Computerized analysis of lesions in US images of the breast

RATIONALE AND OBJECTIVES

Breast sonography is not routinely used to distinguish benign from malignant solid masses because of considerable overlap in their sonographic appearances. The purpose of this study was to investigate the computerized analyses of breast lesions in ultrasonographic (US) images in order to ultimately aid in the task of discriminating between malignant and benign lesions.

MATERIALS AND METHODS

Features related to lesion margin, shape, homogeneity (texture), and posterior acoustic attenuation pattern in US images of the breast were extracted and calculated. The study database contained 184 digitized US images from 58 patients with 78 lesions. Benign lesions were confirmed at biopsy or cyst aspiration or with image interpretation alone; malignant lesions were confirmed at biopsy. Performance of the various individual features and output from linear discriminant analysis in distinguishing benign from malignant lesions was studied by using receiver operating characteristic (ROC) analysis.

RESULTS

At ROC analysis, the feature characterizing the margin yielded Az values (area under the ROC curve) of 0.85 and 0.75 in distinguishing between benign and malignant lesions for the entire database and for an "equivocal" database, respectively. The equivocal database contained lesions that had been proved to be benign or malignant at cyst aspiration or biopsy. Linear discriminant analysis round-robin runs yielded Az values of 0.94 and 0.87 in distinguishing benign from malignant lesions for the entire database and for the equivocal database, respectively.

CONCLUSION

Computerized analysis of US images has the potential to increase the specificity of breast sonography.

Effect of dominant features on neural network performance in the classification of mammographic lesions

Two different classifiers, an artificial neural network (ANN) and a hybrid system (one step rule-based method followed by an artificial neural network) have been investigated to merge computer-extracted features in the task of differentiating between malignant and benign masses. A database consisting of 65 cases (38 malignant and 26 benign) was used in the study. A total of four computer-extracted features--spiculation, margin sharpness and two density-related measures--was used to characterize these masses. Results from our previous study showed that the hybrid system performed better than the ANN classifier. In our current study, to understand the difference between the two classifiers, we investigated their learning and decision-making processes by studying the relationships between the input features and the outputs. A correlation study showed that the outputs from the ANN-alone method correlated strongly with one of the input features (spiculation), yielding a correlation coefficient of 0.91, whereas the correlation coefficients (absolute value) for the other features ranged from 0.19 to 0.40. This strong correlation between the ANN output and spiculation measure indicates that the learning and decision-making processes of the ANN-alone method were dominated by the spiculation measure. Three-dimensional plots of the computer output as functions of the input features demonstrate that the ANN-alone method did not learn as effectively as the hybrid system in differentiating non-spiculated malignant masses from benign masses, thus resulting in an inferior performance at the high sensitivity levels. We found that with a limited database it is detrimental for an ANN to learn the significance of other features in the presence of a dominant feature. The hybrid system, which initially applied a rule concerning the value of the spiculation measure prior to employing an ANN, prevents over-learning from the dominant feature and performed better than the ANN-alone method in merging the computer-extracted features into a correct diagnosis regarding the malignancy of the masses.

Automated computerized classification of malignant and benign masses on digitized mammograms

RATIONALE AND OBJECTIVES

To develop a method for differentiating malignant from benign masses in which a computer automatically extracts lesion features and merges them into an estimated likelihood of malignancy.

MATERIALS AND METHODS

Ninety-five mammograms depicting masses in 65 patients were digitized. Various features related to the margin and density of each mass were extracted automatically from the neighborhoods of the computer-identified mass regions. Selected features were merged into an estimated likelihood of malignancy by, using three different automated classifiers. The performance of the three classifiers in distinguishing between benign and malignant masses was evaluated by receiver operating characteristic analysis and compared with the performance of an experienced mammographer and that of five less experienced mammographers.

RESULTS

Our computer classification scheme yielded an area under the receiver operating characteristic curve (Az) value of 0.94, which was similar to that for an experienced mammographer (Az = 0.91) and was statistically significantly higher than the average performance of the radiologists with less mammographic experience (Az = 0.81) (P = .013). With the database used, the computer scheme achieved, at 100% sensitivity, a positive predictive value of 83%, which was 12% higher than that for the performance of the experienced mammographer and 21% higher than that for the average performance of the less experienced mammographers (P < .0001).

CONCLUSION

Automated computerized classification schemes may be useful in helping radiologists distinguish between benign and malignant masses and thus reducing the number of unnecessary biopsies.

A glycoprotein pneumococcal conjugate vaccine primes for antibody responses to a pneumococcal polysaccharide vaccine in Gambian children

BACKGROUND

Streptococcus pneumoniae is a major cause of acute respiratory infections and acute bacterial meningitis in children. Pneumococcal polysaccharide vaccines are poorly immunogenic in this highly vulnerable group, but protein polysaccharide conjugate vaccines are likely to be more effective.

OBJECTIVES

To determine whether immunization of infants with a pneumococcal conjugate vaccine induces immunologic memory.

METHODS

Eighty-four Gambian children, who had been vaccinated previously with two or three doses of a pentavalent pneumococcal conjugate vaccine (CRM197) or with a Haemophilus influenzae type b (Hib) conjugate vaccine were immunized when approximately 2 years old with a 23-valent pneumococcal polysaccharide vaccine, and a blood sample was obtained 10 days later. Pneumococcal antibody titers in prevaccination and postvaccination sera were measured by enzyme-linked immunosorbent assay and by an opsonophagocytic assay.

