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Lu G, Tian R, Yang W, Liu R, Liu D, Xiang Z, Zhang G. Deep learning radiomics based on multimodal imaging for distinguishing benign and malignant breast tumours. Front Med (Lausanne) 2024; 11:1402967. [PMID: 39036101 PMCID: PMC11257849 DOI: 10.3389/fmed.2024.1402967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/14/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives This study aimed to develop a deep learning radiomic model using multimodal imaging to differentiate benign and malignant breast tumours. Methods Multimodality imaging data, including ultrasonography (US), mammography (MG), and magnetic resonance imaging (MRI), from 322 patients (112 with benign breast tumours and 210 with malignant breast tumours) with histopathologically confirmed breast tumours were retrospectively collected between December 2018 and May 2023. Based on multimodal imaging, the experiment was divided into three parts: traditional radiomics, deep learning radiomics, and feature fusion. We tested the performance of seven classifiers, namely, SVM, KNN, random forest, extra trees, XGBoost, LightGBM, and LR, on different feature models. Through feature fusion using ensemble and stacking strategies, we obtained the optimal classification model for benign and malignant breast tumours. Results In terms of traditional radiomics, the ensemble fusion strategy achieved the highest accuracy, AUC, and specificity, with values of 0.892, 0.942 [0.886-0.996], and 0.956 [0.873-1.000], respectively. The early fusion strategy with US, MG, and MRI achieved the highest sensitivity of 0.952 [0.887-1.000]. In terms of deep learning radiomics, the stacking fusion strategy achieved the highest accuracy, AUC, and sensitivity, with values of 0.937, 0.947 [0.887-1.000], and 1.000 [0.999-1.000], respectively. The early fusion strategies of US+MRI and US+MG achieved the highest specificity of 0.954 [0.867-1.000]. In terms of feature fusion, the ensemble and stacking approaches of the late fusion strategy achieved the highest accuracy of 0.968. In addition, stacking achieved the highest AUC and specificity, which were 0.997 [0.990-1.000] and 1.000 [0.999-1.000], respectively. The traditional radiomic and depth features of US+MG + MR achieved the highest sensitivity of 1.000 [0.999-1.000] under the early fusion strategy. Conclusion This study demonstrated the potential of integrating deep learning and radiomic features with multimodal images. As a single modality, MRI based on radiomic features achieved greater accuracy than US or MG. The US and MG models achieved higher accuracy with transfer learning than the single-mode or radiomic models. The traditional radiomic and depth features of US+MG + MR achieved the highest sensitivity under the early fusion strategy, showed higher diagnostic performance, and provided more valuable information for differentiation between benign and malignant breast tumours.
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Affiliation(s)
- Guoxiu Lu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, China
- Department of Nuclear Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Ronghui Tian
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, China
| | - Wei Yang
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Ruibo Liu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning, China
| | - Dongmei Liu
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zijie Xiang
- Biomedical Engineering, Shenyang University of Technology, Shenyang, Liaoning, China
| | - Guoxu Zhang
- Department of Nuclear Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
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2
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Loizidou K, Elia R, Pitris C. Computer-aided breast cancer detection and classification in mammography: A comprehensive review. Comput Biol Med 2023; 153:106554. [PMID: 36646021 DOI: 10.1016/j.compbiomed.2023.106554] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Cancer is the second cause of mortality worldwide and it has been identified as a perilous disease. Breast cancer accounts for ∼20% of all new cancer cases worldwide, making it a major cause of morbidity and mortality. Mammography is an effective screening tool for the early detection and management of breast cancer. However, the identification and interpretation of breast lesions is challenging even for expert radiologists. For that reason, several Computer-Aided Diagnosis (CAD) systems are being developed to assist radiologists to accurately detect and/or classify breast cancer. This review examines the recent literature on the automatic detection and/or classification of breast cancer in mammograms, using both conventional feature-based machine learning and deep learning algorithms. The review begins with a comparison of algorithms developed specifically for the detection and/or classification of two types of breast abnormalities, micro-calcifications and masses, followed by the use of sequential mammograms for improving the performance of the algorithms. The available Food and Drug Administration (FDA) approved CAD systems related to triage and diagnosis of breast cancer in mammograms are subsequently presented. Finally, a description of the open access mammography datasets is provided and the potential opportunities for future work in this field are highlighted. The comprehensive review provided here can serve both as a thorough introduction to the field but also provide indicative directions to guide future applications.
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Affiliation(s)
- Kosmia Loizidou
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia, Cyprus.
| | - Rafaella Elia
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia, Cyprus.
| | - Costas Pitris
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia, Cyprus.
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Sarvestani ZM, Jamali J, Taghizadeh M, Dindarloo MHF. A novel machine learning approach on texture analysis for automatic breast microcalcification diagnosis classification of mammogram images. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04571-y. [PMID: 36680580 DOI: 10.1007/s00432-023-04571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Screening programs use mammography as a diagnostic tool for the early detection of breast cancer. Mammogram enhancement is used to increase the local contrast of the mammogram so that the lesions are more visible in the advanced image. For accurate diagnosis in the early stage of breast cancer, the appearance of masses and microcalcification on the mammographic image are two important indicators. The objective of this study was to evaluate the feasibility of the automatic separation of images of breast tissue microcalcifications and also to evaluate its accuracy. METHODS The research was carried out by using two techniques of image enhancement and highlighting of breast tissue microcalcifications for the desired areas by regional ROI based on fuzzy system and also Gabor filtering method. After determining the clusters of breast tissue microcalcifications, the clusters are classified using the decision tree classification algorithm. Then, for segmentation, samples suspected of microcalcification are highlighted and masked, and in the last stage, tissue characteristics are extracted. Subsequently, with the help of an artificial neural network (ANN), determining the benign and malignant types of segmented ROI clusters was accomplished. The proposed system is trained with a Digital Database for Screening Mammography (DDSM) developed by the University of South Florida, USA, and the simulations are performed under MATLAB software and the results are compared with previous work. RESULTS The results of this training performed under this work show an accuracy of 93% and an improvement of sensitivity above 95%. CONCLUSION The result indicates that the proposed approach can be applied to ensure breast cancer diagnosis.
