External Testing of a Commercial AI Algorithm for Breast Cancer Detection at Screening Mammography.

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 test a commercial artificial intelligence (AI) system for breast cancer detection at the BC Cancer Breast Screening Program. Materials and Methods In this retrospective study of 136,700 women (age: µ = 58.8, σ = 9.4, M = 59.0, IQR = 14.0) who underwent digital mammography screening in British Columbia, Canada between February 2019 and January 2020, breast cancer detection performance of a commercial AI algorithm was stratified by demographic, clinical, and imaging features and evaluated using the receiver operating characteristic curve (AUC), and AI performance was compared with radiologists using sensitivity and specificity. Results At 1-year follow-up, the AUC of the AI algorithm was 0.93 (95% CI: 0.92-0.94) for breast cancer detection. Statistically significant differences were found for mammograms across radiologist-assigned BI-RADS breast densities-A: 0.96 (0.94-0.91); B: 0.94 (0.92-0.95); C: 0.93 (0.91-0.95) and D: 0.84 (0.76-0.91) (A_AUC > D_AUC, P = .002; B_AUC > D_AUC, P = .009; C_AUC > D_AUC, P = .02). The AI showed higher performance for mammograms with architectural distortion (0.96, 0.94-0.98) versus without (0.92, 0.90-0.93, P = .003) and lower performance for mammograms with calcification (0.87, 0.85-0.90) versus without (0.92, 0.91-0.94, P < .001). Sensitivity of radiologists (92.6 ± 1.0%) exceeded the AI algorithm (89.4 ± 1.1%; P =.01), but there was no evidence of difference at 2-year follow-up (83.5 ± 1.2% versus 84.3 ± 1.2%; P = .69). Conclusion The tested commercial AI algorithm is generalizable for a large external breast cancer screening cohort from Canada but showed different performance for some subgroups, including architectural distortion or calcification in the image. ©RSNA, 2025.