Rationale and Objectives
The aim of this study was to evaluate the improved accuracy of radiologic assessment of lung cancer afforded by computer-aided diagnosis (CADx).
Materials and Methods
Inclusion/exclusion criteria were formulated, and a systematic inquiry of research databases was conducted. Following title and abstract review, an in-depth review of 149 surviving articles was performed with accepted articles undergoing a Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-based quality review and data abstraction.
Results
A total of 14 articles, representing 1868 scans, passed the review. Increases in the receiver operating characteristic (ROC) area under the curve of .8 or higher were seen in all nine studies that reported it, except for one that employed subspecialized radiologists.
Conclusions
This systematic review demonstrated improved accuracy of lung cancer assessment using CADx over manual review, in eight high-quality observer-performance studies. The improved accuracy afforded by radiologic lung-CADx suggests the need to explore its use in screening and regular clinical workflow.
Introduction
Lung cancer is the second leading cause of death in the United States and among the top 10 worldwide. More Americans die each year from lung cancer than from breast, prostate, and colorectal cancers combined. Annually, lung cancer kills more men than prostate cancer and more women than breast cancer .
Whereas overall cancer incidence rates are declining, lung cancer incidence rates among women are rising. Between 1960 and 1990, deaths from lung cancer among women increased over 400%. It is the second most common cancer among African American men and kills more African Americans than any other cancer. Five-year survival ranges from 70% for stage I disease to less than 5% for stage IV disease. As of 2014, overall 5-year survival is 17%, with only 15% diagnosed at the localized stage .
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Materials and Methods
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Computer-aided (Detection OR Diagnosis) AND (“Lung Neoplasms”[MeSH] OR Lung Nodule) AND (“Radiography”[MeSH] OR “Tomography, X-Ray Computed”[MeSH]) NOT review[PT]
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Results
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Table 1
Description of Lung-CADx Studies
Study/Year Population Type Gold Standard QS # R # SCANS Mode/ST ALG 1 /2003 CA/cont UCAD path 8 N/A 393 LDCT/10 mm LDA 2 /2004 CA only UCAD path 12 N/A 106 LDCT/10 mm MTANN 3 /2005 CA/cont OP path 15 14 27 LDCT/10 mm MTANN 4 /2005 CA/cont OP path 15 16 56 HRCT MTANN 5 /2005 CA/cont OP path 16 8 28 LDCT/3 mm DT 6 /2005 CA/cont UCAD path 10 N/A 81 LDCT/3 mm LDA 7 /2005 CA/cont UCAD path 11 N/A 415 LDCT/10 mm MTANN 8 /2006 CA/cont OP path 18 9 48 CXR LDA 9 /2006 CA/cont OP path 17 10 33 HRCT ANN 10 /2007 CA/cont OP path 18 9 200 LDCT/8 mm ANN 11 /2009 CA only UCAD path 9 N/A 69 LDCT/10 mm MTANN 12 /2010 CA/cont OP path 16 11 60 LDCT/10 mm LDA 13 /2010 CA/cont OP path + hx 15 6 152 LDCT/2 mm LDA 14 /2012 CA/cont OP path + CT 15 10 200 CXR LDA
ALG, algorithm; ANN, artificial neural network; CA/cont, cancer control; CADx, computer-aided diagnosis; CXR, chest radiography; DT, Decision Tree; LDA, linear discriminant analysis; LDCT, low-dose computed tomography; HRCT, high-resolution CT; MT, massive training; MTANN, massive training artificial neural network; OP, observer-performance; QS, Quality Assessment of Diagnostic Accuracy Studies Score; #R, number of raters; SCANS, number of scans total in the study; ST, slice thickness; UCAD, unsupervised computer diagnosis; PATH, pathology review of biopsy; hx, history; N/A, not applicable.
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Table 2
Lung-CADx Accuracy Measures
Study Sensitivity/CADx Alone FP/Scan ACC A Z Human A Z Machine A Z Both Δ_P_ Value 1 .84 1.0 NR N/A .79 N/A N/A N/A 2 .83 5.8 NR N/A NR N/A N/A N/A 3 .87 3.0 NR .763 NR .854 .091 .002 4 .90 6.5 NR .785 .831 .853 .068 .016 5 .91 (.67 sp) NR 81% .68 NR .81 .13 .020 6 NR NR NR N/A .92 N/A N/A N/A 7 1.00 (.48 sp) NR NR N/A .882 N/A N/A N/A 8 .81 (.70 sp) 1.2 NR .724 NR .778 .054 .008 9 .72 NR 76% .910 .795 .944 .034 .190 10 .93 NR 93% .85 NR .94 .09 .014 11 .84 .5 NR N/A NR N/A N/A N/A 12 NR NR NR .864 NR .924 .060 .010 13 NR NR NR .833 NR .853 .020 .010 14 .87 1.9 NR N/A NR N/A N/A N/A
ACC, machine accuracy calculation (TP + TN)/(P + N), true-positive, true-negative, total-positive, total-negative; A z , receiver operating characteristic-area index; CADx, computer-aided diagnosis; FP, false-positive; NR, not reported; sp, specificity; Δ, difference.
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Discussion
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Conclusion
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Acknowledgement
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