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Hubbard TJE, Shams O, Gardner B, Gibson F, Rowlands S, Harries T, Stone N. A systematic scoping review exploring variation in practice in specimen mammography for Intraoperative Margin Analysis in Breast Conserving Surgery and the role of artificial intelligence in optimising diagnostic accuracy. Eur J Radiol 2024; 181:111777. [PMID: 39393216 DOI: 10.1016/j.ejrad.2024.111777] [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: 06/24/2024] [Revised: 09/28/2024] [Accepted: 10/05/2024] [Indexed: 10/13/2024]
Abstract
PURPOSE Specimen Mammography (SM) is commonly used in Breast Conserving Surgery (BCS) for intraoperative margin analysis. A systematic scoping review was conducted to identify sources of methodological variation in Specimen Mammography Interpretation (SMI) and assess the role of Artificial Intelligence (AI) techniques to optimise Diagnostic Accuracy (DA). METHODS Embase, Pubmed, Cochrane and web of science databases were searched. Studies were included if SM was used for margin analysis for BCS with reported DA compared with pathological margin status and data extracted. RESULTS 1242 unique studies were identified, of which 40 were included. 39/40 studies did not utilise AI for SMI, with 4 studies comparing 2 relevant techniques, giving 43 non-AI study arms for analysis. There was wide variation in SM techniques, including number of views and location of SM. Specialist performing SMI in usual clinical practice was surgeon (13/39 studies;33 %), radiologist(s) (16/39;41 %), surgeon and radiologist (3/39;8 %) or not stated (7/39;18 %) which differed from the study specialist in 15/39 (38 %) of studies. Diagnostic accuracy in studies ranged from sensitivity 19-91.7 % and specificity 25-100 %. CONCLUSIONS There is marked variation in current techniques used for SM for intraoperative margin analysis with correspondingly disparate DA. Only 1 study applied AI to SMI, and we identify how AI could optimise SMI and a template for future work to apply AI techniques to SMI, reduce unwarranted variation and optimise DA.
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Affiliation(s)
- Thomas J E Hubbard
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Royal Devon University Healthcare NHS Trust, Exeter, UK.
| | - Ola Shams
- Royal Devon University Healthcare NHS Trust, Exeter, UK
| | - Benjamin Gardner
- Department of Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - Finley Gibson
- Institute for Data Science and Artificial Intelligence, University of Exeter, Exeter, UK
| | - Sareh Rowlands
- Department of Computer Science, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - Tim Harries
- Department of Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - Nick Stone
- Department of Physics and Astronomy, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
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Hölzing CR, Rumpf S, Huber S, Papenfuß N, Meybohm P, Happel O. The Potential of Using Generative AI/NLP to Identify and Analyse Critical Incidents in a Critical Incident Reporting System (CIRS): A Feasibility Case-Control Study. Healthcare (Basel) 2024; 12:1964. [PMID: 39408144 PMCID: PMC11475821 DOI: 10.3390/healthcare12191964] [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: 09/09/2024] [Revised: 09/28/2024] [Accepted: 09/29/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND To enhance patient safety in healthcare, it is crucial to address the underreporting of issues in Critical Incident Reporting Systems (CIRSs). This study aims to evaluate the effectiveness of generative Artificial Intelligence and Natural Language Processing (AI/NLP) in reviewing CIRS cases by comparing its performance with human reviewers and categorising these cases into relevant topics. METHODS A case-control feasibility study was conducted using CIRS cases from the German CIRS-Anaesthesiology subsystem. Each case was reviewed by a human expert and by an AI/NLP model (ChatGPT-3.5). Two CIRS experts blindly assessed these reviews, rating them on linguistic quality, recognisable expertise, logical derivability, and overall quality using six-point Likert scales. RESULTS On average, the CIRS experts correctly classified 80% of human CIRS reviews as created by a human and misclassified 45.8% of AI reviews as written by a human. Ratings on a scale of 1 (very good) to 6 (failed) revealed a comparable performance between human- and AI-generated reviews across the dimensions of linguistic expression (p = 0.39), recognisable expertise (p = 0.89), logical derivability (p = 0.84), and overall quality (p = 0.87). The AI model was able to categorise the cases into relevant topics independently. CONCLUSIONS This feasibility study demonstrates the potential of generative AI/NLP in analysing and categorising cases from the CIRS. This could have implications for improving incident reporting in healthcare. Therefore, additional research is required to verify and expand upon these discoveries.
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Affiliation(s)
- Carlos Ramon Hölzing
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Sebastian Rumpf
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Stephan Huber
- Psychological Ergonomics, University of Würzburg, 97070 Würzburg, Germany
| | - Nathalie Papenfuß
- Psychological Ergonomics, University of Würzburg, 97070 Würzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Oliver Happel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
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Zeng A, Houssami N, Noguchi N, Nickel B, Marinovich ML. Frequency and characteristics of errors by artificial intelligence (AI) in reading screening mammography: a systematic review. Breast Cancer Res Treat 2024; 207:1-13. [PMID: 38853221 PMCID: PMC11230971 DOI: 10.1007/s10549-024-07353-3] [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: 12/15/2023] [Accepted: 04/24/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Artificial intelligence (AI) for reading breast screening mammograms could potentially replace (some) human-reading and improve screening effectiveness. This systematic review aims to identify and quantify the types of AI errors to better understand the consequences of implementing this technology. METHODS Electronic databases were searched for external validation studies of the accuracy of AI algorithms in real-world screening mammograms. Descriptive synthesis was performed on error types and frequency. False negative proportions (FNP) and false positive proportions (FPP) were pooled within AI positivity thresholds using random-effects meta-analysis. RESULTS Seven retrospective studies (447,676 examinations; published 2019-2022) met inclusion criteria. Five studies reported AI error as false negatives or false positives. Pooled FPP decreased incrementally with increasing positivity threshold (71.83% [95% CI 69.67, 73.90] at Transpara 3 to 10.77% [95% CI 8.34, 13.79] at Transpara 9). Pooled FNP increased incrementally from 0.02% [95% CI 0.01, 0.03] (Transpara 3) to 0.12% [95% CI 0.06, 0.26] (Transpara 9), consistent with a trade-off with FPP. Heterogeneity within thresholds reflected algorithm version and completeness of the reference standard. Other forms of AI error were reported rarely (location error and technical error in one study each). CONCLUSION AI errors are largely interpreted in the framework of test accuracy. FP and FN errors show expected variability not only by positivity threshold, but also by algorithm version and study quality. Reporting of other forms of AI errors is sparse, despite their potential implications for adoption of the technology. Considering broader types of AI error would add nuance to reporting that can inform inferences about AI's utility.
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Affiliation(s)
- Aileen Zeng
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre and Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Naomi Noguchi
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - M Luke Marinovich
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia.
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Castner N, Arsiwala-Scheppach L, Mertens S, Krois J, Thaqi E, Kasneci E, Wahl S, Schwendicke F. Expert gaze as a usability indicator of medical AI decision support systems: a preliminary study. NPJ Digit Med 2024; 7:199. [PMID: 39068241 PMCID: PMC11283514 DOI: 10.1038/s41746-024-01192-8] [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: 11/10/2023] [Accepted: 07/12/2024] [Indexed: 07/30/2024] Open
Abstract
Given the current state of medical artificial intelligence (AI) and perceptions towards it, collaborative systems are becoming the preferred choice for clinical workflows. This work aims to address expert interaction with medical AI support systems to gain insight towards how these systems can be better designed with the user in mind. As eye tracking metrics have been shown to be robust indicators of usability, we employ them for evaluating the usability and user interaction with medical AI support systems. We use expert gaze to assess experts' interaction with an AI software for caries detection in bitewing x-ray images. We compared standard viewing of bitewing images without AI support versus viewing where AI support could be freely toggled on and off. We found that experts turned the AI on for roughly 25% of the total inspection task, and generally turned it on halfway through the course of the inspection. Gaze behavior showed that when supported by AI, more attention was dedicated to user interface elements related to the AI support, with more frequent transitions from the image itself to these elements. When considering that expert visual strategy is already optimized for fast and effective image inspection, such interruptions in attention can lead to increased time needed for the overall assessment. Gaze analysis provided valuable insights into an AI's usability for medical image inspection. Further analyses of these tools and how to delineate metrical measures of usability should be developed.
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Affiliation(s)
- Nora Castner
- Carl Zeiss Vision International GmbH, Tübingen, Germany.
