 9 Gauge handpiece. All biopsies, except one, have reached the lesions. Five hemorrhages were incurred in the process, but no interruption was needed. Eight breast hematomas, were all spontaneously resolved. One was an infection. About 40% of patients had a skin ecchymosis. Processing is fast, easy, and requires lower irradiation dose than with classical stereotactic biopsies. Histology analysis reported 45 benign clusters of micro‐calcifications, 16 malignant clusters of micro‐calcifications, 24 benign masses, and 33 malignant masses. Of 13 malignant lesions, digital 2D‐mammography failed to detect eight lesions and underestimated the classification of five lesions. Digital breast 3D‐tomosynthesis depicts malignant lesions not visualized on digital 2D‐mammography. Development of tomosynthesis biopsy unit integrated to stereotactic system will permit histology analysis for suspicious lesions.     

Morphological Distribution and Internal Enhancement Architecture of Contrast‐Enhanced Magnetic Resonance Imaging in the Diagnosis of Non‐Mass‐Like Breast Lesions: A Meta‐Analysis

The aim of this study is to assess the diagnostic performance of contrast‐enhanced magnetic resonance (MR) imaging in patients with non‐mass‐like breast lesions in a meta‐analysis. Literature study was performed on PubMed data base on the diagnostic performance of MR imaging in patients with non‐mass‐like breast lesions. Details of the relevant studies were reviewed and a meta‐analysis was performed to estimate the overall sensitivity and specificity of contrast‐enhanced MR imaging of non‐mass‐like breast lesions. A summary receiver operating characteristic curve (sROC) was developed to explore the threshold effect by ROC space. Spearman correlation coefficient was calculated using Meta‐Disc version 1.4 to analyze the heterogeneity between studies. A total of 858 non‐mass‐like lesions from 15 studies were included in the meta‐analysis (sample size range: 27–131). Pooled weighted estimates of sensitivity and specificity were 50% (95% CI: 46%, 53%) and 80% (95% CI: 77%, 83%), respectively. The heterogeneity among studies was caused by other factors other than threshold effect. The findings were influenced by cancer prevalence (p = 0.0359). Subgroup analyses indicated that the sensitivity and specificity in studies with combined diagnostic criterion was higher than that in studies with single diagnostic criterion. In evaluation of non‐mass‐like breast lesions, contrast‐enhanced MRI has high specificity and relatively lower sensitivity.     

Breast Cancers Found with Digital Breast Tomosynthesis: A Comparison of Pathology and Histologic Grade

To compare the pathology and histologic grading of breast cancers detected with digital breast tomosynthesis to those found with conventional digital mammography. The institutional review board approved this study. A database search for all breast cancers diagnosed from June 2012 through December 2013 was performed. Imaging records for these cancers were reviewed and patients who had screening mammography with tomosynthesis as their initial examination were selected. Five dedicated breast imaging radiologists reviewed each of these screening mammograms to determine whether the cancer was visible on conventional digital mammography or whether tomosynthesis was needed to identify the cancer. A cancer was considered mammographically occult if all five radiologists agreed that the cancer could not be seen on conventional digital mammography. The size, pathology and histologic grading for all diagnosed breast cancers were then reviewed. The Mann–Whitney U and Fisher exact tests were utilized to determine any association between imaging findings and cancer size, pathologic type and histologic grade. Sixty‐five cancers in 63 patients were identified. Ten of these cancers were considered occult on conventional digital mammography and detected with the addition of tomosynthesis. These mammographically occult cancers were significantly associated with Nottingham grade 1 histologic pathology (p = 0.02), were smaller (median size: 6 mm versus 10 mm, p = 0.07) and none demonstrated axillary nodal metastases. Breast cancers identified through the addition of tomosynthesis are associated with Nottingham grade 1 histologic pathology and prognostically more favorable than cancers identified with conventional digital mammography alone.     

Disparities in the uptake of digital breast tomosynthesis for breast cancer screening: A retrospective cohort study

We present a retrospective cohort study evaluating the utilization and effectiveness of digital breast tomosynthesis (DBT) for breast cancer screening with a focus on racial differences. 46,236 females underwent screening mammography between 4/1/2013 and 3/30/2020, during which there was an increase in DBT utilization from 18.8% in year 1 to 89.6% in year 7. Black and Asian women were significantly less likely to have a screening study with DBT compared to White women. Overall, the DBT group had a lower recall rate (9.1% versus 11.2%, p < 0.001) and higher cancer detection rate (6.0 vs 4.1, p < 0.001) compared to the FFDM group.     

