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Table 3 Quality of evidence of the difference between single reading (radiologist plus CAD) and double reading (two radiologists) related to cancer detection rate and recall rate in mammography screening (GRADE). Data from Gilbert et al.[71]

From: Is single reading with computer-aided detection (CAD) as good as double reading in mammography screening? A systematic review

Outcome Sample size (no. of studies) True positive: Single reading + CAD (95% CI) True positive: Double reading (95% CI) Absolute difference (95%CI) Quality of evidence Rating based on study design/quality, indirectness, consistency, precision and publication bias**
Cancer detection rate 28,204 (1) 0.702% 0.706% 0.004% (OOO) Study quality –1
   (0.6–0.8) (0.6–0.8) (NS*) Insufficient Indirectness–1
Recall rate 28,204 (1) 3,9% 3,4% 0,5% (OOO) Study quality –1
   (3,7–4,1) (3,2–3,6) (0,3–0,8) Insufficient Indirectness -1 One study –1
  1. *NS = no statistically significant difference.
  2. ** Study quality = Risk of bias, that is, sensitivity probably overestimated due to incomplete follow-up of women with negative test results.
  3. Indirectness = Only breast radiologists with long clinical experience took part in the study.
  4. Lack of precision = The difference in sensitivity between double reading and single reading + CAD has wide confidence intervals.