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Affiliation(s)
| | - Jasem Jamali
- Department of Electrical Engineering, Kazerun Branch, Islamic Azad University, Kazerun, Iran.
| | - Mehdi Taghizadeh
- Department of Electrical Engineering, Kazerun Branch, Islamic Azad University, Kazerun, Iran
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4
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A review on machine learning techniques for the assessment of image grading in breast mammogram. INT J MACH LEARN CYB 2022. [DOI: 10.1007/s13042-022-01546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Shah SM, Khan RA, Arif S, Sajid U. Artificial intelligence for breast cancer analysis: Trends & directions. Comput Biol Med 2022; 142:105221. [PMID: 35016100 DOI: 10.1016/j.compbiomed.2022.105221] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 12/18/2022]
Abstract
Breast cancer is one of the leading causes of death among women. Early detection of breast cancer can significantly improve the lives of millions of women across the globe. Given importance of finding solution/framework for early detection and diagnosis, recently many AI researchers are focusing to automate this task. The other reasons for surge in research activities in this direction are advent of robust AI algorithms (deep learning), availability of hardware that can run/train those robust and complex AI algorithms and accessibility of large enough dataset required for training AI algorithms. Different imaging modalities that have been exploited by researchers to automate the task of breast cancer detection are mammograms, ultrasound, magnetic resonance imaging, histopathological images or any combination of them. This article analyzes these imaging modalities and presents their strengths and limitations. It also enlists resources from where their datasets can be accessed for research purpose. This article then summarizes AI and computer vision based state-of-the-art methods proposed in the last decade to detect breast cancer using various imaging modalities. Primarily, in this article we have focused on reviewing frameworks that have reported results using mammograms as it is the most widely used breast imaging modality that serves as the first test that medical practitioners usually prescribe for the detection of breast cancer. Another reason for focusing on mammogram imaging modalities is the availability of its labelled datasets. Datasets availability is one of the most important aspects for the development of AI based frameworks as such algorithms are data hungry and generally quality of dataset affects performance of AI based algorithms. In a nutshell, this research article will act as a primary resource for the research community working in the field of automated breast imaging analysis.
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Affiliation(s)
- Shahid Munir Shah
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
| | - Rizwan Ahmed Khan
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan.
| | - Sheeraz Arif
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
| | - Unaiza Sajid
- Department of Computer Science, Faculty of Information Technology, Salim Habib University, Karachi, Pakistan
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Sentinel Lymph Node Metastasis on Clinically Negative Patients: Preliminary Results of a Machine Learning Model Based on Histopathological Features. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112110372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The reported incidence of node metastasis at sentinel lymph node biopsy is generally low, so that the majority of women underwent unnecessary invasive axilla surgery. Although the sentinel lymph node biopsy is time consuming and expensive, it is still the intra-operative exam with the highest performance, but sometimes surgery is achieved without a clear diagnosis and also with possible serious complications. In this work, we developed a machine learning model to predict the sentinel lymph nodes positivity in clinically negative patients. Breast cancer clinical and immunohistochemical features of 907 patients characterized by a clinically negative lymph node status were collected. We trained different machine learning algorithms on the retrospective collected data and selected an optimal subset of features through a sequential forward procedure. We found comparable performances for different classification algorithms: on a hold-out training set, the logistics regression classifier with seven features, i.e., tumor diameter, age, histologic type, grading, multiplicity, in situ component and Her2-neu status reached an AUC value of 71.5% and showed a better trade-off between sensitivity and specificity (69.4 and 66.9%, respectively) compared to other two classifiers. On the hold-out test set, the performance dropped by five percentage points in terms of accuracy. Overall, the histological characteristics alone did not allow us to develop a support tool suitable for actual clinical application, but it showed the maximum informative power contained in the same for the resolution of the clinical problem. The proposed study represents a starting point for future development of predictive models to obtain the probability for lymph node metastases by using histopathological features combined with other features of a different nature.
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Touil A, Kalti K, Conze PH, Solaiman B, Mahjoub MA. A new conditional region growing approach for microcalcification delineation in mammograms. Med Biol Eng Comput 2021; 59:1795-1814. [PMID: 34304371 DOI: 10.1007/s11517-021-02379-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
Microcalcifications (MCs) are considered as the first indicator of breast cancer development. Their morphology, in terms of shape and size, is considered as the most important criterion that determines their malignity degrees. Therefore, the accurate delineation of MC is a cornerstone step in their automatic diagnosis process. In this paper, we propose a new conditional region growing (CRG) approach with the ability of finding the accurate MC boundaries starting from selected seed points. The starting seed points are determined based on regional maxima detection and superpixel analysis. The region growing step is controlled by a set of criteria that are adapted to MC detection in terms of contrast and shape variation. These criteria are derived from prior knowledge to characterize MCs and can be divided into two categories. The first one concerns the neighbourhood searching size. The second one deals with the analysis of gradient information and shape evolution within the growing process. In order to prove the effectiveness and the reliability in terms of MC detection and delineation, several experiments have been carried out on MCs of various types, with both qualitative and quantitative analysis. The comparison of the proposed approach with state-of-the art proves the importance of the used criteria in the context of MC delineation, towards a better management of breast cancer. Graphical Abstract Flowchart of the proposed approach.
