Artificial Intelligence in Large-scale Breast Cancer Screening

NCT ID: NCT04778670

Last Updated: 2023-03-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

55579 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-01

Study Completion Date

2024-12-31

Brief Summary

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This is a prospective clinical trial following a paired screen-positive design, with the aims to assess the performance of an artificial intelligence (AI) computer-aided detection (CAD) algorithm as an independent reader, in addition to two radiologists, of screening mammograms in a true screening population. Since all decisions by individual readers will be recorded, it is possible to determine what the outcome would have been had one or two of the readers not been allowed to assess images, and to determine what the outcome would have been had the recall decision been performed by consensus decision (actual) compared to single reader arbitration of discordant cases.

Detailed Description

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Conditions

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Breast Neoplasm Female

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

This is a prospective clinical trial following a paired screen-positive design (Pepe, Alonzo; 2001), with the aims to assess the performance of an AI algorithm combined with radiologists(s) compared to standard-of-care being two radiologists assessing screening mammograms in a true screening population. Since all decisions by individual readers will be recorded, it is possible to determine what the outcome would have been had one or two of the readers not been allowed to assess images, and to determine what the outcome would have been had the recall decision been performed by consensus decision (actual) compared to single reader arbitration of discordant cases.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

TRIPLE

Participants Caregivers Investigators
Positive disease status is ascertained by pathology-verified breast cancer. Disease status is not known to any of the actors (except for the outcomes assessor by necessity). AI decision is not known by the care provider radiologists until they have made their decisions. In the subsequent consensus discussion where a decision is made to recall or not to recall a woman, the AI decision is known. After AI decision has been recorded and outcomes have been assessed, the investigators will have full information on outcomes and AI decisions.

Study Groups

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Standard of Care

Standard of Care means all examinations will receive a flagging decision by: first reader and second reader radiologist as usual. However, in this paired design all participants will belong to both arms.

Group Type ACTIVE_COMPARATOR

Radiologist reading

Intervention Type DIAGNOSTIC_TEST

Standard of care, each radiologist will assess the mammography examination, making a binary flagging decision (flag the examination to continue to consensus discussion, or not)

AI CAD combination

AI CAD combination in the primary end-point means the combination of the flagging decision of the first reader and AI CAD; in the secondary end-points it means any combination of AI alone, or AI in combination with first, second and both readers.

Group Type EXPERIMENTAL

AI CAD

Intervention Type DIAGNOSTIC_TEST

The Lunit INSIGHT MMG will be used as the AI CAD in our study. Initially, version 1.6.1.1 will be installed. The software version will be continuously updated with subsequent software releases, after confirming in a historic calibration dataset that the performance is improved. The operating point will be set based on a historic calibration dataset to attain a joint sensitivity of breast cancer detection of AI and first reader which is 2% higher than for first and second reader.

Radiologist reading

Intervention Type DIAGNOSTIC_TEST

Standard of care, each radiologist will assess the mammography examination, making a binary flagging decision (flag the examination to continue to consensus discussion, or not)

Interventions

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AI CAD

The Lunit INSIGHT MMG will be used as the AI CAD in our study. Initially, version 1.6.1.1 will be installed. The software version will be continuously updated with subsequent software releases, after confirming in a historic calibration dataset that the performance is improved. The operating point will be set based on a historic calibration dataset to attain a joint sensitivity of breast cancer detection of AI and first reader which is 2% higher than for first and second reader.

Intervention Type DIAGNOSTIC_TEST

Radiologist reading

Standard of care, each radiologist will assess the mammography examination, making a binary flagging decision (flag the examination to continue to consensus discussion, or not)

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Lunit INSIGHT MMG

Eligibility Criteria

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Inclusion Criteria

* Participants in regular population-based breast cancer screening at Capio St Göran Hospital

Exclusion Criteria

* Incomplete exam (complete exam: mediolateral oblique and craniocaudal images of Left and Right breast)
* Breast implant
* Complete mastectomy (excluded from screening positive group)
* Participant in surveillance program for prior breast cancer
Minimum Eligible Age

40 Years

Maximum Eligible Age

74 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Capio Sankt Görans Hospital

OTHER

Sponsor Role collaborator

Lunit Inc.

INDUSTRY

Sponsor Role collaborator

Karolinska Institutet

OTHER

Sponsor Role collaborator

Karolinska University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Fredrik Strand

Registrar (biträdande överläkare)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fredrik Strand, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Karolinska University Hospital

Locations

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Capio St Göran Hospital

Stockholm, , Sweden

Site Status

Countries

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Sweden

References

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Dembrower KE, Crippa A, Eklund M, Strand F. Human-AI Interaction in the ScreenTrustCAD Trial: Recall Proportion and Positive Predictive Value Related to Screening Mammograms Flagged by AI CAD versus a Human Reader. Radiology. 2025 Mar;314(3):e242566. doi: 10.1148/radiol.242566.

Reference Type DERIVED
PMID: 40100021 (View on PubMed)

Dembrower K, Crippa A, Colon E, Eklund M, Strand F; ScreenTrustCAD Trial Consortium. Artificial intelligence for breast cancer detection in screening mammography in Sweden: a prospective, population-based, paired-reader, non-inferiority study. Lancet Digit Health. 2023 Oct;5(10):e703-e711. doi: 10.1016/S2589-7500(23)00153-X. Epub 2023 Sep 8.

Reference Type DERIVED
PMID: 37690911 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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EPM 2020-00487

Identifier Type: OTHER

Identifier Source: secondary_id

K 2020-0807

Identifier Type: OTHER

Identifier Source: secondary_id

STGKS001

Identifier Type: -

Identifier Source: org_study_id

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