Evaluating the Impact of Changes in AI-derived Case Scores over Time on Digital Breast Tomosynthesis Screening Outcomes.

Abstract

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To evaluate the change in DBT-AI (digital breast tomosynthesis-artificial intelligence) case scores over sequential screens. Materials and Methods This retrospective review included 21,108 female patients (mean age, 58.1 ± [SD] 11.5 years) with 31,741 DBT screening examinations performed at a single site from 2/3/2020 to 9/12/2022. Among 7,000 patients with two or more DBT-AI screenings, 1,799 had one year follow up and were included in the analysis. DBT-AI case scores and differences in case score over time were determined. Case scores ranged from 0-100. For each screening outcome (true positive (TP), false positive (FP), true negative (TN), false negative (FN)), mean and median case score change was calculated. Results The highest average case score was seen in TP examinations (average 75, range 7-100, n = 41), and the lowest average case score was seen in TN examinations (average 34, range 0-100, n = 1640). The largest positive case score change was seen in TP examinations (mean case score change 21.1, median case score change 17). FN examinations included mammographically occult cancers diagnosed following supplemental screening and those found on symptomatic diagnostic imaging. Differences between TP and TN mean case score change (P < .001) and between TP and FP mean case score change (P = .02) were statistically significant. Conclusion Using the combination of DBT-AI case score with change in case score over time may help radiologists make recall decisions in DBT screening. All studies with high case score and/or case score changes should be carefully scrutinized to maximize screening performance. ©RSNA, 2025.