- University of Tübingen, Tübingen, Germany.
| | | | - Sarah Mertens
- Charité - Univesitätsmedizin, Oral Diagnostics, Digital Health and Services Research, Berlin, Germany
| | - Joachim Krois
- Charité - Univesitätsmedizin, Oral Diagnostics, Digital Health and Services Research, Berlin, Germany
| | - Enkeleda Thaqi
- Technical University of Munich, Human-Centered Technologies for Learning, Munich, Germany
| | - Enkelejda Kasneci
- Technical University of Munich, Human-Centered Technologies for Learning, Munich, Germany
| | - Siegfried Wahl
- Carl Zeiss Vision International GmbH, Tübingen, Germany
- Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Falk Schwendicke
- Ludwig Maximilian University, Operative, Preventative and Pediatric Dentistry and Periodontology, Munich, Germany
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Warner-Smith M, Ren K, Mistry C, Walton R, Roder D, Bhola N, McGill S, O'Brien TA. Protocol for evaluating the fitness for purpose of an artificial intelligence product for radiology reporting in the BreastScreen New South Wales breast cancer screening programme. BMJ Open 2024; 14:e082350. [PMID: 38806433 PMCID: PMC11138303 DOI: 10.1136/bmjopen-2023-082350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Radiologist shortages threaten the sustainability of breast cancer screening programmes. Artificial intelligence (AI) products that can interpret mammograms could mitigate this risk. While previous studies have suggested this technology has accuracy comparable to radiologists most have been limited by using 'enriched' datasets and/or not considering the interaction between the algorithm and human readers. This study will address these limitations by comparing the accuracy of a workflow using AI alongside radiologists on a large consecutive cohort of examinations from a breast cancer screening programme. The study will combine the strengths of a large retrospective design with the benefit of prospective data collection. It will test this technology without risk to screening programme participants nor the need to wait for follow-up data. With a sample of 2 years of consecutive screening examinations, it is likely the largest test of this technology to date. The study will help determine whether this technology can safely be introduced into the BreastScreen New South Wales (NSW) population-based screening programme to address radiology workforce risks without compromising cancer detection rates or increasing false-positive recalls. METHODS AND ANALYSIS A retrospective, consecutive cohort of digital mammography screens from 658 207 examinations from BreastScreen NSW will be reinterpreted by the Lunit Insight MMG AI product. The cohort includes 4383 screen-detected and 1171 interval cancers. The results will be compared with radiologist single reading and the AI results will also be used to replace the second reader in a double-reading model. New adjudication reading will be performed where the AI disagrees with the first reader. Recall rates and cancer detection rates of combined AI-radiologist reading will be compared with the rates obtained at the time of screening. ETHICS AND DISSEMINATION This study has ethical approval from the NSW Health Population Health Services Research Ethics Committee (2022/ETH02397). Findings will be published in peer-reviewed journals and presented at conferences. The findings of this evaluation will be provided to programme managers, governance bodies and other stakeholders in Australian breast cancer screening programmes.
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Affiliation(s)
| | - Kan Ren
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Chirag Mistry
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Richard Walton
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - David Roder
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Nalini Bhola
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Sarah McGill
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Tracey A O'Brien
- Cancer Institute NSW, St Leonards, New South Wales, Australia
- UNSW Medicine & Health, Sydney, New South Wales, Australia
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Lokaj B, Pugliese MT, Kinkel K, Lovis C, Schmid J. Barriers and facilitators of artificial intelligence conception and implementation for breast imaging diagnosis in clinical practice: a scoping review. Eur Radiol 2024; 34:2096-2109. [PMID: 37658895 PMCID: PMC10873444 DOI: 10.1007/s00330-023-10181-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Although artificial intelligence (AI) has demonstrated promise in enhancing breast cancer diagnosis, the implementation of AI algorithms in clinical practice encounters various barriers. This scoping review aims to identify these barriers and facilitators to highlight key considerations for developing and implementing AI solutions in breast cancer imaging. METHOD A literature search was conducted from 2012 to 2022 in six databases (PubMed, Web of Science, CINHAL, Embase, IEEE, and ArXiv). The articles were included if some barriers and/or facilitators in the conception or implementation of AI in breast clinical imaging were described. We excluded research only focusing on performance, or with data not acquired in a clinical radiology setup and not involving real patients. RESULTS A total of 107 articles were included. We identified six major barriers related to data (B1), black box and trust (B2), algorithms and conception (B3), evaluation and validation (B4), legal, ethical, and economic issues (B5), and education (B6), and five major facilitators covering data (F1), clinical impact (F2), algorithms and conception (F3), evaluation and validation (F4), and education (F5). CONCLUSION This scoping review highlighted the need to carefully design, deploy, and evaluate AI solutions in clinical practice, involving all stakeholders to yield improvement in healthcare. CLINICAL RELEVANCE STATEMENT The identification of barriers and facilitators with suggested solutions can guide and inform future research, and stakeholders to improve the design and implementation of AI for breast cancer detection in clinical practice. KEY POINTS • Six major identified barriers were related to data; black-box and trust; algorithms and conception; evaluation and validation; legal, ethical, and economic issues; and education. • Five major identified facilitators were related to data, clinical impact, algorithms and conception, evaluation and validation, and education. • Coordinated implication of all stakeholders is required to improve breast cancer diagnosis with AI.
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Affiliation(s)
- Belinda Lokaj
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland.
| | - Marie-Thérèse Pugliese
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
| | - Karen Kinkel
- Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Schmid
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Delémont, Switzerland
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Bassi E, Russo A, Oliboni E, Zamboni F, De Santis C, Mansueto G, Montemezzi S, Foti G. The role of an artificial intelligence software in clinical senology: a mammography multi-reader study. LA RADIOLOGIA MEDICA 2024; 129:202-210. [PMID: 38082194 DOI: 10.1007/s11547-023-01751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/07/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE To evaluate the diagnostic role of a dedicated AI software in detecting anomalous breast findings on mammography and tomosynthesis images in the clinical setting, stand-alone and as aid of four readers. METHODS A total of 210 patients with complete clinical and radiologic records were retrospectively analyzed. Pathology was used as the reference standard for patients undergoing surgery or biopsy, and a 1-year follow-up was used to confirm no change in the remaining patients. The image evaluation was performed by four readers with different levels of experience (a junior and three senior breast radiologists) using a 5-point Likert scale moving from 1 (definitively no cancer) to 5 (definitively cancer). The positivity of mammograms was assessed on the presence of any breast lesion (masses, architectural distortions, asymmetries, calcifications), including malignant and benign ones. A multi-reader multi-case analysis was performed. A p value < 0.05 was considered statistically significant. RESULTS The stand-alone AI system achieved an accuracy of 71% (69% sensitivity and 73% specificity), which is overall lower than the value achieved by readers without AI. However, with the aid of AI, a significant increase of accuracy (p value = 0.004) and specificity (p value = 0.04) was achieved for the less experienced radiologist and a senior one. CONCLUSION The use of AI software as a second reader for breast lesions assessment could play a crucial role in the clinical setting, by increasing sensitivity and specificity, especially for less experienced radiologists.
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Affiliation(s)
- Enrica Bassi
- Department of Radiology, Verona University Hospital, Verona, Italy
| | - Anna Russo
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar (VR), Italy
| | - Eugenio Oliboni
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar (VR), Italy
| | - Federico Zamboni
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar (VR), Italy
| | - Cecilia De Santis
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar (VR), Italy
| | | | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37024, Negrar (VR), Italy.
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Pertuz S, Ortega D, Suarez É, Cancino W, Africano G, Rinta-Kiikka I, Arponen O, Paris S, Lozano A. Saliency of breast lesions in breast cancer detection using artificial intelligence. Sci Rep 2023; 13:20545. [PMID: 37996504 PMCID: PMC10667547 DOI: 10.1038/s41598-023-46921-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
The analysis of mammograms using artificial intelligence (AI) has shown great potential for assisting breast cancer screening. We use saliency maps to study the role of breast lesions in the decision-making process of AI systems for breast cancer detection in screening mammograms. We retrospectively collected mammograms from 191 women with screen-detected breast cancer and 191 healthy controls matched by age and mammographic system. Two radiologists manually segmented the breast lesions in the mammograms from CC and MLO views. We estimated the detection performance of four deep learning-based AI systems using the area under the ROC curve (AUC) with a 95% confidence interval (CI). We used automatic thresholding on saliency maps from the AI systems to identify the areas of interest on the mammograms. Finally, we measured the overlap between these areas of interest and the segmented breast lesions using Dice's similarity coefficient (DSC). The detection performance of the AI systems ranged from low to moderate (AUCs from 0.525 to 0.694). The overlap between the areas of interest and the breast lesions was low for all the studied methods (median DSC from 4.2% to 38.0%). The AI system with the highest cancer detection performance (AUC = 0.694, CI 0.662-0.726) showed the lowest overlap (DSC = 4.2%) with breast lesions. The areas of interest found by saliency analysis of the AI systems showed poor overlap with breast lesions. These results suggest that AI systems with the highest performance do not solely rely on localized breast lesions for their decision-making in cancer detection; rather, they incorporate information from large image regions. This work contributes to the understanding of the role of breast lesions in cancer detection using AI.
