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Peters J, van Dijck JA, Elias SG, Otten JD, Broeders MJ. The prognostic potential of mammographic growth rate of invasive breast cancer in the Nijmegen breast cancer screening cohort. J Med Screen 2024; 31:166-175. [PMID: 38295359 PMCID: PMC11330081 DOI: 10.1177/09691413231222765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/15/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Insight into the aggressiveness of potential breast cancers found in screening may optimize recall decisions. Specific growth rate (SGR), measured on mammograms, may provide valuable prognostic information. This study addresses the association of SGR with prognostic factors and overall survival in patients with invasive carcinoma of no special type (NST) from a screened population. METHODS In this historic cohort study, 293 women with NST were identified from all participants in the Nijmegen screening program (2003-2007). Information on clinicopathological factors was retrieved from patient files and follow-up on vital status through municipalities. On consecutive mammograms, tumor volumes were estimated. After comparing five growth functions, SGR was calculated using the best-fitting function. Regression and multivariable survival analyses described associations between SGR and prognostic factors as well as overall survival. RESULTS Each one standard deviation increase in SGR was associated with an increase in the Nottingham prognostic index by 0.34 [95% confidence interval (CI): 0.21-0.46]. Each one standard deviation increase in SGR increased the odds of a tumor with an unfavorable subtype (based on histologic grade and hormone receptors; odds ratio 2.14 [95% CI: 1.45-3.15]) and increased the odds of diagnosis as an interval cancer (versus screen-detected; odds ratio 1.57 [95% CI: 1.20-2.06]). After a median of 12.4 years of follow-up, 78 deaths occurred. SGR was not associated with overall survival (hazard ratio 1.12 [95% CI: 0.87-1.43]). CONCLUSIONS SGR may indicate prognostically relevant differences in tumor aggressiveness if serial mammograms are available. A potential association with cause-specific survival could not be determined and is of interest for future research.
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Affiliation(s)
- Jim Peters
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos A.A.M. van Dijck
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd G. Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes D.M. Otten
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mireille J.M. Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening (LRCB), Nijmegen, The Netherlands
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2
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Deep learning in mammography and breast histology, an overview and future trends. Med Image Anal 2018; 47:45-67. [DOI: 10.1016/j.media.2018.03.006] [Citation(s) in RCA: 160] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022]
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van der Waal D, Verbeek ALM, Broeders MJM. Breast density and breast cancer-specific survival by detection mode. BMC Cancer 2018; 18:386. [PMID: 29618328 PMCID: PMC5885304 DOI: 10.1186/s12885-018-4316-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 03/27/2018] [Indexed: 01/05/2023] Open
Abstract
Background Breast density is known to affect breast cancer risk and screening sensitivity, but it may also be associated with breast cancer survival. The interpretation of results from previous studies on breast density and survival is complicated by the association between detection mode and survival. Here, we studied the effect of breast density on breast cancer-specific survival for different detection modes (screen-detected, interval ≤ 24 or > 24 months, non-participant). Methods Data from the Nijmegen (Dutch) breast cancer screening programme were used. Women diagnosed with invasive breast cancer between 1975 and 2011 were included. Breast density was assessed visually, based on a dichotomized Wolfe scale: ‘fatty breasts’ (≤25%) and ‘dense breasts’ (> 25%). Cox proportional hazard regression was used to obtain hazard ratios (HR). Results We identified 2742 eligible women, with a breast pattern available for 2233 women. A diagnosis of interval cancer (HR 2.06, 95% CI 1.62–2.61) led to a significantly increased risk of breast cancer death compared with screen-detected cancer. No significant cause-specific survival difference between women with dense and fatty breasts was observed (HR 0.94, 95% CI 0.77–1.15). The hazard was only higher for women with dense breasts among interval cancers ≤24 m (HR 1.07, 95% CI 0.74–1.56). The hazard appeared to be lower for women with dense breasts than for women with fatty breasts among screen-detected (HR 0.77, 95% CI 0.53–1.11) and interval cancers > 24 m (HR 0.80, 95% CI 0.53–1.20). None of the effects were statistically significant. Conclusions Detection mode is strongly associated with breast cancer death. No clear association is apparent between breast density and breast cancer death, regardless of detection mode.
