Abstract

BACKGROUND

   Brain Metastases are the most common cancers in central nervous system
   and carry poor prognosis in cancer patients with their rapidly growing
   nature. Early identification of these tumors is crucial in improving
   patient survival. This investigation aims to study the rate of human
   error in missing early brain metastases and factors associated with the
   threshold of sensitivity of human eyes at the professional level.

METHODS

   The database from a single institution was used which included patients
   with new brain metastasis diagnosed based on brain magnetic resonance
   imaging (MRI) who also had previous MRI scan(s) 1-6 months before
   diagnosis and no exposure to whole brain radiotherapy. The brain MRI
   used for diagnosis of brain metastasis and the MRI performed 1-6 months
   prior were reviewed. Based on the location of the newly diagnosed
   tumor, the corresponding location in the previous MRI was assessed for
   a missed incidence of a preexisting tumor. The sizes of the missed
   tumors were then measured to assess the threshold of human eyes in
   detecting metastases.

RESULTS

   The percentage of missed metastases was 44% (56/126). The mean size of
   missed metastases was 3.0 millimeters (range 1.2 mm to 7.7 mm). No
   clinical factors were significantly associated with higher rate of
   missed diagnosis. The most likely reason for the missed diagnosis is
   the tiny size although visual distraction seems to play a role
   including adjacent contrast-enhancing structures such as blood vessels.

CONCLUSIONS

   The results show a high rate of human error for missing small
   metastases even with high level of expertise indicating the limits of
   human capacity to reliably detect brain metastases at 1-2 mm in size.
   These results justify the development of artificial intelligence-based
   recognition to assist neuroradiologists in diagnosis. Our data support
   current standard practice of surveillance brain MRI every 3-6 months
   for patients with history of brain metastasis.
     __________________________________________________________________

   Articles from Neuro-Oncology Advances are provided here courtesy of
   Oxford University Press
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