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Affiliation(s)
- Said Pertuz
- Escuela de Ingenierías Eléctrica Electrónica y de Telecomunicaciones, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - David Ortega
- Escuela de Ingenierías Eléctrica Electrónica y de Telecomunicaciones, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Érika Suarez
- Escuela de Ingenierías Eléctrica Electrónica y de Telecomunicaciones, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - William Cancino
- Escuela de Ingenierías Eléctrica Electrónica y de Telecomunicaciones, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Gerson Africano
- Escuela de Ingenierías Eléctrica Electrónica y de Telecomunicaciones, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Irina Rinta-Kiikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Otso Arponen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Department of Radiology, Tampere University Hospital, Tampere, Finland.
| | - Sara Paris
- Departamento de Imágenes Diagnósticas, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Alfonso Lozano
- Departamento de Imágenes Diagnósticas, Universidad Nacional de Colombia, Bogotá, Colombia
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Houssami N, Marinovich ML. AI for mammography screening: enter evidence from prospective trials. Lancet Digit Health 2023; 5:e641-e642. [PMID: 37690910 DOI: 10.1016/s2589-7500(23)00176-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Nehmat Houssami
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - M Luke Marinovich
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Wang X, Chou K, Zhang G, Zuo Z, Zhang T, Zhou Y, Mao F, Lin Y, Shen S, Zhang X, Wang X, Zhong Y, Qin X, Guo H, Wang X, Xiao Y, Yi Q, Yan C, Liu J, Li D, Liu W, Liu M, Ma X, Tao J, Sun Q, Zhai J, Huang L. Breast cancer pre-clinical screening using infrared thermography and artificial intelligence: a prospective, multicentre, diagnostic accuracy cohort study. Int J Surg 2023; 109:3021-3031. [PMID: 37678284 PMCID: PMC10583949 DOI: 10.1097/js9.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Given the limited access to breast cancer (BC) screening, the authors developed and validated a mobile phone-artificial intelligence-based infrared thermography (AI-IRT) system for BC screening. MATERIALS AND METHODS This large prospective clinical trial assessed the diagnostic performance of the AI-IRT system. The authors constructed two datasets and two models, performed internal and external validation, and compared the diagnostic accuracy of the AI models and clinicians. Dataset A included 2100 patients recruited from 19 medical centres in nine regions of China. Dataset B was used for independent external validation and included 102 patients recruited from Langfang People's Hospital. RESULTS The area under the receiver operating characteristic curve of the binary model for identifying low-risk and intermediate/high-risk patients was 0.9487 (95% CI: 0.9231-0.9744) internally and 0.9120 (95% CI: 0.8460-0.9790) externally. The accuracy of the binary model was higher than that of human readers (0.8627 vs. 0.8088, respectively). In addition, the binary model was better than the multinomial model and used different diagnostic thresholds based on BC risk to achieve specific goals. CONCLUSIONS The accuracy of AI-IRT was high across populations with different demographic characteristics and less reliant on manual interpretations, demonstrating that this model can improve pre-clinical screening and increase screening rates.
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Affiliation(s)
| | | | - Guochao Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhichao Zuo
- Department of Radiology, Xiangtan Central Hospital
| | - Ting Zhang
- Community Health Service Guidance Center, Shanxi Provincial People’s Hospital
| | | | | | - Yan Lin
- Departments ofBreast Surgery
| | | | | | | | | | - Xue Qin
- Department of Oncology, Langfang People's Hospital, Hebei
| | | | | | - Yao Xiao
- Anesthesia Operation Center, Longhui People's Hospital, Hunan
| | - Qianchuan Yi
- Department of General Surgery, University-Town Hospital of Chongqing Medical University, Chongqing
| | - Cunli Yan
- Department of Breast Surgery, Baoji Maternal and Child Health Hospital, Shaanxi
| | - Jian Liu
- Department of General Surgery, ZhaLanTun Hospital of Traditional Chinese Medicine, Inner Mongolia
| | - Dongdong Li
- Department of Radiology and Otolaryngology, Karamay Center Hospital, Xinjiang
| | - Wei Liu
- Department of Radiology and Otolaryngology, Karamay Center Hospital, Xinjiang
| | - Mengwen Liu
- Radiology, Peking Union Medical College Hospital
| | - Xiaoying Ma
- Department of Breast Surgery, Qinghai Provincial People’s Hospital, Qinghai
| | - Jiangtao Tao
- Department of General Surgery, Shenzhen People’s Hospital, Guangdong, China
| | | | | | - Likun Huang
- Community Health Service Guidance Center, Shanxi Provincial People’s Hospital
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11
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van Nijnatten TJA, Payne NR, Hickman SE, Ashrafian H, Gilbert FJ. Overview of trials on artificial intelligence algorithms in breast cancer screening - A roadmap for international evaluation and implementation. Eur J Radiol 2023; 167:111087. [PMID: 37690352 DOI: 10.1016/j.ejrad.2023.111087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
Accumulating evidence from retrospective studies demonstrate at least non-inferior performance when using AI algorithms with different strategies versus double-reading in mammography screening. In addition, AI algorithms for mammography screening can reduce work load by moving to single human reading. Prospective trials are essential to avoid unintended adverse consequences before incorporation of AI algorithms into UK's National Health Service (NHS) Breast Screening Programme (BSP). A stakeholders' meeting was organized in Newnham College, Cambridge, UK to undertake a review of the current evidence to enable consensus discussion on next steps required before implementation into a screening programme. It was concluded that a multicentre multivendor testing platform study with opt-out consent is preferred. AI thresholds from different vendors should be determined while maintaining non-inferior screening performance results, particularly ensuring recall rates are not increased. Automatic recall of cases using an agreed high sensitivity AI score versus automatic rule out with a low AI score set at a high sensitivity could be used. A human reader should still be involved in decision making with AI-only recalls requiring human arbitration. Standalone AI algorithms used without prompting maintain unbiased screening reading performance, but reading with prompts should be tested prospectively and ideally provided for arbitration.
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Affiliation(s)
- T J A van Nijnatten
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - N R Payne
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - S E Hickman
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Department of Radiology, Barts Health NHS Trust, The Royal London Hospital, 80 Newark Street, London E1 2ES, United Kingdom
| | - H Ashrafian
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, United Kingdom
| | - F J Gilbert
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom.
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12
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Chowdhury NA, Wang L, Gu L, Kaya M. Exploring the Potential of Sensing for Breast Cancer Detection. APPLIED SCIENCES 2023; 13:9982. [DOI: 10.3390/app13179982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Abstract
Breast cancer is a generalized global problem. Biomarkers are the active substances that have been considered as the signature of the existence and evolution of cancer. Early screening of different biomarkers associated with breast cancer can help doctors to design a treatment plan. However, each screening technique for breast cancer has some limitations. In most cases, a single technique can detect a single biomarker at a specific time. In this study, we address different types of biomarkers associated with breast cancer. This review article presents a detailed picture of different techniques and each technique’s associated mechanism, sensitivity, limit of detection, and linear range for breast cancer detection at early stages. The limitations of existing approaches require researchers to modify and develop new methods to identify cancer biomarkers at early stages.
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Affiliation(s)
- Nure Alam Chowdhury
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL 32901, USA
| | - Lulu Wang
- Biomedical Device Innovation Center, Shenzhen Technology University, Shenzhen 518118, China
| | - Linxia Gu
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL 32901, USA
| | - Mehmet Kaya
- Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL 32901, USA
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13
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Fatima Qizilbash F, Sartaj A, Qamar Z, Kumar S, Imran M, Mohammed Y, Ali J, Baboota S, Ali A. Nanotechnology revolutionises breast cancer treatment: harnessing lipid-based nanocarriers to combat cancer cells. J Drug Target 2023; 31:794-816. [PMID: 37525966 DOI: 10.1080/1061186x.2023.2243403] [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: 04/18/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
One of the most common cancers that occur in females is breast cancer. Despite the significant leaps and bounds that have been made in treatment of breast cancer, the disease remains one of the leading causes of death among women and a major public health challenge. The therapeutic efficacy of chemotherapeutics is hindered by chemoresistance and toxicity. Nano-based lipid drug delivery systems offer controlled drug release, nanometric size and site-specific targeting. Breast cancer treatment includes surgery, chemotherapy and radiotherapy. Despite this, no single method of treatment for the condition is currently effective due to cancer stem cell metastasis and chemo-resistance. Therefore, the employment of nanocarrier systems is necessary in order to target breast cancer stem cells. This article addresses breast cancer treatment options, including modern treatment procedures such as chemotherapy, etc. and some innovative therapeutic options highlighting the role of lipidic nanocarriers loaded with chemotherapeutic drugs such as nanoemulsion, solid-lipid nanoparticles, nanostructured lipid carriers and liposomes, and their investigations have demonstrated that they can limit cancer cell growth, reduce the risk of recurrence, as well as minimise post-chemotherapy metastasis. This article also explores FDA-approved lipid-based nanocarriers, commercially available formulations, and ligand-based formulations that are being considered for further research.
