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The effect of the presentation of similar images for distinction between benign and malignant masses on mammograms was evaluated in the observer performance study. Images of masses were obtained from the Digital Database for Screening Mammography. We selected 50 benign and 50 malignant masses by a stratified randomization method. For each case, similar images were selected based on the size of masses and the similarity measures. Radiologists were shown images with unknown masses and asked to provide their confidence level that the lesions were malignant before and after the presentation of the similar images. Eleven observers, including three attending breast radiologists, three breast imaging fellows, and five residents, participated. The average areas under the receiver operating characteristic curves without and with the presentation of the similar images were almost equivalent. However, there were many cases in which the similar images caused beneficial effects to the observers, whereas there were a small number of cases in which the similar images had detrimental effects. From a detailed analysis of the reasons for these detrimental effects, we found that the similar images would not be useful for diagnosis of rare and very difficult cases, i.e., benign-looking malignant and malignant-looking benign cases. In addition, these cases should not be included in the reference database, because radiologists would be confused by these unusual cases. The results of this study could be very important and useful for the future development and improvement of a computer-aided diagnosis system.

Presentation of Similar Images as a Reference for Distinction Between Benign and Malignant Masses on Mammograms: Analysis of Initial Observer Study