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Affiliation(s)
- Asma Touil
- Ecole Nationale d'Ingénieurs de Sousse, LATIS-Laboratory of Advanced Technology and Intelligent Systems, Université de Sousse, 4023, Sousse, Tunisia. .,Université de Sousse, Institut Supérieur d'Informatique et des Techniques de Communication, 4011, Hammam Sousse, Tunisia. .,IMT Atlantique, LaTIM UMR 1101, UBL, Brest, 29200, France.
| | - Karim Kalti
- Ecole Nationale d'Ingénieurs de Sousse, LATIS-Laboratory of Advanced Technology and Intelligent Systems, Université de Sousse, 4023, Sousse, Tunisia
| | | | - Basel Solaiman
- IMT Atlantique, LaTIM UMR 1101, UBL, Brest, 29200, France
| | - Mohamed Ali Mahjoub
- Ecole Nationale d'Ingénieurs de Sousse, LATIS-Laboratory of Advanced Technology and Intelligent Systems, Université de Sousse, 4023, Sousse, Tunisia
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Rehman KU, Li J, Pei Y, Yasin A, Ali S, Mahmood T. Computer Vision-Based Microcalcification Detection in Digital Mammograms Using Fully Connected Depthwise Separable Convolutional Neural Network. SENSORS 2021; 21:s21144854. [PMID: 34300597 PMCID: PMC8309805 DOI: 10.3390/s21144854] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023]
Abstract
Microcalcification clusters in mammograms are one of the major signs of breast cancer. However, the detection of microcalcifications from mammograms is a challenging task for radiologists due to their tiny size and scattered location inside a denser breast composition. Automatic CAD systems need to predict breast cancer at the early stages to support clinical work. The intercluster gap, noise between individual MCs, and individual object’s location can affect the classification performance, which may reduce the true-positive rate. In this study, we propose a computer-vision-based FC-DSCNN CAD system for the detection of microcalcification clusters from mammograms and classification into malignant and benign classes. The computer vision method automatically controls the noise and background color contrast and directly detects the MC object from mammograms, which increases the classification performance of the neural network. The breast cancer classification framework has four steps: image preprocessing and augmentation, RGB to grayscale channel transformation, microcalcification region segmentation, and MC ROI classification using FC-DSCNN to predict malignant and benign cases. The proposed method was evaluated on 3568 DDSM and 2885 PINUM mammogram images with automatic feature extraction, obtaining a score of 0.97 with a 2.35 and 0.99 true-positive ratio with 2.45 false positives per image, respectively. Experimental results demonstrated that the performance of the proposed method remains higher than the traditional and previous approaches.
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Affiliation(s)
- Khalil ur Rehman
- The School of Software Engineering, Beijing University of Technology, Beijing 100024, China; (K.u.R.); (J.L.); (A.Y.); (S.A.); (T.M.)
| | - Jianqiang Li
- The School of Software Engineering, Beijing University of Technology, Beijing 100024, China; (K.u.R.); (J.L.); (A.Y.); (S.A.); (T.M.)
- Beijing Engineering Research Center for IoT Software and Systems, Beijing 100124, China
| | - Yan Pei
- Computer Science Division, University of Aizu, Aizuwakamatsu, Fukushima 965-8580, Japan
- Correspondence:
| | - Anaa Yasin
- The School of Software Engineering, Beijing University of Technology, Beijing 100024, China; (K.u.R.); (J.L.); (A.Y.); (S.A.); (T.M.)
| | - Saqib Ali
- The School of Software Engineering, Beijing University of Technology, Beijing 100024, China; (K.u.R.); (J.L.); (A.Y.); (S.A.); (T.M.)
| | - Tariq Mahmood
- The School of Software Engineering, Beijing University of Technology, Beijing 100024, China; (K.u.R.); (J.L.); (A.Y.); (S.A.); (T.M.)
- Division of Science and Technology, University of Education, Lahore 54000, Pakistan
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9
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Massafra R, Bove S, Lorusso V, Biafora A, Comes MC, Didonna V, Diotaiuti S, Fanizzi A, Nardone A, Nolasco A, Ressa CM, Tamborra P, Terenzio A, La Forgia D. Radiomic Feature Reduction Approach to Predict Breast Cancer by Contrast-Enhanced Spectral Mammography Images. Diagnostics (Basel) 2021; 11:diagnostics11040684. [PMID: 33920221 PMCID: PMC8070152 DOI: 10.3390/diagnostics11040684] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Contrast-enhanced spectral mammography (CESM) is an advanced instrument for breast care that is still operator dependent. The aim of this paper is the proposal of an automated system able to discriminate benign and malignant breast lesions based on radiomic analysis. We selected a set of 58 regions of interest (ROIs) extracted from 53 patients referred to Istituto Tumori "Giovanni Paolo II" of Bari (Italy) for the breast cancer screening phase between March 2017 and June 2018. We extracted 464 features of different kinds, such as points and corners of interest, textural and statistical features from both the original ROIs and the ones obtained by a Haar decomposition and a gradient image implementation. The features data had a large dimension that can affect the process and accuracy of cancer classification. Therefore, a classification scheme for dimension reduction was needed. Specifically, a principal component analysis (PCA) dimension reduction technique that includes the calculation of variance proportion for eigenvector selection was used. For the classification method, we trained three different classifiers, that is a random forest, a naïve Bayes and a logistic regression, on each sub-set of principal components (PC) selected by a sequential forward algorithm. Moreover, we focused on the starting features that contributed most to the calculation of the related PCs, which returned the best classification models. The method obtained with the aid of the random forest classifier resulted in the best prediction of benign/malignant ROIs with median values for sensitivity and specificity of 88.37% and 100%, respectively, by using only three PCs. The features that had shown the greatest contribution to the definition of the same were almost all extracted from the LE images. Our system could represent a valid support tool for radiologists for interpreting CESM images.