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Affiliation(s)
| | - Ali Sartaj
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, New Delhi, India
- Lloyd School of Pharmacy, Greater Noida, India
| | - Zufika Qamar
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, New Delhi, India
| | - Shobhit Kumar
- Department of Pharmaceutical Technology, Meerut Institute of Engineering and Technology (MIET), Meerut, India
| | - Mohammad Imran
- Therapeutics Research Group, Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yousuf Mohammed
- Therapeutics Research Group, Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, New Delhi, India
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, New Delhi, India
| | - Asgar Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, New Delhi, India
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14
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Krishnan G, Singh S, Pathania M, Gosavi S, Abhishek S, Parchani A, Dhar M. Artificial intelligence in clinical medicine: catalyzing a sustainable global healthcare paradigm. Front Artif Intell 2023; 6:1227091. [PMID: 37705603 PMCID: PMC10497111 DOI: 10.3389/frai.2023.1227091] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Abstract
As the demand for quality healthcare increases, healthcare systems worldwide are grappling with time constraints and excessive workloads, which can compromise the quality of patient care. Artificial intelligence (AI) has emerged as a powerful tool in clinical medicine, revolutionizing various aspects of patient care and medical research. The integration of AI in clinical medicine has not only improved diagnostic accuracy and treatment outcomes, but also contributed to more efficient healthcare delivery, reduced costs, and facilitated better patient experiences. This review article provides an extensive overview of AI applications in history taking, clinical examination, imaging, therapeutics, prognosis and research. Furthermore, it highlights the critical role AI has played in transforming healthcare in developing nations.
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Affiliation(s)
- Gokul Krishnan
- Department of Internal Medicine, Kasturba Medical College, Manipal, India
| | - Shiana Singh
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Monika Pathania
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Siddharth Gosavi
- Department of Internal Medicine, Kasturba Medical College, Manipal, India
| | - Shuchi Abhishek
- Department of Internal Medicine, Kasturba Medical College, Manipal, India
| | - Ashwin Parchani
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Minakshi Dhar
- Department of Geriatric Medicine, All India Institute of Medical Sciences, Rishikesh, India
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15
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Ji X, Huang X, Li C, Guan N, Pan T, Dong J, Li L. Effect of tumor-associated macrophages on the pyroptosis of breast cancer tumor cells. Cell Commun Signal 2023; 21:197. [PMID: 37542283 PMCID: PMC10401873 DOI: 10.1186/s12964-023-01208-y] [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: 04/25/2023] [Accepted: 06/26/2023] [Indexed: 08/06/2023] Open
Abstract
Macrophages are immune cells with high plasticity that are widely distributed in all tissues and organs of the body. Under the influence of the immune microenvironment of breast tumors, macrophages differentiate into various germline lineages. They exert pro-tumor or tumor-suppressive effects by secreting various cytokines. Pyroptosis is mediated by Gasdermin family proteins, which form holes in cell membranes and cause a violent inflammatory response and cell death. This is an important way for the body to fight off infections. Tumor cell pyroptosis can activate anti-tumor immunity and inhibit tumor growth. At the same time, it releases inflammatory mediators and recruits tumor-associated macrophages (TAMs) for accumulation. Macrophages act as "mediators" of cytokine interactions and indirectly influence the pyroptosis pathway. This paper describes the mechanism of action on the part of TAM in affecting the pyroptosis process of breast tumor cells, as well as its key role in the tumor microenvironment. Additionally, it provides the basis for in-depth research on how to use immune cells to affect breast tumors and guide anti-tumor trends, with important implications for the prevention and treatment of breast tumors. Video Abstract.
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Affiliation(s)
- XuLing Ji
- College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, 110866, China
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, 110866, China
| | - Xiaoxia Huang
- College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, 110866, China
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, 110866, China
| | - Chao Li
- College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, 110866, China
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, 110866, China
| | - Ningning Guan
- College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, 110866, China
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, 110866, China
| | - Tingting Pan
- College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, 110866, China
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, 110866, China
| | - Jing Dong
- College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, 110866, China.
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, 110866, China.
| | - Lin Li
- College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Shenyang, 110866, China.
- Key Laboratory of Livestock Infectious Diseases, Ministry of Education, Shenyang Agricultural University, Shenyang, 110866, China.
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16
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Zhang B, Vakanski A, Xian M. BI-RADS-NET-V2: A Composite Multi-Task Neural Network for Computer-Aided Diagnosis of Breast Cancer in Ultrasound Images With Semantic and Quantitative Explanations. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2023; 11:79480-79494. [PMID: 37608804 PMCID: PMC10443928 DOI: 10.1109/access.2023.3298569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Computer-aided Diagnosis (CADx) based on explainable artificial intelligence (XAI) can gain the trust of radiologists and effectively improve diagnosis accuracy and consultation efficiency. This paper proposes BI-RADS-Net-V2, a novel machine learning approach for fully automatic breast cancer diagnosis in ultrasound images. The BI-RADS-Net-V2 can accurately distinguish malignant tumors from benign ones and provides both semantic and quantitative explanations. The explanations are provided in terms of clinically proven morphological features used by clinicians for diagnosis and reporting mass findings, i.e., Breast Imaging Reporting and Data System (BI-RADS). The experiments on 1,192 Breast Ultrasound (BUS) images indicate that the proposed method improves the diagnosis accuracy by taking full advantage of the medical knowledge in BI-RADS while providing both semantic and quantitative explanations for the decision.
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Affiliation(s)
- Boyu Zhang
- Institute for Interdisciplinary Data Sciences, University of Idaho, Moscow, ID 83844, USA
| | - Aleksandar Vakanski
- Department of Nuclear Engineering and Industrial Management, University of Idaho, Idaho Falls, ID 83402, USA
| | - Min Xian
- Department of Computer Science, University of Idaho, Idaho Falls, ID 83402, USA
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17
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Stafie CS, Sufaru IG, Ghiciuc CM, Stafie II, Sufaru EC, Solomon SM, Hancianu M. Exploring the Intersection of Artificial Intelligence and Clinical Healthcare: A Multidisciplinary Review. Diagnostics (Basel) 2023; 13:1995. [PMID: 37370890 PMCID: PMC10297646 DOI: 10.3390/diagnostics13121995] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Artificial intelligence (AI) plays a more and more important role in our everyday life due to the advantages that it brings when used, such as 24/7 availability, a very low percentage of errors, ability to provide real time insights, or performing a fast analysis. AI is increasingly being used in clinical medical and dental healthcare analyses, with valuable applications, which include disease diagnosis, risk assessment, treatment planning, and drug discovery. This paper presents a narrative literature review of AI use in healthcare from a multi-disciplinary perspective, specifically in the cardiology, allergology, endocrinology, and dental fields. The paper highlights data from recent research and development efforts in AI for healthcare, as well as challenges and limitations associated with AI implementation, such as data privacy and security considerations, along with ethical and legal concerns. The regulation of responsible design, development, and use of AI in healthcare is still in early stages due to the rapid evolution of the field. However, it is our duty to carefully consider the ethical implications of implementing AI and to respond appropriately. With the potential to reshape healthcare delivery and enhance patient outcomes, AI systems continue to reveal their capabilities.
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Affiliation(s)
- Celina Silvia Stafie
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania;
| | - Irina-Georgeta Sufaru
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Department of Morpho-Functional Sciences II—Pharmacology and Clinical Pharmacology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Ingrid-Ioana Stafie
- Endocrinology Residency Program, Sf. Spiridon Clinical Emergency Hospital, Independentei 1, 700111 Iasi, Romania
| | | | - Sorina Mihaela Solomon
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Monica Hancianu
- Pharmacognosy-Phytotherapy, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
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18
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Noor J, Chaudhry A, Batool S. Microfluidic Technology, Artificial Intelligence, and Biosensors As Advanced Technologies in Cancer Screening: A Review Article. Cureus 2023; 15:e39634. [PMID: 37388583 PMCID: PMC10305590 DOI: 10.7759/cureus.39634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Cancer screening techniques aim to detect premalignant lesions and enable early intervention to delay the onset of cancer while keeping incidence constant. Technology advancements have led to the development of powerful tools such as microfluidic technology, artificial intelligence, machine learning algorithms, and electrochemical biosensors to aid in early cancer detection. Non-invasive cancer screening methods like virtual colonoscopy and endoscopic ultrasonography have also been developed to provide comprehensive pictures of organs and detect cancer early. This review article provides an overview of recent advances in cancer screening in microfluidic technology, artificial intelligence, and biomarkers through a narrative literature search. Microfluidic devices enable easy handling of sub-microliter volumes and have become a promising tool for cancer detection, drug screening, and modeling angiogenesis and metastasis in cancer research. Machine learning and artificial intelligence have shown high accuracy in oncology-related diagnostic imaging, reducing the manual steps in lesion detection and providing standardized and accurate results, with potential for global standardization in areas like colon polyps, breast cancer, and primary and metastatic brain cancer. A biomarker-based cancer diagnosis is promising for early detection and effective therapy, and electrochemical biosensors integrated with nanoparticles offer multiplexing and amplification capabilities. Understanding these advanced technologies' basics, achievements, and challenges is crucial for advancing their use in oncology.