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Affiliation(s)
- Daniëlle van der Waal
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands.
| | - André L M Verbeek
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands.,Dutch Expert Centre for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands
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4
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van der Waal D, Ripping TM, Verbeek ALM, Broeders MJM. Breast cancer screening effect across breast density strata: A case-control study. Int J Cancer 2016; 140:41-49. [PMID: 27632020 DOI: 10.1002/ijc.30430] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/30/2016] [Indexed: 12/24/2022]
Abstract
Breast cancer screening is known to reduce breast cancer mortality. A high breast density may affect this reduction. We assessed the effect of screening on breast cancer mortality in women with dense and fatty breasts separately. Analyses were performed within the Nijmegen (Dutch) screening programme (1975-2008), which invites women (aged 50-74 years) biennially. Performance measures were determined. Furthermore, a case-control study was performed for women having dense and women having fatty breasts. Breast density was assessed visually with a dichotomized Wolfe scale. Breast density data were available for cases. The prevalence of dense breasts among controls was estimated with age-specific rates from the general population. Sensitivity analyses were performed on these estimates. Screening performance was better in the fatty than in the dense group (sensitivity 75.7% vs 57.8%). The mortality reduction appeared to be smaller for women with dense breasts, with an odds ratio (OR) of 0.87 (95% CI 0.52-1.45) in the dense and 0.59 (95% CI 0.44-0.79) in the fatty group. We can conclude that high density results in lower screening performance and appears to be associated with a smaller mortality reduction. Breast density is thus a likely candidate for risk-stratified screening. More research is needed on the association between density and screening harms.
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Affiliation(s)
- Daniëlle van der Waal
- Radboud university medical center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Theodora M Ripping
- Radboud university medical center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - André L M Verbeek
- Radboud university medical center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Mireille J M Broeders
- Radboud university medical center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands.,Dutch Reference Centre for Screening, GJ 6503, Nijmegen, The Netherlands
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5
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Gastounioti A, Conant EF, Kontos D. Beyond breast density: a review on the advancing role of parenchymal texture analysis in breast cancer risk assessment. Breast Cancer Res 2016; 18:91. [PMID: 27645219 PMCID: PMC5029019 DOI: 10.1186/s13058-016-0755-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The assessment of a woman's risk for developing breast cancer has become increasingly important for establishing personalized screening recommendations and forming preventive strategies. Studies have consistently shown a strong relationship between breast cancer risk and mammographic parenchymal patterns, typically assessed by percent mammographic density. This paper will review the advancing role of mammographic texture analysis as a potential novel approach to characterize the breast parenchymal tissue to augment conventional density assessment in breast cancer risk estimation. MAIN TEXT The analysis of mammographic texture provides refined, localized descriptors of parenchymal tissue complexity. Currently, there is growing evidence in support of textural features having the potential to augment the typically dichotomized descriptors (dense or not dense) of area or volumetric measures of breast density in breast cancer risk assessment. Therefore, a substantial research effort has been devoted to automate mammographic texture analysis, with the aim of ultimately incorporating such quantitative measures into breast cancer risk assessment models. In this paper, we review current and emerging approaches in this field, summarizing key methodological details and related studies using novel computerized approaches. We also discuss research challenges for advancing the role of parenchymal texture analysis in breast cancer risk stratification and accelerating its clinical translation. CONCLUSIONS The objective is to provide a comprehensive reference for researchers in the field of parenchymal pattern analysis in breast cancer risk assessment, while indicating key directions for future research.
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Affiliation(s)
- Aimilia Gastounioti
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Emily F Conant
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Despina Kontos
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Oliver A, Tortajada M, Lladó X, Freixenet J, Ganau S, Tortajada L, Vilagran M, Sentís M, Martí R. Breast Density Analysis Using an Automatic Density Segmentation Algorithm. J Digit Imaging 2016; 28:604-12. [PMID: 25720749 DOI: 10.1007/s10278-015-9777-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Breast density is a strong risk factor for breast cancer. In this paper, we present an automated approach for breast density segmentation in mammographic images based on a supervised pixel-based classification and using textural and morphological features. The objective of the paper is not only to show the feasibility of an automatic algorithm for breast density segmentation but also to prove its potential application to the study of breast density evolution in longitudinal studies. The database used here contains three complete screening examinations, acquired 2 years apart, of 130 different patients. The approach was validated by comparing manual expert annotations with automatically obtained estimations. Transversal analysis of the breast density analysis of craniocaudal (CC) and mediolateral oblique (MLO) views of both breasts acquired in the same study showed a correlation coefficient of ρ = 0.96 between the mammographic density percentage for left and right breasts, whereas a comparison of both mammographic views showed a correlation of ρ = 0.95. A longitudinal study of breast density confirmed the trend that dense tissue percentage decreases over time, although we noticed that the decrease in the ratio depends on the initial amount of breast density.