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Affiliation(s)
- Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (R.M.); (M.C.C.); (V.D.); (P.T.)
| | - Samantha Bove
- Dipartimento di Matematica, Università degli Studi di Bari, 70121 Bari, Italy;
| | - Vito Lorusso
- Unità Operativa Complessa di Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (V.L.); (A.N.)
| | - Albino Biafora
- Dipartimento di Economia e Finanza, Università degli Studi di Bari, 70124 Bari, Italy;
| | - Maria Colomba Comes
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (R.M.); (M.C.C.); (V.D.); (P.T.)
| | - Vittorio Didonna
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (R.M.); (M.C.C.); (V.D.); (P.T.)
| | - Sergio Diotaiuti
- Struttura Semplice Dipartimentale di Chirurgia, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (R.M.); (M.C.C.); (V.D.); (P.T.)
- Correspondence: ; Tel.: +39-080-555-5111
| | - Annalisa Nardone
- Unita Opertiva Complessa di Radioterapia, IRCCS Istituto Tumori ”Giovanni Paolo II”, 70124 Bari, Italy;
| | - Angelo Nolasco
- Unità Operativa Complessa di Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (V.L.); (A.N.)
| | - Cosmo Maurizio Ressa
- Unità Operativa Complessa di Chirurgica Plastica e Ricostruttiva, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Pasquale Tamborra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (R.M.); (M.C.C.); (V.D.); (P.T.)
| | - Antonella Terenzio
- Unità di Oncologia Medica, Università Campus Bio-Medico, 00128 Roma, Italy;
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
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10
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Massafra R, Latorre A, Fanizzi A, Bellotti R, Didonna V, Giotta F, La Forgia D, Nardone A, Pastena M, Ressa CM, Rinaldi L, Russo AOM, Tamborra P, Tangaro S, Zito A, Lorusso V. A Clinical Decision Support System for Predicting Invasive Breast Cancer Recurrence: Preliminary Results. Front Oncol 2021; 11:576007. [PMID: 33777733 PMCID: PMC7991309 DOI: 10.3389/fonc.2021.576007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022] Open
Abstract
The mortality associated to breast cancer is in many cases related to metastasization and recurrence. Personalized treatment strategies are critical for the outcomes improvement of BC patients and the Clinical Decision Support Systems can have an important role in medical practice. In this paper, we present the preliminary results of a prediction model of the Breast Cancer Recurrence (BCR) within five and ten years after diagnosis. The main breast cancer-related and treatment-related features of 256 patients referred to Istituto Tumori “Giovanni Paolo II” of Bari (Italy) were used to train machine learning algorithms at the-state-of-the-art. Firstly, we implemented several feature importance techniques and then we evaluated the prediction performances of BCR within 5 and 10 years after the first diagnosis by means different classifiers. By using a small number of features, the models reached highly performing results both with reference to the BCR within 5 years and within 10 years with an accuracy of 77.50% and 80.39% and a sensitivity of 92.31% and 95.83% respectively, in the hold-out sample test. Despite validation studies are needed on larger samples, our results are promising for the development of a reliable prognostic supporting tool for clinicians in the definition of personalized treatment plans.
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Affiliation(s)
- Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Agnese Latorre
- Unitá Opertiva Complessa di Oncologia Medica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Roberto Bellotti
- Dipartimento di Fisica, Universitá degli Studi "Aldo Moro" e Istituto Nazionale di Fisica Nucleare - Sezione di Bari, Bari, Italy
| | - Vittorio Didonna
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Francesco Giotta
- Unitá Opertiva Complessa di Oncologia Medica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Annalisa Nardone
- Unitá Opertiva Complessa di Radioterapia, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Maria Pastena
- Unitá Opertiva Complessa di Anatomia Patologica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Cosmo Maurizio Ressa
- Unitá Opertiva Complessa di Chirurgia Plastica e Ricostruttiva, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Lucia Rinaldi
- Struttura Semplice Dipartimentale di Oncologia Per la Presa in Carico Globale del Paziente, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Pasquale Tamborra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Sabina Tangaro
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Universitá degli Studi "Aldo Moro" e Istituto Nazionale di Fisica Nucleare - Sezione di Bari, Bari, Italy
| | - Alfredo Zito
- Unitá Opertiva Complessa di Anatomia Patologica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vito Lorusso
- Unitá Opertiva Complessa di Oncologia Medica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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11
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Artificial intelligence applications in medical imaging: A review of the medical physics research in Italy. Phys Med 2021; 83:221-241. [DOI: 10.1016/j.ejmp.2021.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/31/2021] [Accepted: 04/03/2021] [Indexed: 02/06/2023] Open
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12
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A Proposal of Quantum-Inspired Machine Learning for Medical Purposes: An Application Case. MATHEMATICS 2021. [DOI: 10.3390/math9040410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Learning tasks are implemented via mappings of the sampled data set, including both the classical and the quantum framework. Biomedical data characterizing complex diseases such as cancer typically require an algorithmic support for clinical decisions, especially for early stage tumors that typify breast cancer patients, which are still controllable in a therapeutic and surgical way. Our case study consists of the prediction during the pre-operative stage of lymph node metastasis in breast cancer patients resulting in a negative diagnosis after clinical and radiological exams. The classifier adopted to establish a baseline is characterized by the result invariance for the order permutation of the input features, and it exploits stratifications in the training procedure. The quantum one mimics support vector machine mapping in a high-dimensional feature space, yielded by encoding into qubits, while being characterized by complexity. Feature selection is exploited to study the performances associated with a low number of features, thus implemented in a feasible time. Wide variations in sensitivity and specificity are observed in the selected optimal classifiers during cross-validations for both classification system types, with an easier detection of negative or positive cases depending on the choice between the two training schemes. Clinical practice is still far from being reached, even if the flexible structure of quantum-inspired classifier circuits guarantees further developments to rule interactions among features: this preliminary study is solely intended to provide an overview of the particular tree tensor network scheme in a simplified version adopting just product states, as well as to introduce typical machine learning procedures consisting of feature selection and classifier performance evaluation.