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Affiliation(s)
- Jawad Noor
- Internal Medicine, St. Dominic Hospital, Jackson, USA
| | | | - Saima Batool
- Pathology, Nishtar Medical University, Multan, PAK
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19
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Marinovich ML, Wylie E, Lotter W, Lund H, Waddell A, Madeley C, Pereira G, Houssami N. Artificial intelligence (AI) for breast cancer screening: BreastScreen population-based cohort study of cancer detection. EBioMedicine 2023; 90:104498. [PMID: 36863255 PMCID: PMC9996220 DOI: 10.1016/j.ebiom.2023.104498] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) has been proposed to reduce false-positive screens, increase cancer detection rates (CDRs), and address resourcing challenges faced by breast screening programs. We compared the accuracy of AI versus radiologists in real-world population breast cancer screening, and estimated potential impacts on CDR, recall and workload for simulated AI-radiologist reading. METHODS External validation of a commercially-available AI algorithm in a retrospective cohort of 108,970 consecutive mammograms from a population-based screening program, with ascertained outcomes (including interval cancers by registry linkage). Area under the ROC curve (AUC), sensitivity and specificity for AI were compared with radiologists who interpreted the screens in practice. CDR and recall were estimated for simulated AI-radiologist reading (with arbitration) and compared with program metrics. FINDINGS The AUC for AI was 0.83 compared with 0.93 for radiologists. At a prospective threshold, sensitivity for AI (0.67; 95% CI: 0.64-0.70) was comparable to radiologists (0.68; 95% CI: 0.66-0.71) with lower specificity (0.81 [95% CI: 0.81-0.81] versus 0.97 [95% CI: 0.97-0.97]). Recall rate for AI-radiologist reading (3.14%) was significantly lower than for the BSWA program (3.38%) (-0.25%; 95% CI: -0.31 to -0.18; P < 0.001). CDR was also lower (6.37 versus 6.97 per 1000) (-0.61; 95% CI: -0.77 to -0.44; P < 0.001); however, AI detected interval cancers that were not found by radiologists (0.72 per 1000; 95% CI: 0.57-0.90). AI-radiologist reading increased arbitration but decreased overall screen-reading volume by 41.4% (95% CI: 41.2-41.6). INTERPRETATION Replacement of one radiologist by AI (with arbitration) resulted in lower recall and overall screen-reading volume. There was a small reduction in CDR for AI-radiologist reading. AI detected interval cases that were not identified by radiologists, suggesting potentially higher CDR if radiologists were unblinded to AI findings. These results indicate AI's potential role as a screen-reader of mammograms, but prospective trials are required to determine whether CDR could improve if AI detection was actioned in double-reading with arbitration. FUNDING National Breast Cancer Foundation (NBCF), National Health and Medical Research Council (NHMRC).
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Affiliation(s)
- M Luke Marinovich
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
| | | | - William Lotter
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Helen Lund
- BreastScreen WA, Perth, Western Australia, Australia
| | | | | | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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20
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Robustness Fine-Tuning Deep Learning Model for Cancers Diagnosis Based on Histopathology Image Analysis. Diagnostics (Basel) 2023; 13:diagnostics13040699. [PMID: 36832186 PMCID: PMC9955143 DOI: 10.3390/diagnostics13040699] [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: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Histopathology is the most accurate way to diagnose cancer and identify prognostic and therapeutic targets. The likelihood of survival is significantly increased by early cancer detection. With deep networks' enormous success, significant attempts have been made to analyze cancer disorders, particularly colon and lung cancers. In order to do this, this paper examines how well deep networks can diagnose various cancers using histopathology image processing. This work intends to increase the performance of deep learning architecture in processing histopathology images by constructing a novel fine-tuning deep network for colon and lung cancers. Such adjustments are performed using regularization, batch normalization, and hyperparameters optimization. The suggested fine-tuned model was evaluated using the LC2500 dataset. Our proposed model's average precision, recall, F1-score, specificity, and accuracy were 99.84%, 99.85%, 99.84%, 99.96%, and 99.94%, respectively. The experimental findings reveal that the suggested fine-tuned learning model based on the pre-trained ResNet101 network achieves higher results against recent state-of-the-art approaches and other current powerful CNN models.
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21
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Karger E, Kureljusic M. Artificial Intelligence for Cancer Detection-A Bibliometric Analysis and Avenues for Future Research. Curr Oncol 2023; 30:1626-1647. [PMID: 36826086 PMCID: PMC9954989 DOI: 10.3390/curroncol30020125] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
After cardiovascular diseases, cancer is responsible for the most deaths worldwide. Detecting a cancer disease early improves the chances for healing significantly. One group of technologies that is increasingly applied for detecting cancer is artificial intelligence. Artificial intelligence has great potential to support clinicians and medical practitioners as it allows for the early detection of carcinomas. During recent years, research on artificial intelligence for cancer detection grew a lot. Within this article, we conducted a bibliometric study of the existing research dealing with the application of artificial intelligence in cancer detection. We analyzed 6450 articles on that topic that were published between 1986 and 2022. By doing so, we were able to give an overview of this research field, including its key topics, relevant outlets, institutions, and articles. Based on our findings, we developed a future research agenda that can help to advance research on artificial intelligence for cancer detection. In summary, our study is intended to serve as a platform and foundation for researchers that are interested in the potential of artificial intelligence for detecting cancer.
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Affiliation(s)
- Erik Karger
- Information Systems and Strategic IT Management, University of Duisburg-Essen, 45141 Essen, Germany
| | - Marko Kureljusic
- International Accounting, University of Duisburg-Essen, 45141 Essen, Germany
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22
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Jeong JJ, Vey BL, Bhimireddy A, Kim T, Santos T, Correa R, Dutt R, Mosunjac M, Oprea-Ilies G, Smith G, Woo M, McAdams CR, Newell MS, Banerjee I, Gichoya J, Trivedi H. The EMory BrEast imaging Dataset (EMBED): A Racially Diverse, Granular Dataset of 3.4 Million Screening and Diagnostic Mammographic Images. Radiol Artif Intell 2023; 5:e220047. [PMID: 36721407 PMCID: PMC9885379 DOI: 10.1148/ryai.220047] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/04/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Abstract
Supplemental material is available for this article. Keywords: Mammography, Breast, Machine Learning © RSNA, 2023.
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23
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Artificial Intelligence (AI) in Breast Imaging: A Scientometric Umbrella Review. Diagnostics (Basel) 2022; 12:diagnostics12123111. [PMID: 36553119 PMCID: PMC9777253 DOI: 10.3390/diagnostics12123111] [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: 11/14/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Artificial intelligence (AI), a rousing advancement disrupting a wide spectrum of applications with remarkable betterment, has continued to gain momentum over the past decades. Within breast imaging, AI, especially machine learning and deep learning, honed with unlimited cross-data/case referencing, has found great utility encompassing four facets: screening and detection, diagnosis, disease monitoring, and data management as a whole. Over the years, breast cancer has been the apex of the cancer cumulative risk ranking for women across the six continents, existing in variegated forms and offering a complicated context in medical decisions. Realizing the ever-increasing demand for quality healthcare, contemporary AI has been envisioned to make great strides in clinical data management and perception, with the capability to detect indeterminate significance, predict prognostication, and correlate available data into a meaningful clinical endpoint. Here, the authors captured the review works over the past decades, focusing on AI in breast imaging, and systematized the included works into one usable document, which is termed an umbrella review. The present study aims to provide a panoramic view of how AI is poised to enhance breast imaging procedures. Evidence-based scientometric analysis was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline, resulting in 71 included review works. This study aims to synthesize, collate, and correlate the included review works, thereby identifying the patterns, trends, quality, and types of the included works, captured by the structured search strategy. The present study is intended to serve as a "one-stop center" synthesis and provide a holistic bird's eye view to readers, ranging from newcomers to existing researchers and relevant stakeholders, on the topic of interest.