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Affiliation(s)
- Arnau Oliver
- Department of Computer Architecture and Technology, University of Girona, 17071, Girona, Spain.
| | - Meritxell Tortajada
- Department of Computer Architecture and Technology, University of Girona, 17071, Girona, Spain
- UDIAT-Centre Diagnòstic, Corporació Parc Taulí, 08208, Sabadell, Spain
| | - Xavier Lladó
- Department of Computer Architecture and Technology, University of Girona, 17071, Girona, Spain
| | - Jordi Freixenet
- Department of Computer Architecture and Technology, University of Girona, 17071, Girona, Spain
| | - Sergi Ganau
- UDIAT-Centre Diagnòstic, Corporació Parc Taulí, 08208, Sabadell, Spain
| | - Lidia Tortajada
- UDIAT-Centre Diagnòstic, Corporació Parc Taulí, 08208, Sabadell, Spain
| | - Mariona Vilagran
- UDIAT-Centre Diagnòstic, Corporació Parc Taulí, 08208, Sabadell, Spain
| | - Melcior Sentís
- UDIAT-Centre Diagnòstic, Corporació Parc Taulí, 08208, Sabadell, Spain
| | - Robert Martí
- Department of Computer Architecture and Technology, University of Girona, 17071, Girona, Spain
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Ng KH, Lau S. Vision 20/20: Mammographic breast density and its clinical applications. Med Phys 2015; 42:7059-77. [PMID: 26632060 DOI: 10.1118/1.4935141] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kwan-Hoong Ng
- Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Susie Lau
- Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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He W, Juette A, Denton ERE, Oliver A, Martí R, Zwiggelaar R. A Review on Automatic Mammographic Density and Parenchymal Segmentation. Int J Breast Cancer 2015; 2015:276217. [PMID: 26171249 PMCID: PMC4481086 DOI: 10.1155/2015/276217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/21/2015] [Accepted: 05/17/2015] [Indexed: 01/03/2023] Open
Abstract
Breast cancer is the most frequently diagnosed cancer in women. However, the exact cause(s) of breast cancer still remains unknown. Early detection, precise identification of women at risk, and application of appropriate disease prevention measures are by far the most effective way to tackle breast cancer. There are more than 70 common genetic susceptibility factors included in the current non-image-based risk prediction models (e.g., the Gail and the Tyrer-Cuzick models). Image-based risk factors, such as mammographic densities and parenchymal patterns, have been established as biomarkers but have not been fully incorporated in the risk prediction models used for risk stratification in screening and/or measuring responsiveness to preventive approaches. Within computer aided mammography, automatic mammographic tissue segmentation methods have been developed for estimation of breast tissue composition to facilitate mammographic risk assessment. This paper presents a comprehensive review of automatic mammographic tissue segmentation methodologies developed over the past two decades and the evidence for risk assessment/density classification using segmentation. The aim of this review is to analyse how engineering advances have progressed and the impact automatic mammographic tissue segmentation has in a clinical environment, as well as to understand the current research gaps with respect to the incorporation of image-based risk factors in non-image-based risk prediction models.
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Affiliation(s)
- Wenda He
- Department of Computer Science, Aberystwyth University, Aberystwyth SY23 3DB, UK
| | - Arne Juette
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK
| | - Erika R. E. Denton
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK
| | - Arnau Oliver
- Department of Architecture and Computer Technology, University of Girona, 17071 Girona, Spain
| | - Robert Martí
- Department of Architecture and Computer Technology, University of Girona, 17071 Girona, Spain
| | - Reyer Zwiggelaar
- Department of Computer Science, Aberystwyth University, Aberystwyth SY23 3DB, UK
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9
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Anter AM, Abu ElSoud M, Hassanien AE. Automatic Mammographic Parenchyma Classification According to BIRADS Dictionary. ACTA ACUST UNITED AC 2014. [DOI: 10.4018/978-1-4666-6030-4.ch002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Internal density of the breast is a parameter that clearly affects the performance of segmentation and classification algorithms to define abnormality regions. Recent studies have shown that their sensitivity is significantly decreased as the density of the breast is increased. In this chapter, enhancement and segmentation process is applied to increase the computation and focus on mammographic parenchyma. This parenchyma is analyzed to discriminate tissue density according to BIRADS using Local Binary Pattern (LBP), Gray Level Co-Occurrence Matrix (GLCM), Fractal Dimension (FD), and feature fusion technique is applied to maximize and enhance the performance of the classifier rate. The different methods for computing tissue density parameter are reviewed, and the authors also present and exhaustively evaluate algorithms using computer vision techniques. The experimental results based on confusion matrix and kappa coefficient show a higher accuracy is obtained by automatic agreement classification.