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Dosimetry and Comparison between Different CT Protocols (Low Dose, Ultralow Dose, and Conventional CT) for Lung Nodules' Detection in a Phantom. Radiol Res Pract 2021; 2021:6667779. [PMID: 33552601 PMCID: PMC7847358 DOI: 10.1155/2021/6667779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 12/17/2022] Open
Abstract
Background The effects of dose reduction in lung nodule detection need better understanding. Purpose To compare the detection rate of simulated lung nodules in a chest phantom using different computed tomography protocols, low dose (LD), ultralow dose (ULD), and conventional (CCT), and to quantify their respective amount of radiation. Materials and Methods A chest phantom containing 93 simulated lung nodules was scanned using five different protocols: ULD (80 kVp/30 mA), LD A (120 kVp/20 mA), LD B (100 kVp/30 mA), LD C (120 kVp/30 mA), and CCT (120 kVp/automatic mA). Four chest radiologists analyzed a selected image from each protocol and registered in diagrams the nodules they detected. Kruskal-Wallis and McNemar's tests were performed to determine the difference in nodule detection. Equivalent doses were estimated by placing thermoluminescent dosimeters on the surface and inside the phantom. Results There was no significant difference in lung nodules' detection when comparing ULD and LD protocols (p=0.208 to p=1.000), but there was a significant difference when comparing each one of those against CCT (p < 0.001). The detection rate of nodules with CT attenuation values lower than -600 HU was also different when comparing all protocols against CCT (p < 0.001 to p=0.007). There was at least moderate agreement between observers in all protocols (κ-value >0.41). Equivalent dose values ranged from 0.5 to 9 mSv. Conclusion There is no significant difference in simulated lung nodules' detection when comparing ULD and LD protocols, but both differ from CCT, especially when considering lower-attenuating nodules.
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Predicting of Sentinel Lymph Node Status in Breast Cancer Patients with Clinically Negative Nodes: A Validation Study. Cancers (Basel) 2021; 13:cancers13020352. [PMID: 33477893 PMCID: PMC7833376 DOI: 10.3390/cancers13020352] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Sentinel lymph node biopsy procedure is time consuming and expensive, but it is still the intra-operative exam capable of the best performance. However, sometimes, surgery is achieved without a clear diagnosis, so clinical decision support systems developed with artificial intelligence techniques are essential to assist current diagnostic procedures. In this work, we evaluated the usefulness of a CancerMath tool in the sentinel lymph nodes positivity prediction for clinically negative patients. We tested it on 993 patients referred to our institute characterized by sentinel lymph node status, tumor size, age, histologic type, grading, expression of estrogen receptor, progesterone receptor, HER2, and Ki-67. By training the CancerMath (CM) model on our dataset, we reached a sensitivity value of 72%, whereas the online one was 46%, despite a specificity reduction. It was found the addiction of the prognostic factors Her2 and Ki67 could help improve performances on the classification of particular types of patients. Abstract In the absence of lymph node abnormalities detectable on clinical examination or imaging, the guidelines provide for the dissection of the first axillary draining lymph nodes during surgery. It is not always possible to arrive at surgery without diagnostic doubts, and machine learning algorithms can support clinical decisions. The web calculator CancerMath (CM) allows you to estimate the probability of having positive lymph nodes valued on the basis of tumor size, age, histologic type, grading, expression of estrogen receptor, and progesterone receptor. We collected 993 patients referred to our institute with clinically negative results characterized by sentinel lymph node status, prognostic factors defined by CM, and also human epidermal growth factor receptor 2 (HER2) and Ki-67. Area Under the Curve (AUC) values obtained by the online CM application were comparable with those obtained after training its algorithm on our database. Nevertheless, by training the CM model on our dataset and using the same feature, we reached a sensitivity median value of 72%, whereas the online one was equal to 46%, despite a specificity reduction. We found that the addition of the prognostic factors Her2 and Ki67 could help improve performances on the classification of particular types of patients with the aim of reducing as much as possible the false positives that lead to axillary dissection. As showed by our experimental results, it is not particularly suitable for use as a support instrument for the prediction of metastatic lymph nodes on clinically negative patients.