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AI in breast screening mammography: breast screening readers' perspectives. Insights Imaging 2022; 13:186. [PMID: 36484919 PMCID: PMC9733732 DOI: 10.1186/s13244-022-01322-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study surveyed the views of breast screening readers in the UK on how to incorporate Artificial Intelligence (AI) technology into breast screening mammography. METHODS An online questionnaire was circulated to the UK breast screening readers. Questions included their degree of approval of four AI implementation scenarios: AI as triage, AI as a companion reader/reader aid, AI replacing one of the initial two readers, and AI replacing all readers. They were also asked to rank five AI representation options (discrete opinion; mammographic scoring; percentage score with 100% indicating malignancy; region of suspicion; heat map) and indicate which evidence they considered necessary to support the implementation of AI into their practice among six options offered. RESULTS The survey had 87 nationally accredited respondents across the UK; 73 completed the survey in full. Respondents approved of AI replacing one of the initial two human readers and objected to AI replacing all human readers. Participants were divided on AI as triage and AI as a reader companion. A region of suspicion superimposed on the image was the preferred AI representation option. Most screen readers considered national guidelines (77%), studies using a nationally representative dataset (65%) and independent prospective studies (60%) as essential evidence. Participants' free-text comments highlighted concerns and the need for additional validation. CONCLUSIONS Overall, screen readers supported the introduction of AI as a partial replacement of human readers and preferred a graphical indication of the suspected tumour area, with further evidence and national guidelines considered crucial prior to implementation.
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Baek J, O’Connell AM, Parker KJ. Improving breast cancer diagnosis by incorporating raw ultrasound parameters into machine learning. MACHINE LEARNING: SCIENCE AND TECHNOLOGY 2022; 3:045013. [PMID: 36698865 PMCID: PMC9855672 DOI: 10.1088/2632-2153/ac9bcc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 01/28/2023] Open
Abstract
The improved diagnostic accuracy of ultrasound breast examinations remains an important goal. In this study, we propose a biophysical feature-based machine learning method for breast cancer detection to improve the performance beyond a benchmark deep learning algorithm and to furthermore provide a color overlay visual map of the probability of malignancy within a lesion. This overall framework is termed disease-specific imaging. Previously, 150 breast lesions were segmented and classified utilizing a modified fully convolutional network and a modified GoogLeNet, respectively. In this study multiparametric analysis was performed within the contoured lesions. Features were extracted from ultrasound radiofrequency, envelope, and log-compressed data based on biophysical and morphological models. The support vector machine with a Gaussian kernel constructed a nonlinear hyperplane, and we calculated the distance between the hyperplane and each feature's data point in multiparametric space. The distance can quantitatively assess a lesion and suggest the probability of malignancy that is color-coded and overlaid onto B-mode images. Training and evaluation were performed on in vivo patient data. The overall accuracy for the most common types and sizes of breast lesions in our study exceeded 98.0% for classification and 0.98 for an area under the receiver operating characteristic curve, which is more precise than the performance of radiologists and a deep learning system. Further, the correlation between the probability and Breast Imaging Reporting and Data System enables a quantitative guideline to predict breast cancer. Therefore, we anticipate that the proposed framework can help radiologists achieve more accurate and convenient breast cancer classification and detection.
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Affiliation(s)
- Jihye Baek
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States of America
| | - Avice M O’Connell
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Kevin J Parker
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States of America
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Potnis KC, Ross JS, Aneja S, Gross CP, Richman IB. Artificial Intelligence in Breast Cancer Screening: Evaluation of FDA Device Regulation and Future Recommendations. JAMA Intern Med 2022; 182:1306-1312. [PMID: 36342705 PMCID: PMC10623674 DOI: 10.1001/jamainternmed.2022.4969] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Importance Contemporary approaches to artificial intelligence (AI) based on deep learning have generated interest in the application of AI to breast cancer screening (BCS). The US Food and Drug Administration (FDA) has approved several next-generation AI products indicated for BCS in recent years; however, questions regarding their accuracy, appropriate use, and clinical utility remain. Objectives To describe the current FDA regulatory process for AI products, summarize the evidence used to support FDA clearance and approval of AI products indicated for BCS, consider the advantages and limitations of current regulatory approaches, and suggest ways to improve the current system. Evidence Review Premarket notifications and other publicly available documents used for FDA clearance and approval of AI products indicated for BCS from January 1, 2017, to December 31, 2021. Findings Nine AI products indicated for BCS for identification of suggestive lesions and mammogram triage were included. Most of the products had been cleared through the 510(k) pathway, and all clearances were based on previously collected retrospective data; 6 products used multicenter designs; 7 products used enriched data; and 4 lacked details on whether products were externally validated. Test performance measures, including sensitivity, specificity, and area under the curve, were the main outcomes reported. Most of the devices used tissue biopsy as the criterion standard for BCS accuracy evaluation. Other clinical outcome measures, including cancer stage at diagnosis and interval cancer detection, were not reported for any of the devices. Conclusions and Relevance The findings of this review suggest important gaps in reporting of data sources, data set type, validation approach, and clinical utility assessment. As AI-assisted reading becomes more widespread in BCS and other radiologic examinations, strengthened FDA evidentiary regulatory standards, development of postmarketing surveillance, a focus on clinically meaningful outcomes, and stakeholder engagement will be critical for ensuring the safety and efficacy of these products.
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Affiliation(s)
| | - Joseph S Ross
- Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Sanjay Aneja
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Ilana B Richman
- Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
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Development and testing of a new application for measuring motion at the cervical spine. BMC Med Imaging 2022; 22:193. [DOI: 10.1186/s12880-022-00923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Cervical myelopathy is a progressive disease, and early detection and treatment contribute to prognosis. Evaluation of cervical intervertebral instability by simple X-ray is used in clinical setting and the information about instability is important to understand the cause of myelopathy, but evaluation of the intervertebral instability by X-ray is complicated. To reduce the burden of clinicians, a system that automatically measures the range of motion was developed by comparing the flexed and extended positions in the lateral view of a simple X-ray of the cervical spine. The accuracy of the system was verified by comparison with spine surgeons and residents to determine whether the system could withstand actual use.
Methods
An algorithm was created to recognize the four corners of the vertebral bodies in a lateral cervical spine X-ray image, and a system was constructed to automatically measure the range of motion between each vertebra by comparing X-ray images of the cervical spine in extension and flexion. Two experienced spine surgeons and two residents performed the study on the remaining 23 cases. Cervical spine range of motion was measured manually on X-ray images and compared with automatic measurement by this system.
Results
Of a total of 322 cervical vertebrae in 46 images, 313 (97%) were successfully estimated by our learning model. The mean intersection over union value for all the 46-test data was 0.85. The results of measuring the CRoM angle with the proposed cervical spine motion angle measurement system showed that the mean error from the true value was 3.5° and the standard deviation was 2.8°. The average standard deviations for each measurement by specialist and residents are 2.9° and 3.2°.
Conclusions
A system for measuring cervical spine range of motion on X-ray images was constructed and showed accuracy comparable to that of spine surgeons. This system will be effective in reducing the burden on and saving time of orthopedic surgeons by avoiding manually measuring X-ray images.
Trial registration Retrospectively registered with opt-out agreement.
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Hsu W, Hippe DS, Nakhaei N, Wang PC, Zhu B, Siu N, Ahsen ME, Lotter W, Sorensen AG, Naeim A, Buist DSM, Schaffter T, Guinney J, Elmore JG, Lee CI. External Validation of an Ensemble Model for Automated Mammography Interpretation by Artificial Intelligence. JAMA Netw Open 2022; 5:e2242343. [PMID: 36409497 PMCID: PMC9679879 DOI: 10.1001/jamanetworkopen.2022.42343] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Importance With a shortfall in fellowship-trained breast radiologists, mammography screening programs are looking toward artificial intelligence (AI) to increase efficiency and diagnostic accuracy. External validation studies provide an initial assessment of how promising AI algorithms perform in different practice settings. Objective To externally validate an ensemble deep-learning model using data from a high-volume, distributed screening program of an academic health system with a diverse patient population. Design, Setting, and Participants In this diagnostic study, an ensemble learning method, which reweights outputs of the 11 highest-performing individual AI models from the Digital Mammography Dialogue on Reverse Engineering Assessment and Methods (DREAM) Mammography Challenge, was used to predict the cancer status of an individual using a standard set of screening mammography images. This study was conducted using retrospective patient data collected between 2010 and 2020 from women aged 40 years and older who underwent a routine breast screening examination and participated in the Athena Breast Health Network at the University of California, Los Angeles (UCLA). Main Outcomes and Measures Performance of the challenge ensemble method (CEM) and the CEM combined with radiologist assessment (CEM+R) were compared with diagnosed ductal carcinoma in situ and invasive cancers within a year of the screening examination using performance metrics, such as sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Results Evaluated on 37 317 examinations from 26 817 women (mean [SD] age, 58.4 [11.5] years), individual model AUROC estimates ranged from 0.77 (95% CI, 0.75-0.79) to 0.83 (95% CI, 0.81-0.85). The CEM model achieved an AUROC of 0.85 (95% CI, 0.84-0.87) in the UCLA cohort, lower than the performance achieved in the Kaiser Permanente Washington (AUROC, 0.90) and Karolinska Institute (AUROC, 0.92) cohorts. The CEM+R model achieved a sensitivity (0.813 [95% CI, 0.781-0.843] vs 0.826 [95% CI, 0.795-0.856]; P = .20) and specificity (0.925 [95% CI, 0.916-0.934] vs 0.930 [95% CI, 0.929-0.932]; P = .18) similar to the radiologist performance. The CEM+R model had significantly lower sensitivity (0.596 [95% CI, 0.466-0.717] vs 0.850 [95% CI, 0.766-0.923]; P < .001) and specificity (0.803 [95% CI, 0.734-0.861] vs 0.945 [95% CI, 0.936-0.954]; P < .001) than the radiologist in women with a prior history of breast cancer and Hispanic women (0.894 [95% CI, 0.873-0.910] vs 0.926 [95% CI, 0.919-0.933]; P = .004). Conclusions and Relevance This study found that the high performance of an ensemble deep-learning model for automated screening mammography interpretation did not generalize to a more diverse screening cohort, suggesting that the model experienced underspecification. This study suggests the need for model transparency and fine-tuning of AI models for specific target populations prior to their clinical adoption.