Contrast‐enhanced Digital Mammography: A Single‐Institution Experience of the First 208 Cases

Contrast‐enhanced digital mammography (CEDM) is the only imaging modality that provides both (a) a high‐resolution, low‐energy image comparable to that of digital mammography and (b) a contrast‐enhanced image similar to that of magnetic resonance imaging. We report the initial 208 CEDM examinations performed for various clinical indications and provide illustrative case examples. Given its success in recent studies and our experience of CEDM primarily as a diagnostic adjunct, CEDM can potentially improve breast cancer detection by combining the low‐cost conclusions of screening mammography with the high sensitivity of magnetic resonance imaging.     

Cost Minimization Analysis of Ultrasound‐Guided Diagnostic Evaluation of Probably Benign Breast Lesions

The objective of this study was to compare direct health care costs for two competing diagnostic strategies for probably benign breast lesions detected by ultrasound in young women. We developed a decision analytic model and performed a cost minimization analysis comparing ultrasound‐guided vacuum‐assisted core biopsy and conservative short‐term diagnostic ultrasound follow‐up. Relative probabilities for diagnostic outcomes were derived from pooled analysis of the medical literature. Direct health care costs were estimated using United States national average figures from calendar year 2010. Deterministic sensitivity analyses were conducted, as well as a first‐order Monte Carlo simulation to confirm cost differences between the two strategies. The conservative short‐term imaging follow‐up strategy ($639.55 average cost per patient) was the most economical strategy compared to immediate vacuum‐assisted core biopsy ($879.55 average cost per patient). Sensitivity analyses demonstrated that the preferred strategy is most dependent on the probabilities of detecting change in appearance on follow‐up ultrasound, having a benign finding on immediate core biopsy, and finding cancer on a biopsy triggered by an interval change in ultrasound appearance. The model was also sensitive to the costs of vacuum‐assisted core biopsy and diagnostic ultrasound. Conservative imaging follow‐up of BIRADS 3 breast masses by ultrasound is cost saving compared to immediate vacuum‐assisted core biopsy, with a potential of saving more than one‐third of overall costs associated with the diagnostic work‐up of such lesions. Watchful waiting with short‐term interval follow‐up ultrasounds will spare women from unnecessary procedures and spare the United States health care system from unnecessary direct health care costs.     

Evaluation of contrast‐enhanced digital mammography (CEDM) in the preoperative staging of breast cancer: Large‐scale single‐center experience

One of the most important indications for contrast‐enhanced breast imaging is the presurgical breast cancer (BC) staging. This is a large‐scale single‐center experience which evaluates the role of CEDM in presurgical staging and its impact on surgical planning. The aims of this retrospective study were to define the diagnostic performance of CEDM in the presurgical setting and to identify which types of patients could benefit from having CEDM. We selected 326 patients with BC who underwent CEDM as preoperative staging and had breast cancer‐related surgery at our institution. We analyzed those cases in which CEDM led to additional imaging or biopsy and those in which it changed the type of surgery that was planned according to conventional breast imaging (CI) techniques (digital mammography, tomosynthesis and bilateral handheld ultrasound). CEDM sensitivity in identifying the index lesion and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy in the correct preoperative staging of BC of the whole population and in various subgroups were calculated. CEDM sensitivity for the index lesion was 98.8% (322/326), which led to additional breast imaging in 23.6% (77/326) of patients and additional biopsies in 17.5% (57/326). CEDM changed the type of surgery in 18.4% (60/326). In the preoperative breast cancer staging, CEDM sensitivity, specificity, PPV, NPV, and accuracy produced results of 93%, 98%, 90%, 98%, and 97%, respectively. CEDM performance was better in patients with palpable lesions. CEDM has an excellent diagnostic performance in the presurgical staging of BC. Symptomatic patients with palpable lesions benefitted most from preoperative CEDM, with a statistically significant difference compared with nonpalpable.     

Digital breast tomosynthesis and contrast‐enhanced dual‐energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification

To compare diagnostic performance of contrast‐enhanced dual‐energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast‐enhanced MRI (DCE‐MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3‐5 at imaging or clinically suspicious). CEDM, DBT, and DCE‐MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two‐dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE‐MRI. DCE‐MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE‐MRI and CEDM (P = .03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE‐MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE‐MRI. Dynamic information obtained by time‐intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions.     