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Shen L, Ma X, Jiang T, Shen X, Yang W, You C, Peng W. Malignancy Risk Stratification Prediction of Amorphous Calcifications Based on Clinical and Mammographic Features. Cancer Manag Res 2021; 13:235-245. [PMID: 33469367 PMCID: PMC7811441 DOI: 10.2147/cmar.s286269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To explore the potential factors influencing the malignancy risk of amorphous calcifications and establish a predictive nomogram for malignancy risk stratification. Patients and Methods Consecutive mammograms from January 2013 to December 2018 were retrospectively reviewed. Traditional clinical features were recorded, and mammographic features were estimated according to the 5th BI-RADS. Included calcifications were randomly divided into the training and validation cohorts. A nomogram was developed to graphically predict the risk of malignancy (risk) based on stepwise multivariate logistic regression analysis. The discrimination and calibration performance of the model were assessed in both the training and validation cohorts. Results Finally, 1018 amorphous calcifications with final pathological results in 907 women were identified with a malignancy rate of 28.4% (95% CI: 25.7%, 31.3%). The malignancy rates of subgroups divided by the distribution of calcifications, quantity of calcifications, age, menopausal status and family history of cancer were significantly different. There were 712 cases and 306 cases in the training and validation cohorts. The prediction nomogram was finally developed based on four risk factors, including age and distribution, maximum diameter and quantity of calcifications. The AUC of the nomogram was 0.799 (95% CI: 0.761, 0.836) in the training cohort and 0.795 (95% CI: 0.738, 0.852) in the validation cohort. Conclusion On mammography, the distribution, maximum diameter and quantity of calcifications are independent predictors of malignant amorphous calcifications and can be easily obtained in the clinic. The nomogram developed in this study for individualized malignancy risk stratification of amorphous calcifications shows good discrimination performance.
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Affiliation(s)
- Lijuan Shen
- Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiaowen Ma
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Tingting Jiang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xigang Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Wentao Yang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
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La Forgia D, Fanizzi A, Campobasso F, Bellotti R, Didonna V, Lorusso V, Moschetta M, Massafra R, Tamborra P, Tangaro S, Telegrafo M, Pastena MI, Zito A. Radiomic Analysis in Contrast-Enhanced Spectral Mammography for Predicting Breast Cancer Histological Outcome. Diagnostics (Basel) 2020; 10:E708. [PMID: 32957690 PMCID: PMC7555402 DOI: 10.3390/diagnostics10090708] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Contrast-Enhanced Spectral Mammography (CESM) is a recently introduced mammographic method with characteristics particularly suitable for breast cancer radiomic analysis. This work aims to evaluate radiomic features for predicting histological outcome and two cancer molecular subtypes, namely Human Epidermal growth factor Receptor 2 (HER2)-positive and triple-negative. From 52 patients, 68 lesions were identified and confirmed on histological examination. Radiomic analysis was performed on regions of interest (ROIs) selected from both low-energy (LE) and ReCombined (RC) CESM images. Fourteen statistical features were extracted from each ROI. Expression of estrogen receptor (ER) was significantly correlated with variation coefficient and variation range calculated on both LE and RC images; progesterone receptor (PR) with skewness index calculated on LE images; and Ki67 with variation coefficient, variation range, entropy and relative smoothness indices calculated on RC images. HER2 was significantly associated with relative smoothness calculated on LE images, and grading tumor with variation coefficient, entropy and relative smoothness calculated on RC images. Encouraging results for differentiation between ER+/ER-, PR+/PR-, HER2+/HER2-, Ki67+/Ki67-, High-Grade/Low-Grade and TN/NTN were obtained. Specifically, the highest performances were obtained for discriminating HER2+/HER2- (90.87%), ER+/ER- (83.79%) and Ki67+/Ki67- (84.80%). Our results suggest an interesting role for radiomics in CESM to predict histological outcomes and particular tumors' molecular subtype.
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Affiliation(s)
- Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Francesco Campobasso
- Dipartimento di Economia e Finanza, Università degli Studi di Bari “Aldo Moro”, Largo Abbazia S. Scolastica, 70124 Bari, Italy;
| | - Roberto Bellotti
- Dipartimento Interateneo di Fisica, Università degli Studi di Bari “Aldo Moro”, Via Giovanni Amendola, 165/a, 70126 Bari, Italy;
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Via Giovanni Amendola, 165/a, 70126 Bari, Italy;
| | - Vittorio Didonna
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Vito Lorusso
- Unità Operativa Complessa di Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Marco Moschetta
- Unità Operativa Semplice Dipartimentale Radiodiagnostica ad Indirizzo Senologico, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (M.T.)
| | - Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Pasquale Tamborra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (A.F.); (V.D.); (P.T.)
| | - Sabina Tangaro
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Via Giovanni Amendola, 165/a, 70126 Bari, Italy;
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Università degli Studi di Bari Aldo Moro, 70121 Bari, Italy
| | - Michele Telegrafo
- Unità Operativa Semplice Dipartimentale Radiodiagnostica ad Indirizzo Senologico, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy; (M.M.); (M.T.)
| | - Maria Irene Pastena
- Unità Operativa Complessa di Anatomia Patologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (M.I.P.); (A.Z.)
| | - Alfredo Zito
- Unità Operativa Complessa di Anatomia Patologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (M.I.P.); (A.Z.)
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Fausto A, Fanizzi A, Volterrani L, Mazzei FG, Calabrese C, Casella D, Marcasciano M, Massafra R, La Forgia D, Mazzei MA. Feasibility, Image Quality and Clinical Evaluation of Contrast-Enhanced Breast MRI Performed in a Supine Position Compared to the Standard Prone Position. Cancers (Basel) 2020; 12:cancers12092364. [PMID: 32825583 PMCID: PMC7564182 DOI: 10.3390/cancers12092364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background: To assess the feasibility, image quality and diagnostic value of contrast-enhanced breast magnetic resonance imaging (MRI) performed in a supine compared to a prone position. Methods: One hundred and fifty-one patients who had undergone a breast MRI in both the standard prone and supine position were evaluated retrospectively. Two 1.5 T MR scanners were used with the same image resolution, sequences and contrast medium in all examinations. The image quality and the number and dimensions of lesions were assessed by two expert radiologists in an independent and randomized fashion. Two different classification systems were used. Histopathology was the standard of reference. Results: Two hundred and forty MRIs from 120 patients were compared. The analysis revealed 134 MRIs with monofocal (U), 68 with multifocal (M) and 38 with multicentric (C) lesions. There was no difference between the image quality and number of lesions in the prone and supine examinations. A significant difference in the lesion extension was observed between the prone and supine position. No significant differences emerged in the classification of the lesions detected in the prone compared to the supine position. Conclusions: It is possible to perform breast MRI in a supine position with the same image quality, resolution and diagnostic value as in a prone position. In the prone position, the lesion dimensions are overestimated with a higher wash-in peak than in the supine position.