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Affiliation(s)
- William Hsu
- Medical and Imaging Informatics, Department of Radiological Sciences, David Geffen School of Medicine at University California, Los Angeles
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Noor Nakhaei
- Medical and Imaging Informatics, Department of Radiological Sciences, David Geffen School of Medicine at University California, Los Angeles
| | - Pin-Chieh Wang
- Department of Medicine, David Geffen School of Medicine at University California, Los Angeles
| | - Bing Zhu
- Medical and Imaging Informatics, Department of Radiological Sciences, David Geffen School of Medicine at University California, Los Angeles
| | - Nathan Siu
- Medical Informatics Home Area, Graduate Programs in Biosciences, David Geffen School of Medicine at University California, Los Angeles, Los Angeles, California
| | - Mehmet Eren Ahsen
- Gies College of Business, University of Illinois at Urbana-Champaign
| | - William Lotter
- DeepHealth, RadNet AI Solutions, Cambridge, Massachusetts
| | | | - Arash Naeim
- Center for Systematic, Measurable, Actionable, Resilient, and Technology-driven Health, Clinical and Translational Science Institute, David Geffen School of Medicine at University California, Los Angeles
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | | | - Joann G. Elmore
- Department of Medicine, David Geffen School of Medicine at University California, Los Angeles
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Department of Health Services, University of Washington School of Public Health, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington
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Impact of artificial intelligence in breast cancer screening with mammography. Breast Cancer 2022; 29:967-977. [PMID: 35763243 PMCID: PMC9587927 DOI: 10.1007/s12282-022-01375-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/29/2022] [Indexed: 11/21/2022]
Abstract
Objectives To demonstrate that radiologists, with the help of artificial intelligence (AI), are able to better classify screening mammograms into the correct breast imaging reporting and data system (BI-RADS) category, and as a secondary objective, to explore the impact of AI on cancer detection and mammogram interpretation time. Methods A multi-reader, multi-case study with cross-over design, was performed, including 314 mammograms. Twelve radiologists interpreted the examinations in two sessions delayed by a 4 weeks wash-out period with and without AI support. For each breast of each mammogram, they had to mark the most suspicious lesion (if any) and assign it with a forced BI-RADS category and a level of suspicion or “continuous BI-RADS 100”.
Cohen’s kappa correlation coefficient evaluating the inter-observer agreement for BI-RADS category per breast, and the area under the receiver operating characteristic curve (AUC), were used as metrics and analyzed. Results On average, the quadratic kappa coefficient increased significantly when using AI for all readers [κ = 0.549, 95% CI (0.528–0.571) without AI and κ = 0.626, 95% CI (0.607–0.6455) with AI]. AUC was significantly improved when using AI (0.74 vs 0.77, p = 0.004). Reading time was not significantly affected for all readers (106 s without AI and vs 102 s with AI; p = 0.754). Conclusions When using AI, radiologists were able to better assign mammograms with the correct BI-RADS category without slowing down the interpretation time.
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Meyer J, Khademi A, Têtu B, Han W, Nippak P, Remisch D. Impact of artificial intelligence on pathologists' decisions: an experiment. J Am Med Inform Assoc 2022; 29:1688-1695. [PMID: 35751441 DOI: 10.1093/jamia/ocac103] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The accuracy of artificial intelligence (AI) in medicine and in pathology in particular has made major progress but little is known on how much these algorithms will influence pathologists' decisions in practice. The objective of this paper is to determine the reliance of pathologists on AI and to investigate whether providing information on AI impacts this reliance. MATERIALS AND METHODS The experiment using an online survey design. Under 3 conditions, 116 pathologists and pathology students were tasked with assessing the Gleason grade for a series of 12 prostate biopsies: (1) without AI recommendations, (2) with AI recommendations, and (3) with AI recommendations accompanied by information about the algorithm itself, specifically algorithm accuracy rate and algorithm decision-making process. RESULTS Participant responses were significantly more accurate with the AI decision aids than without (92% vs 87%, odds ratio 13.30, P < .01). Unexpectedly, the provision of information on the algorithm made no significant difference compared to AI without information. The reliance on AI correlated with general beliefs on AI's usefulness but not with particular assessments of the AI tool offered. Decisions were made faster when AI was provided. DISCUSSION These results suggest that pathologists are willing to rely on AI regardless of accuracy or explanations. Generalization beyond the specific tasks and explanations provided will require further studies. CONCLUSION This study suggests that the factors that influence the reliance on AI differ in practice from beliefs expressed by clinicians in surveys. Implementation of AI in prospective settings should take individual behaviors into account.
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Affiliation(s)
- Julien Meyer
- School of Health Services Management, Ted Rogers School of Management, Toronto, Ontario, Canada
| | - April Khademi
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Bernard Têtu
- Départment de biologie médicale, Université Laval, Québec City, Quebec, Canada
| | - Wencui Han
- Department of Business administration, Gies College of Business, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Pria Nippak
- School of Health Services Management, Ted Rogers School of Management, Toronto, Ontario, Canada
| | - David Remisch
- School of Health Services Management, Ted Rogers School of Management, Toronto, Ontario, Canada
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Pomerantz A, Tsoref D, Grubstein A, Wadhawker S, Rapson Y, Gadiel I, Goldvaser H, Feldhamer I, Hammerman A, Shochat T, Sharon E, Kedar I, Yerushalmi R. Rate of breast biopsy referrals in female BRCA mutation carriers aged 50 years or more: a retrospective comparative study and matched analysis. Breast Cancer Res Treat 2022; 193:507-514. [PMID: 35391652 PMCID: PMC9090689 DOI: 10.1007/s10549-021-06498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the total biopsy and positive biopsy rates in women at high risk of breast cancer compared to the general population. METHODS The study group consisted of 330 women with pathogenic variants (PVs) in BRCA1/2 attending the dedicated multidisciplinary breast cancer clinic of a tertiary medical center in Israel. Clinical, genetic, and biopsy data were retrieved from the central healthcare database and the medical files. Patients aged 50 years or older during follow-up were matched 1:10 to women in the general population referred for routine breast cancer screening at the same age, as recommended by international guidelines. The groups were compared for rate of biopsy studies performed and percentage of positive biopsy results. Matched analysis was performed to correct for confounders. RESULTS The total biopsy rate per 1000 follow-up years was 61.7 in the study group and 22.7 in the control group (p < 0.001). The corresponding positive biopsy rates per 1000 follow-up years were 26.4 and 2.0 (p < 0.001), and the positive biopsy percentages, 42.9% and 8.7% (p < 0.0001). CONCLUSION Women aged 50 + years with PVs in BRCA1/2 attending a dedicated clinic have a 2.7 times higher biopsy rate per 1000 follow-up years, a 13.2 times higher positive biopsy rate per 1000 follow-up years, and a 4.9 times higher positive biopsy percentage than same-aged women in the general population.
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Affiliation(s)
- Adi Pomerantz
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Daliah Tsoref
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Ahuva Grubstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
- Imaging Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Sonya Wadhawker
- Surgery Department, Breast Cancer Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Yael Rapson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
- Imaging Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Itay Gadiel
- Imaging Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Hadar Goldvaser
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Ilan Feldhamer
- Chief Physician's Office, Clalit Health Services Headquarters, Tel Aviv, 6340412, Israel
| | - Ariel Hammerman
- Chief Physician's Office, Clalit Health Services Headquarters, Tel Aviv, 6340412, Israel
| | - Tzipora Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Eran Sharon
- Surgery Department, Breast Cancer Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Inbal Kedar
- Raphael Recanati Genetic Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 4941492, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel.
