Impact of using artificial intelligence as a second reader in breast screening including arbitration

The impact of incorporating artificial intelligence (AI) into a double-read breast-screening workflow, including arbitration, is unclear. This retrospective study included 50,000 representative women from two NHS breast-screening centers. All the women had long-term follow-up, allowing us to determine whether use of AI leads to earlier cancer detection. Cases requiring arbitration (8,732 cases) were read by 22 readers in a reader study, following their normal arbitration workflow. Overall, after arbitration, replacing the second reader with AI was noninferior (5% margin) to two human readers in terms of sensitivity and specificity (P < 0.001) while offering a workload benefit. Arbitration improved the specificity of the AI arm by overruling cases incorrectly recalled by the AI tool; however, it also overruled the AI tool recall decision for some interval and next-round cancers. Further development of the AI tool alongside improvement in its explainability could lead to the earlier detection of cancers.