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Affiliation(s)
- Alfonso Fausto
- Department of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
- Correspondence: ; Tel.: +39-0577585287 or +39-3477601341
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; (L.V.); (M.A.M.)
| | - Francesco Giuseppe Mazzei
- Department of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | | | - Donato Casella
- Department of Oncologic and Reconstructive Breast Surgery, Azienda Ospedaliera Universitaria Senese, University Hospital of Siena, 53100 Siena, Italy;
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, “Spedali Riuniti” di Livorno, Breast Unit Integrata di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, 57100 Livorno, Italy;
| | - Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.F.); (R.M.)
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy; (L.V.); (M.A.M.)
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La Forgia D, Catino A, Fausto A, Cutrignelli D, Fanizzi A, Gatta G, Losurdo L, Maiorella A, Moschetta M, Ressa C, Scattone A, Portincasa A. Diagnostic challenges and potential early indicators of breast periprosthetic anaplastic large cell lymphoma: A case report. Medicine (Baltimore) 2020; 99:e21095. [PMID: 32791685 PMCID: PMC7387005 DOI: 10.1097/md.0000000000021095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Anaplastic large T-cell lymphoma (BI-ALCL) is a rare primitive lymphoma described in women with breast implant prostheses, which has been arousing interest in recent years due to its potentially high social impact. The difficult diagnosis associated with the high and increasing number of prosthetic implants worldwide has led to hypothesize an underestimation of the real impact of the disease among prosthesis-bearing women. The aim of this work is to search for specific radiological signs of disease linked to the chronic inflammatory pathogenetic mechanism. PATIENT CONCERNS This work describes a case of BI-ALCL in an American woman with no personal or family history of cancer, who underwent breast augmentation for esthetic purposes at our Institute. After about 10 years of relative well-being, the patient returned to our Institute with clear evidence of breast asymmetry due to the increase in volume of the right breast which had progressively become larger over a period of 6 months. There was no evidence of palpable axillary lymph nodes or other noteworthy signs. DIAGNOSIS The ultrasound and magnetic resonance (MR) tests indicated the presence of seroma with amorphous material in the exudate which was confirmed by indirect signs, visible in right breast mammography. Due to suspected cold seroma, an ultrasound-guided needle aspiration was performed for the cytological analysis of the effusion which highlighted the presence of a number of large-sized atypical cells with an irregular nucleus with CD30 immunoreactivity, leucocyte common antigen (CD45) compatible with the BI-ALCL diagnosis. INTERVENTIONS In our case, a capsulectomy was performed because the disease was limited inside the capsule and periprosthetic seroma. The final histological examination confirmed the stage. LESSONS The patient is being monitored and shows no signs of recurrence of disease >24 months after surgery. CONCLUSION A diagnosis of BI-ALCL can be reached using new radiological indicators, such as fibrin, which is clearly visible by MR in the form of nonvascularized debris of amorphous material hypointense in all sequences, free flowing or adhered to the external surface of the prosthesis.
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Affiliation(s)
| | | | - Alfonso Fausto
- Dip. di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Siena
| | | | | | - Gianluca Gatta
- Dip. di Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Napoli
| | - Liliana Losurdo
- Dip. di Scienze Fisiche, della Terra e dell’Ambiente, Università degli Studi di Siena, Siena
| | | | - Marco Moschetta
- Dip. di Emergenza e Trapianti d’organi, Università degli Studi di Bari “Aldo Moro,” Bari
| | - Cosmo Ressa
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari
| | - Anna Scattone
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari
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Fujioka T, Kubota K, Mori M, Kikuchi Y, Katsuta L, Kimura M, Yamaga E, Adachi M, Oda G, Nakagawa T, Kitazume Y, Tateishi U. Efficient Anomaly Detection with Generative Adversarial Network for Breast Ultrasound Imaging. Diagnostics (Basel) 2020; 10:diagnostics10070456. [PMID: 32635547 PMCID: PMC7400007 DOI: 10.3390/diagnostics10070456] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022] Open
Abstract
We aimed to use generative adversarial network (GAN)-based anomaly detection to diagnose images of normal tissue, benign masses, or malignant masses on breast ultrasound. We retrospectively collected 531 normal breast ultrasound images from 69 patients. Data augmentation was performed and 6372 (531 × 12) images were available for training. Efficient GAN-based anomaly detection was used to construct a computational model to detect anomalous lesions in images and calculate abnormalities as an anomaly score. Images of 51 normal tissues, 48 benign masses, and 72 malignant masses were analyzed for the test data. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of this anomaly detection model were calculated. Malignant masses had significantly higher anomaly scores than benign masses (p < 0.001), and benign masses had significantly higher scores than normal tissues (p < 0.001). Our anomaly detection model had high sensitivities, specificities, and AUC values for distinguishing normal tissues from benign and malignant masses, with even greater values for distinguishing normal tissues from malignant masses. GAN-based anomaly detection shows high performance for the detection and diagnosis of anomalous lesions in breast ultrasound images.