RESULTS

On revaccination with a pneumococcal polysaccharide vaccine, children who had previously received pneumococcal conjugate vaccine had higher antibody concentrations to each of the five polysaccharide components of the conjugate vaccine than did control children. For type 6B polysaccharide, which is poorly immunogenic in young children, postvaccination antibody concentrations were 0.37, 27.6 and 50.9 microg/ml in children who had received no previous pneumococcal immunization or two or three doses of conjugate vaccine, respectively. Type 14 antibodies produced after revaccination were of high avidity and had opsonic activity.

CONCLUSION

Vaccination of young infants with two or three doses of a pneumococcal conjugate vaccine primes the immune system to respond strongly and rapidly on subsequent exposure to pneumococcal polysaccharide.

The glial glutamate transporter in hyperammonemia and hepatic encephalopathy: relation to energy metabolism and glutamatergic neurotransmission

Abnormalities in glutamate metabolism and glutamatergic neurotransmission appear to play a major role in the pathogenesis of hyperammonemia and hepatic encephalopathy. Astrocytes may be involved in these derangements as ammonia has been shown to impair the ability of these cells to take up glutamate. This study presents a northern blot analysis of the GLT-1 glutamate transporter in hyperammonemic rats, and in rats with thioacetamide-induced acute liver failure. Our findings demonstrate a downregulation of GLT-1 mRNA in both conditions. This article examines the potential impact of deficits in glutamate uptake on energy metabolism and glutamatergic neurotransmission in the context of abnormalities in glial-neuronal interactions. We propose that an ammonia-induced abnormality in astroglial glutamate uptake constitutes a critical aspect in the pathogenesis of hepatic encephalopathy and other hyperammonemic conditions.

Severe pneumococcal disease and temporary splenic dysfunction

We report a patient presenting with pneumonia in whom temporary splenic dysfunction was diagnosed by counting pitted red blood cells. This under-recognised condition caused a transient immunosuppression which may have had serious implications for our patient's recovery.

Analysis of spiculation in the computerized classification of mammographic masses

Spiculation is a primary sign of malignancy for masses detected by mammography. In this study, we developed a technique that analyzes patterns and quantifies the degree of spiculation present. Our current approach involves (1) automatic lesion extraction using region growing and (2) feature extraction using radial edge-gradient analysis. Two spiculation measures are obtained from an analysis of radial edge gradients. These measures are evaluated in four different neighborhoods about the extracted mammographic mass. The performance of each of the two measures of spiculation was tested on a database of 95 mammographic masses using ROC analysis that evaluates their individual ability to determine the likelihood of malignancy of a mass. The dependence of the performance of these measures on the choice of neighborhood was analyzed. We have found that it is only necessary to accurately extract an approximate outline of a mass lesion for the purposes of this analysis since the choice of a neighborhood that accommodates the thin spicules at the margin allows for the assessment of margin spiculation with the radial edge-gradient analysis technique. The two measures performed at their highest level when the surrounding periphery of the extracted region is used for feature extraction, yielding Az values of 0.83 and 0.85, respectively, for the determination of malignancy. These are similar to that achieved when a radiologist's ratings of spiculation (Az = 0.85) are used alone. The maximum value of one of the two spiculation measures (FWHM) from the four neighborhoods yielded an Az of 0.88 in the classification of mammographic mass lesions.

[Experimental study of antiinfection effect of topical "moist ointment" in burn wound infection]

A controversy on the therapeutic effect of topical "moist ointment" in burns has been noticed recently. An experimental study is designed for the evaluation of its antibacterial and antiinfection effect. A 20% fullthickness burn wound is produced on SD rat back, and they are seeded with 10(9) CFU of Pseudomonas aeruginosa ATCC-27853. "Moist ointment", cream base, 1% silver sulfadiazine (Ag-SD) cream or 1.2% silver norfloxacin (Ag-FLX) cream is topically applied to the burn wounds at various time interval of 10 min, 8h, 24h, and 48h, after the inoculation of Pseudomonas aeruginosa. Topical therapy lasted for 48h, with dressing change once a day but twice a day for "moist ointment" therapy only. Bacterial counts of subeschar tissue and heart blood culture, and histopathologic study of the wounds are made as laboratory criteria. A modified agar well diffusion (AWD) test is performed as a bacterial inhibitory study using Pseudomonas aeruginosa ATCC-27853, E. coli ATCC-25922, or Staphylococcus aureus ATCC-25923. Results of the study show that Ag-FLX cream has a strong antibacterial effect and Ag-SD cream a moderate effect. However, "moist ointment" and cream base do not show antibacterial effect. Bacterial counts of subeschar tissue and histopathologic study of the infected burn wounds show that more than 70% of the animals in the "moist ointment" group have invasive wound infection, and the incidence of septicemia with Pseudomonas aeruginosa is 50% as determined by blood cultures. The above mentioned results indicate that "moist ointment" has no antibacterial and anti-infection effect.

[Multi-locus DNA fingerprints using oligonucleotide probe (CAC)5/(GTG)5 in the Chinese population]

In order to test the practical applicability of oligonucleotide fingerprinting in China we have investigated unrelated individuals, family members and a pair of twins from the Beijing area using the probe (CAC)5/(GTG)5. Except for the monozygotic twins highly variable banding patterns were demonstrated as expected for the randomly selected individuals but also for the relatives. On the basis of an initial survey of 50 unrelated individuals the calculated probability for obtaining by chance two identical multilocus patterns is very small (less than 1.93 x 10(-13). Therefore it seems reasonable to conclude that like in caucasians, (CAC)5/(GTG)5 fingerprints are completely individual-specific also in this population. Therefore they have already been used successfully for identification purposes and paternity tests in many actual cases.