Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate.

BACKGROUND There are two competing methods for improving the accuracy of a radiologist interpreting screening mammograms: computer aids (CAD) or independent second reading. METHODS Bibliographic databases were searched for clinical trials. Meta-analyses estimated impacts of CAD and double reading on odds ratios for cancer detection and recall rates. Sub-group analyses considered double reading with arbitration. RESULTS Ten studies compared single reading with CAD to single reading. Seventeen compared double to single reading. Double reading increases cancer detection and recall rates. Double reading with arbitration increases detection rate (confidence interval (CI): 1.02, 1.15) and decreases recall rate (CI: 0.92, 0.96). CAD does not have a significant effect on cancer detection rate (CI: 0.96, 1.13) and increases recall rate (95% CI: 1.09, 1.12). However, there is considerable heterogeneity in the impact on recall rate in both sets of studies. CONCLUSION The evidence that double reading with arbitration enhances screening is stronger than that for single reading with CAD.