With the FFDM-CAD combination, detection performance is at least as good as that with SFM. The detection of ductal carcinoma in situ and microcalcification clusters improved with FFDM using CAD, while the recall rate increased.

ObjectivesTo determine the influence of local contrast optimisation on diagnostic accuracy and perceived suspiciousness of digital screening mammograms.MethodsData were collected from a screening region in the Netherlands and consisted of 263 digital screening cases (153 recalled,110 normal). Each case was available twice, once processed with a tissue equalisation (TE) algorithm and once with local contrast optimisation (PV). All cases had digitised previous mammograms. For both algorithms, the probability of malignancy of each finding was scored independently by six screening radiologists. Perceived case suspiciousness was defined as the highest probability of malignancy of all findings of a radiologist within a case. Differences in diagnostic accuracy of the processing algorithms were analysed by comparing the areas under the receiver operating characteristic curves (Az). Differences in perceived case suspiciousness were analysed using sign tests.ResultsThere was no significant difference in Az (TE: 0.909, PV 0.917, P = 0.46). For all radiologists, perceived case suspiciousness using PV was higher than using TE more often than vice versa (ratio: 1.14–2.12). This was significant (P <0.0083) for four radiologists.ConclusionsOptimisation of local contrast by image processing may increase perceived case suspiciousness, while diagnostic accuracy may remain similar.Key Points• Variations among different image processing algorithms for digital screening mammography are large.• Current algorithms still aim for optimal local contrast with a low dynamic range.• Although optimisation of contrast may increase sensitivity, diagnostic accuracy is probably unchanged.• Increased local contrast may render both normal and abnormal structures more conspicuous.