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Affiliation(s)
- Ahmed M. Anter
- Mansoura University, Egypt & Scientific Research Group in Egypt (SRGE), Egypt
| | - Mohamed Abu ElSoud
- Mansoura University, Egypt & Scientific Research Group in Egypt (SRGE), Egypt
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10
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He W, Denton ER, Stafford K, Zwiggelaar R. Mammographic image segmentation and risk classification based on mammographic parenchymal patterns and geometric moments. Biomed Signal Process Control 2011. [DOI: 10.1016/j.bspc.2011.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Wei CH, Li Y, Huang PJ. Mammogram retrieval through machine learning within BI-RADS standards. J Biomed Inform 2011; 44:607-14. [PMID: 21277387 DOI: 10.1016/j.jbi.2011.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/17/2011] [Accepted: 01/25/2011] [Indexed: 11/17/2022]
Abstract
A content-based mammogram retrieval system can support usual comparisons made on images by physicians, answering similarity queries over images stored in the database. The importance of searching for similar mammograms lies in the fact that physicians usually try to recall similar cases by seeking images that are pathologically similar to a given image. This paper presents a content-based mammogram retrieval system, which employs a query example to search for similar mammograms in the database. In this system the mammographic lesions are interpreted based on their medical characteristics specified in the Breast Imaging Reporting and Data System (BI-RADS) standards. A hierarchical similarity measurement scheme based on a distance weighting function is proposed to model user's perception and maximizes the effectiveness of each feature in a mammographic descriptor. A machine learning approach based on support vector machines and user's relevance feedback is also proposed to analyze the user's information need in order to retrieve target images more accurately. Experimental results demonstrate that the proposed machine learning approach with Radial Basis Function (RBF) kernel function achieves the best performance among all tested ones. Furthermore, the results also show that the proposed learning approach can improve retrieval performance when applied to retrieve mammograms with similar mass and calcification lesions, respectively.
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Affiliation(s)
- Chia-Hung Wei
- Department of Information Management, Ching Yun University, Taiwan
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Freixenet J, Oliver A, Martí R, Lladó X, Pont J, Pérez E, Denton ERE, Zwiggelaar R. Eigendetection of masses considering false positive reduction and breast density information. Med Phys 2008; 35:1840-53. [PMID: 18561659 DOI: 10.1118/1.2897950] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this article is to present a novel algorithm for the detection of masses in mammographic computer-aided diagnosis systems. Four key points provide the novelty of our approach: (1) the use of eigenanalysis for describing variation in mass shape and size; (2) a Bayesian detection methodology providing a mathematical sound framework, flexible enough to include additional information; (3) the use of a two-dimensional principal components analysis approach to facilitate false positive reduction; and (4) the incorporation of breast density information, a parameter correlated with the performance of most mass detection algorithms and which is not considered in existing approaches. To study the performance of the system two experiments were carried out. The first is related to the ability of the system to detect masses, and thus, free-response receiver operating characteristic analysis was used, showing that the method is able to give high accuracy at a high specificity (80% detection at 1.40 false positives per image). Second, the ability of the system to highlight the pixels belonging to a mass is studied using receiver operating characteristic analysis, resulting in A(z) = 0.89 +/- 0.04. In addition, the robustness of the approach is demonstrated in an experiment where we used the Digital Database for Screening Mammography database for training and the Mammographic Image Analysis Society database for testing the algorithm.
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Affiliation(s)
- Jordi Freixenet
- Institute of Informatics and Applications - IdiBGi, University of Girona, Campus Montilivi, Ed. P-IV 17071, Girona, Spain
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Oliver A, Freixenet J, Martí R, Pont J, Pérez E, Denton ERE, Zwiggelaar R. A novel breast tissue density classification methodology. ACTA ACUST UNITED AC 2008; 12:55-65. [PMID: 18270037 DOI: 10.1109/titb.2007.903514] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It has been shown that the accuracy of mammographic abnormality detection methods is strongly dependent on the breast tissue characteristics, where a dense breast drastically reduces detection sensitivity. In addition, breast tissue density is widely accepted to be an important risk indicator for the development of breast cancer. Here, we describe the development of an automatic breast tissue classification methodology, which can be summarized in a number of distinct steps: 1) the segmentation of the breast area into fatty versus dense mammographic tissue; 2) the extraction of morphological and texture features from the segmented breast areas; and 3) the use of a Bayesian combination of a number of classifiers. The evaluation, based on a large kappa = 0.81 and 0.67 for the two data sets) between automatic and expert-based Breast Imaging Reporting and Data System mammographic density assessment.
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Affiliation(s)
- A Oliver
- Institute of Informatics and Applications, Unversity of Girona, 17071 Girona, Spain.
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