Performance of Two Deep Learning–based AI Models for Breast Cancer Detection and Localization on Screening Mammograms from BreastScreen Norway

Purpose To evaluate cancer detection and marker placement accuracy of two artificial intelligence (AI) models developed for interpretation of screening mammograms. Materials and Methods This retrospective study included data from 129 434 screening examinations (all female patients; mean age, 59.2 years ± 5.8 [SD]) performed between January 2008 and December 2018 in BreastScreen Norway. Model A was commercially available and model B was an in-house model. Area under the receiver operating characteristic curve (AUC) with 95% CIs were calculated. The study defined 3.2% and 11.1% of the examinations with the highest AI scores as positive, threshold 1 and 2, respectively. A radiologic review assessed location of AI markings and classified interval cancers as true or false negative. Results The AUC value was 0.93 (95% CI: 0.92, 0.94) for model A and B when including screen-detected and interval cancers. Model A identified 82.5% (611 of 741) of the screen-detected cancers at threshold 1 and 92.4% (685 of 741) at threshold 2. Model B identified 81.8% (606 of 741) at threshold 1 and 93.7% (694 of 741) at threshold 2. The AI markings were correctly localized for all screen-detected cancers identified by both models and 82% (56 of 68) of the interval cancers for model A and 79% (54 of 68) for model B. At the review, 21.6% (45 of 208) of the interval cancers were identified at the preceding screening by either or both models, correctly localized and classified as false negative (<i>n</i> = 17) or with minimal signs of malignancy (<i>n</i> = 28). Conclusion Both AI models showed promising performance for cancer detection on screening mammograms. The AI markings corresponded well to the true cancer locations. <b>Keywords:</b> Breast, Mammography, Screening, Computed-aided Diagnosis <i>Supplemental material is available for this article.</i> © RSNA, 2025 See also commentary by Cadrin-Chênevert in this issue.