Effectiveness of Breast-Specific Gamma Imaging (BSGI) for Breast Cancer in Korea: A Comparative Study

Abstract: Despite the fact that mammography has been the golden standard in breast cancer detection for several decades, its sensitivity decreases for women with dense breast tissue, which happens to be common in Korea. As an alternative, breast ultrasonography can be effective diagnostic modalities that complement the defect of mammography. Recently, breast‐specific gamma imaging (BSGI) has been introduced as a new diagnostic modality for breast cancer. This study was designed to analyze the effectiveness of BSGI in particular. In a retrospective study, 471 patients underwent BSGI, breast ultrasonography, and mammography simultaneously during the period between February 2009 and March 2010. The indications of BSGI were as follows: (a) patient who was diagnosed with malignancy prior to surgery, (b) patient who is under follow up after cancer surgery, (c) patient with lesions which cannot be evaluated by breast ultrasonography or mammography, (d) patient with multiple benign lesions, and (e) patient with suspicious lesion who refuses biopsy. Among these patients, 121 patients underwent biopsy, whereas others were followed up with imaging studies. We compared the BSGI results with those of mammography, breast ultrasonography, and pathology. The mean age of the patients was 49.63 ± 10.43 years. There were 107 patients with 110 malignant lesions and 364 patients with benign lesions. Total 474 lesions were evaluated. The sensitivities of BSGI, mammography, and breast ultrasonography were 94.45%, 93.64%, and 98.18%, respectively, whereas the specificities of BSGI, mammography, and breast ultrasonography were 90.93%, 90.66%, and 87.09%, respectively. The sensitivity and specificity of BSGI for axillary lymph node (LN) status were 44.7 4% and 87.88%, respectively. BSGI is a good complementary imaging modality with high sensitivity and high specificity for breast cancer detection. However, it has low efficacy for the evaluation for axillary LN status.     

Role of Fusion of Prone FDG‐PET and Magnetic Resonance Imaging of the Breasts in the Evaluation of Breast Cancer

Abstract: The purpose of this study is to report further about the statistically significant results from a prospective study, which suggests that fusion of prone F‐18 Fluoro‐deoxy‐glucose (FDG) positron emission tomography (PET) and magnetic resonance (MR) breast scans increases the positive predictive value (PPV) and specificity for patients in whom the MR outcome alone would be nonspecific. Thirty‐six women (mean age, 43 years; range, 24–65 years) with 90 lesions detected on MR consented to undergo a FDG‐PET scan. Two blinded readers evaluated the MR and the computer tomography (CT) attenuation‐corrected prone FDG‐PET scans side‐by‐side, then after the volumes were superimposed (fused). A semiautomatic, landmark‐based program was used to perform nonrigid fusion. Pathology and radiologic follow‐up were used as the reference standard. The sensitivity, specificity, PPV, negative predictive value (NPV), and accuracy (with 95% confidence intervals) for MR alone, FDG‐PET alone, and fused MR and FDG‐PET were calculated. The median lesion size measured from the MR was 2.5 cm (range, 0.5–10 cm). Histologically, 56 lesions were malignant, and 15 were benign. Nineteen lesions were benign after 20–47 months of clinical and radiologic surveillance. The sensitivity of MR alone was 95%, FDG‐PET alone was 57%, and fusion was 83%. The increase in PPV from 77% in MR alone to 98% when fused and the increase in specificity from 53% to 97% were statistically significant (p < 0.05). The false‐negative rate on FDG‐PET alone was 26.7%, and after fusion this number was reduced to 9%. FDG‐PET and MR fusions were helpful in selecting which lesion to biopsy, especially in women with multiple suspicious MR breast lesions.     