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Affiliation(s)
- Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
- Correspondence: ; Tel.: +81-3-5803-5311
| | - Kazunori Kubota
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
- Department of Radiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun, Tochigi 321-0293, Japan
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
| | - Yuka Kikuchi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
| | - Leona Katsuta
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
| | - Mizuki Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
| | - Mio Adachi
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.A.); (G.O.); (T.N.)
| | - Goshi Oda
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.A.); (G.O.); (T.N.)
| | - Tsuyoshi Nakagawa
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (M.A.); (G.O.); (T.N.)
| | - Yoshio Kitazume
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; (K.K.); (M.M.); (Y.K.); (L.K.); (M.K.); (E.Y.); (Y.K.); (U.T.)
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Automatic detection of microcalcification based on morphological operations and structural similarity indices. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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La Forgia D, Fausto A, Gatta G, Di Grezia G, Faggian A, Fanizzi A, Cutrignelli D, Dentamaro R, Didonna V, Lorusso V, Massafra R, Tangaro S, Mazzei MA. Elite VABB 13G: A New Ultrasound-Guided Wireless Biopsy System for Breast Lesions. Technical Characteristics and Comparison with Respect to Traditional Core-Biopsy 14-16G Systems. Diagnostics (Basel) 2020; 10:diagnostics10050291. [PMID: 32397505 PMCID: PMC7277965 DOI: 10.3390/diagnostics10050291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
The typification of breast lumps with fine-needle biopsies is often affected by inconclusive results that extend diagnostic time. Many breast centers have progressively substituted cytology with micro-histology. The aim of this study is to assess the performance of a 13G-needle biopsy using cable-free vacuum-assisted breast biopsy (VABB) technology. Two of our operators carried out 200 micro-histological biopsies using the Elite 13G-needle VABB and 1314 14–16G-needle core biopsies (CBs) on BI-RADS 3, 4, and 5 lesions. Thirty-one of the procedures were repeated following CB, eighteen following cytological biopsy, and three after undergoing both procedures. The VABB Elite procedure showed high diagnostic performance with an accuracy of 94.00%, a sensitivity of 92.30%, and a specificity of 100%, while the diagnostic underestimation was 11.00%, all significantly comparable to of the CB procedure. The VABB Elite 13G system has been shown to be a simple, rapid, reliable, and well-tolerated biopsy procedure, without any significant complications and with a diagnostic performance comparable to traditional CB procedures. The histological class change in an extremely high number of samples would suggest the use of this procedure as a second-line biopsy for suspect cases or those with indeterminate cyto-histological results.
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Affiliation(s)
- Daniele La Forgia
- Radiodiagnostica Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (D.L.F.); (R.D.)
| | - Alfonso Fausto
- Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy; (A.F.); (M.A.M.)
| | - Gianluca Gatta
- Dipartimento Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Piazza L. Miraglia 2, 80138 Napoli, Italy;
| | - Graziella Di Grezia
- Dipartimento dei Servizi—Diagnostica per Immagini, Ospedale “G. Criscuoli”, Via Quadrivio, 83054 Avellino, Italy;
| | - Angela Faggian
- UOC Diagnostica per Immagini, Azienda Ospedaliera San Pio, Via dell’Angelo 1, 82100 Benevento, Italy;
| | - Annarita Fanizzi
- Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-080-5555111
| | - Daniela Cutrignelli
- Chirurgia Plastica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Rosalba Dentamaro
- Radiodiagnostica Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (D.L.F.); (R.D.)
| | - Vittorio Didonna
- Fisica Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (V.D.); (R.M.)
| | - Vito Lorusso
- Oncologia Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy;
| | - Raffaella Massafra
- Fisica Medica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy; (V.D.); (R.M.)
| | - Sabina Tangaro
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Università degli Studi di Bari ‘Aldo Moro’, 70125 Bari, Italy;
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Via Giovanni Amendola, 165/a, 70126 Bari, Italy
| | - Maria Antonietta Mazzei
- Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Viale Bracci 10, 53100 Siena, Italy; (A.F.); (M.A.M.)
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Scimeca M, Trivigno D, Bonfiglio R, Ciuffa S, Urbano N, Schillaci O, Bonanno E. Breast cancer metastasis to bone: From epithelial to mesenchymal transition to breast osteoblast-like cells. Semin Cancer Biol 2020; 72:155-164. [PMID: 32045651 DOI: 10.1016/j.semcancer.2020.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
In this review we highlighted the newest aspects concerning the physiopathology of breast cancer metastatization into the bone including: a) in situ biomarkers of breast cancer metastatic diseases, b) biological processes related to the origin of metastatic cells (epithelial to mesenchymal transition), c) the nature and the possible role of Breast Osteoblast-Like Cells in the formation of bone lesions and d) the prognostic value of breast microcalcifications for the bone metastatic disease. In addition, the more recent data about the biology of breast cancer metastatic process and the origin and function of Breast Osteoblast-Like Cells have been analyzed to propose the use of molecular imaging investigations able to identify early neoplastic lesions with high propensity to form bone metastasis in vivo.
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Affiliation(s)
- Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy; San Raffaele University, Via di Val Cannuta 247, 00166, Rome, Italy; Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, 20122, Milano, Mi, Italy; Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131 Rome, Italy.
| | - Donata Trivigno
- Department of Experimental Medicine, University "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy
| | - Rita Bonfiglio
- Department of Experimental Medicine, University "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy
| | - Sara Ciuffa
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Elena Bonanno
- Department of Experimental Medicine, University "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy; "Diagnostica Medica" and "Villa dei Platani", Avellino, Italy
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Shaikh TA, Ali R. An intelligent healthcare system for optimized breast cancer diagnosis using harmony search and simulated annealing (HS-SA) algorithm. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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