  Objectives: To assess evaluative methodologies for comparative measurements
of test sensitivity in clinical mammographic screening trials of computer-aided
detection (CAD) technologies. Materials and Methods: This meta-analysis was
performed by analytically reviewing the relevant literature on the clinical
application of computer-aided detection (CAD) technologies as part of a breast
cancer screening program based on x-ray mammography. Each clinical study's
method for measuring the CAD system's improvement in test sensitivity is
examined in this meta-analysis. The impact of the chosen sensitivity
measurement on the study's conclusions are analyzed. Results: This
meta-analysis demonstrates that some studies have inappropriately compared
sensitivity measurements between control groups and CAD enabled groups. The
inappropriate comparison of control groups and CAD enabled groups can lead to
an underestimation of the benefits of the clinical application of
computer-aided detection technologies. Conclusions: The potential for the
sensitivity measurement issues raised in this meta-analysis to alter the
conclusions of multiple existing large clinical studies is discussed. Two large
scale studies are substantially affected by the analysis provided in this study
and this meta-analysis demonstrates that computer-aided detection systems are
successfully assisting in the breast cancer screening process.