Feasibility and safety of image‐guided vacuum‐assisted breast biopsy: A PRISMA‐compliant systematic review and meta‐analysis of 20 000 population from 36 longitudinal studies

Breast cancer is a serious disease in women. We estimated the global technical success rate and complication rates of percutaneous vacuum‐assisted breast biopsy (VABB). PubMed, Embase, Web of Science, and Scopus databases were retrieved up to July 2018 to find studies in which technical success rate and complication rates of VABB were available. Pooled rates were calculated according to location mode (ultrasonography [US] or mammography) and needle type (8‐ or 11‐gauge Mammotome probes). Of the 36 articles with 20 868 cases, we found the pooled technical success rate 0.9999(0.9997, 1.0000) (I ² = 17.1%, P = .187) and low complication risks including haematoma 0.1092(0.0748, 0.1437) (I ² = 98.3%, P < .001), pain 0.0738(0.0334, 0.1141) (I ² = 95.9%, P < .001), vasovagal reflex 0.0281(0.0035, 0.0527) (I ² = 92.5%, P < .001), and infection 0.0027(−0.0019, 0.0073) (I ² = 49.8%, P = .113). In this systematic review and meta‐analysis, the pooled data suggested that VABB with US or mammography could be promising for diagnosis and treatment of breast disease. Further studies were necessary to identify strategies for these findings.     

Follow‐up of Probably Benign Lesions (BI‐RADS 3 category) in Breast MR Imaging

Abstract: The purpose of our study was to determine the frequency of BI‐RADS 3 lesions in breast MR imaging in a clinical patient population and their frequency of malignancy in follow‐up breast MR imaging. In 44/698 (6.3%) patients with breast MR imaging, 56 lesions were categorized to BI‐RADS 3. These lesions were all not palpable and not detectable at conventional mammography or ultrasound. In follow‐up, lesions were score in complete resolved (CRL), partial resolved (PRL), stable lesions (SL), and progressive lesions (PL). Initial signal enhancement of lesions was coded by color intensity (bright for high, medium for medium, dark for low), the postinitial signal enhancement by color hue (blue for increase, green for plateau, red for wash‐out). In first follow‐up breast MR imaging 23/56 (41%) lesions were PRL, 14/56 (25%) lesions were CRL, 14/56 (25%) lesions remained SL. In one of five PL lesions, histopathology revealed a malignant tumor. In initial breast MR imaging, CRL showed significant fewer high pixels (p = 0.002), medium pixels (p = 0.006) significant more low pixels (p = 0.005) and significant more increase pixels (p = 0.037) than PRL. In a clinical patient population the frequency of malignancy of BI‐RADS 3 lesions in breast MR imaging and their frequency of malignancy are similar to that in conventional mammography. In initial breast MR imaging, complete resolved lesions showed less suspicious contrast kinetics than other lesions. In follow‐up, the increase of lesion size should warrant histopathological diagnosis.     

Clinical Implications of Subcategorizing BI‐RADS 4 Breast Lesions associated with Microcalcification: A Radiology–Pathology Correlation Study

Abstract: Currently radiologists have the option of subcategorizing BI‐RADS 4 breast lesions into 4A (low suspicion for malignancy), 4B (intermediate suspicion of malignancy), and 4C (moderate concern, but not classic for malignancy). To determine the clinical significance of BI‐RADS 4 subcategories and the common pathologic changes associated with these mammographic lesions, a retrospective review of 239 consecutive stereotactic‐needle core biopsies (SNCB) for microcalcifications was performed. All 239 SNCBs were BI‐RADS 4 lesions, and of these, 191 were subcategorized to 4A, 4B or 4C. Ninety‐four of 191 (49%) were 4A, 73 (38%) were 4B, and 24 (13%) were 4C. Fibrocystic change was the most common finding (66/239; 28%) followed by ductal carcinoma in situ (DCIS) accounting for 23% of cases. This was followed by columnar cell alteration with or without atypia (47/239; 19%), and fibroadenoma (45/239; 19%). While 70% (17/24) of BI‐RADS 4C category lesions were DCIS, only 21% (15/73) of BI‐RADS 4B and 10% (10/94) of BI‐RADS 4A were DCIS. Without sub‐categorization, carcinoma was diagnosed in 23% (55/239) of all cases with BI‐RADS 4. Therefore, subcategorizing BI‐RADS 4 lesions is important since it not only benefits the patient and clinician in understanding the level of concern for carcinoma, but will also alert the pathologist.     

Fine‐Needle Aspiration Cytology for Diagnosis and Management of Palpable Breast Mass

Background : The present study aims to clarify the use, in a developing country, of fine‐needle aspiration cytology (FNA) instead of open biopsy as a cost‐saving, reliable initial diagnostic and management tool for patients with breast mass. Methods : A prospective study of 60 patients (71 breast masses) was carried out. The accuracy of physical diagnosis of the mass was compared with that obtained by FNA. The cytological results were analysed with the clinical profile s and pathological result s . Results : Physical examination was unreliable for the diagnosis of breast cyst (61.1% positive predictive value, 73.6% negative predictive value), which accounted for 35% of breast masses studied. Aspiration alone determined the diagnosis and management in 39% of masses. For solid breast masses benign cytological results (class I, II) were proved to be reliable (100% positive predictive value), as were malignant cytological results (class V; 100% positive predictive value). Inadequate cytology was reported for five masses (11.9%). Conclusions : Fine‐needle aspiration should be routinely performed in all patients with breast masses. This would facilitate prompt diagnosis and treatment in one‐third of patients with breast cyst, and the benign cytological result could facilitate definite management in the majority of patients with a low risk of malignancy. This could save cost, time and patient anxiety. For the patients with a high clinical suspicion of breast cancer, the positive cytological result could reliably confirm the diagnosis, while the equivocal result could be combined with mammography or open biopsy. Considering the ease, simplicity and low cost, FNA may be suitable for developing countries where other non‐invasive procedures are unavailable or difficult to obtain, and it could replace open biopsy, which is still commonly done.     

Survival after Breast‐Conserving Surgery with Whole Breast or Partial Breast Irradiation in Women with Early Stage Breast Cancer: A SEER Data‐base Analysis

Randomized clinical trials have demonstrated equivalency in survival outcomes for early stage breast cancer patients treated with either mastectomy or breast‐conserving surgery (BCS) with radiation. Recent, state‐level data confirm comparable survival outcomes. Using Surveillance Epidemiology and End Research (SEER) data, we sought to evaluate survival outcomes among patients with early stage breast cancer treated with mastectomy, BCS with whole breast irradiation (BCS + WBI), or BCS with accelerated partial breast irradiation (BCS + APBI). Data on women 50 years or older diagnosed with a node negative invasive breast cancer (≤3 cm in size) between 1995 and 2009 were extracted from the SEER data base. Women treated with mastectomy alone or BCS with radiation were eligible for analysis. Kaplan–Meier estimates and Cox proportional hazard models were used to compare overall survival (OS) and cancer‐specific survival (CSS) among the treatment groups. 150,171 women fulfilled inclusion criteria. OS was significantly improved among women treated with BCS and WBI or BCS and APBI compared to mastectomy alone. Adjusted hazard ratios for death in BCS with WBI or APBI (versus mastectomy alone) were 0.73 (95% CI: 0.71, 0.76) and 0.68 (95% CI: 0.58, 0.79), respectively. Adjusted CSS was also significantly improved in patients treated with BCS and WBI (HR 0.80, 95% CI: 0.76, 0.85) as compared to mastectomy. BCS with radiation (WBI or APBI) was associated with significantly improved OS and CSS, versus mastectomy alone. These results support the use of BCS with WBI or APBI (in well selected patients) for the treatment of breast cancer.     

Computer‐assisted Diagnosis in Full‐field Digital Mammography—Results in Dependence of Readers Experiences

Abstract: The object of this study was to assess the clinical usefulness of computer‐assisted diagnosis (CAD) in the interpretation of early‐research, benign and malignant mammograms in dependence on readers’ experience with CAD. CAD was applied on digital mammograms of 303 patients who were divided into three groups: early‐research (n = 103), benign (n = 102) and malignant group (n = 98). Mammograms were analyzed by three readers with different experience in evaluating mammograms (medical student, an assistant and an attending physician specifically trained in mammography). All images were presented accidentally with and without the influence of CAD and from different patient groups. The mammograms were classified according to BI‐RADS classification. To evaluate readers’ sensitivity and specificity with and without the application of the CAD system, ROC analysis and the corresponding area under the curve (AUC) were evaluated for each reader. Afterwards significant differences of the accuracy according to readers experience and according to the assistance of the CAD system were calculated. All readers have an account of accuracy by using CAD in both patient groups. The highest benefit has the student (10% increase of the AUC) followed by the resident (4%) and at least followed by the mammography fellow (3%). There are significant varieties of the accuracy in addiction to the readers’ experience and to the examination method with and without CAD system. Patient group has not a significant influence to the elevation of accuracy by using the CAD. All three readers have nearly the same increase of AUC in the examinations of malignant and early‐research group summarized and of the malignant group only. Finally, the increase of accuracy depends on the readers’ experience. For all patient groups CAD‐application causes a steeply increase of the ROC curve and consequently a gain of sensitivity.