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Peng Q, Ren X. Mapping of Female Breast Cancer Incidence and Mortality Rates to Socioeconomic Factors Cohort: Path Diagram Analysis. Front Public Health 2022; 9:761023. [PMID: 35178368 PMCID: PMC8843849 DOI: 10.3389/fpubh.2021.761023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Breast cancer is the leading cause of death in women around the world. Its occurrence and development have been linked to genetic factors, living habits, health conditions, and socioeconomic factors. Comparisons of incidence and mortality rates of female breast cancer are useful approaches to define cancer-related socioeconomic disparities. METHODS This was a retrospective observational cohort study on breast cancer of women in several developed countries over 30 years. Effects of socioeconomic factors were analyzed using a path diagram method. RESULTS We found a positive, significant association of public wealth on incidence and mortality of breast cancer, and the path coefficients in the structural equations are -0.51 and -0.39, respectively. The unemployment rate (UR) is critical and the path coefficients are all 0.2. The path coefficients of individual economic wealth to the rates of breast cancer are 0.18 and 0.27, respectively. CONCLUSION The influence of social pressure on the incidence and mortality of breast cancer was not typical monotonous. The survival rate of breast cancer determined by the ratio of mortality rate to incidence rate showed a similar pattern with socioeconomic factors.
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Affiliation(s)
- Qiongle Peng
- Blood Transfusion Department, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaoling Ren
- Central Laboratory, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
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Advancements in Oncology with Artificial Intelligence—A Review Article. Cancers (Basel) 2022; 14:cancers14051349. [PMID: 35267657 PMCID: PMC8909088 DOI: 10.3390/cancers14051349] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary With the advancement of artificial intelligence, including machine learning, the field of oncology has seen promising results in cancer detection and classification, epigenetics, drug discovery, and prognostication. In this review, we describe what artificial intelligence is and its function, as well as comprehensively summarize its evolution and role in breast, colorectal, and central nervous system cancers. Understanding the origin and current accomplishments might be essential to improve the quality, accuracy, generalizability, cost-effectiveness, and reliability of artificial intelligence models that can be used in worldwide clinical practice. Students and researchers in the medical field will benefit from a deeper understanding of how to use integrative AI in oncology for innovation and research. Abstract Well-trained machine learning (ML) and artificial intelligence (AI) systems can provide clinicians with therapeutic assistance, potentially increasing efficiency and improving efficacy. ML has demonstrated high accuracy in oncology-related diagnostic imaging, including screening mammography interpretation, colon polyp detection, glioma classification, and grading. By utilizing ML techniques, the manual steps of detecting and segmenting lesions are greatly reduced. ML-based tumor imaging analysis is independent of the experience level of evaluating physicians, and the results are expected to be more standardized and accurate. One of the biggest challenges is its generalizability worldwide. The current detection and screening methods for colon polyps and breast cancer have a vast amount of data, so they are ideal areas for studying the global standardization of artificial intelligence. Central nervous system cancers are rare and have poor prognoses based on current management standards. ML offers the prospect of unraveling undiscovered features from routinely acquired neuroimaging for improving treatment planning, prognostication, monitoring, and response assessment of CNS tumors such as gliomas. By studying AI in such rare cancer types, standard management methods may be improved by augmenting personalized/precision medicine. This review aims to provide clinicians and medical researchers with a basic understanding of how ML works and its role in oncology, especially in breast cancer, colorectal cancer, and primary and metastatic brain cancer. Understanding AI basics, current achievements, and future challenges are crucial in advancing the use of AI in oncology.
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Zhang M, Ma Y, Geng C, Liu Y. Assisted computer and imaging system improve accuracy of breast tumor size assessment after neoadjuvant chemotherapy. Transl Cancer Res 2022; 10:1346-1357. [PMID: 35116460 PMCID: PMC8798524 DOI: 10.21037/tcr-20-2373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/22/2021] [Indexed: 02/05/2023]
Abstract
Background The use of neoadjuvant therapy (NAT) in patients with early breast cancer is becoming increasingly common. The purpose of this study was to explore the combined use of breast pathology cabinet X-ray system (CXS) to accurately assess the response to neoadjuvant treatment of breast cancer and establish a standard evaluation system. Methods A total of 100 patients with breast cancer after neoadjuvant treatment were randomly selected. Preoperative imaging evaluation of tumor masses were significantly degenerated, and they were randomly divided into experimental and control groups of 50 cases each. Compared with the traditional two methods of material extraction, the effective material extraction rate is comparative. Take the two largest diameters of the largest two-dimensional surface of the tumor bed as the measurement object, the macro-description value is D1/D2, the radiographic system description measurement value is the experimental group d1/d2, and the correction under the microscope is worth the true size of the tumor bed H1/H2 as the final test standard, calculate the difference between D1/D2 and d1/d2 with H1 and H2, and compare the difference between d1− H1, d2 − H2 and D1− H1, D2 − H2. Results The average group of tissue samples in the experimental group was 16.4, and the average group of tissue samples in the control group was 16.7, and there was no difference between the two groups; The effective tissue blocks of tumor bed samples in the experimental group were11.8, and the control group was 7.5. There is difference between the two groups. The average effective percentage of tumor bed in the experimental group was 72%, and the average effective percentage of tumor bed in the control group was 44.8%. The difference was also statistically significant; d1− H1, d2 − H2 and D1− H1, D2 − H2 are all different. Conclusions CXS assists the collection of breast tumor bed, which can significantly improve the efficiency of tumor bed collection and save the cost of collection. Compared with the maximum diameter of the tumor bed by eyes, the CXS mapping value is closer to the value measured under the microscope.
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Affiliation(s)
- Meng Zhang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanqi Ma
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cuizhi Geng
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Anderson AW, Marinovich ML, Houssami N, Lowry KP, Elmore JG, Buist DS, Hofvind S, Lee CI. Independent External Validation of Artificial Intelligence Algorithms for Automated Interpretation of Screening Mammography: A Systematic Review. J Am Coll Radiol 2022; 19:259-273. [PMID: 35065909 PMCID: PMC8857031 DOI: 10.1016/j.jacr.2021.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to describe the current state of science regarding independent external validation of artificial intelligence (AI) technologies for screening mammography. METHODS A systematic review was performed across five databases (Embase, PubMed, IEEE Explore, Engineer Village, and arXiv) through December 10, 2020. Studies that used screening examinations from real-world settings to externally validate AI algorithms for mammographic cancer detection were included. The main outcome was diagnostic accuracy, defined by area under the receiver operating characteristic curve (AUC). Performance was also compared between radiologists and either stand-alone AI or combined radiologist and AI interpretation. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS After data extraction, 13 studies met the inclusion criteria (148,361 total patients). Most studies (77% [n = 10]) evaluated commercially available AI algorithms. Studies included retrospective reader studies (46% [n = 6]), retrospective simulation studies (38% [n = 5]), or both (15% [n = 2]). Across 5 studies comparing stand-alone AI with radiologists, 60% (n = 3) demonstrated improved accuracy with AI (AUC improvement range, 0.02-0.13). All 5 studies comparing combined radiologist and AI interpretation with radiologists alone demonstrated improved accuracy with AI (AUC improvement range, 0.028-0.115). Most studies had risk for bias or applicability concerns for patient selection (69% [n = 9]) and the reference standard (69% [n = 9]). Only two studies obtained ground-truth cancer outcomes through regional cancer registry linkage. CONCLUSIONS To date, external validation efforts for AI screening mammographic technologies suggest small potential diagnostic accuracy improvements but have been retrospective in nature and suffer from risk for bias and applicability concerns.
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Affiliation(s)
- Anna W. Anderson
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - M. Luke Marinovich
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Nehmat Houssami
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kathryn P. Lowry
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Joann G. Elmore
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA
| | - Diana S.M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
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Ayana G, Park J, Jeong JW, Choe SW. A Novel Multistage Transfer Learning for Ultrasound Breast Cancer Image Classification. Diagnostics (Basel) 2022; 12:135. [PMID: 35054303 PMCID: PMC8775102 DOI: 10.3390/diagnostics12010135] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 12/31/2022] Open
Abstract
Breast cancer diagnosis is one of the many areas that has taken advantage of artificial intelligence to achieve better performance, despite the fact that the availability of a large medical image dataset remains a challenge. Transfer learning (TL) is a phenomenon that enables deep learning algorithms to overcome the issue of shortage of training data in constructing an efficient model by transferring knowledge from a given source task to a target task. However, in most cases, ImageNet (natural images) pre-trained models that do not include medical images, are utilized for transfer learning to medical images. Considering the utilization of microscopic cancer cell line images that can be acquired in large amount, we argue that learning from both natural and medical datasets improves performance in ultrasound breast cancer image classification. The proposed multistage transfer learning (MSTL) algorithm was implemented using three pre-trained models: EfficientNetB2, InceptionV3, and ResNet50 with three optimizers: Adam, Adagrad, and stochastic gradient de-scent (SGD). Dataset sizes of 20,400 cancer cell images, 200 ultrasound images from Mendeley and 400 ultrasound images from the MT-Small-Dataset were used. ResNet50-Adagrad-based MSTL achieved a test accuracy of 99 ± 0.612% on the Mendeley dataset and 98.7 ± 1.1% on the MT-Small-Dataset, averaging over 5-fold cross validation. A p-value of 0.01191 was achieved when comparing MSTL against ImageNet based TL for the Mendeley dataset. The result is a significant improvement in the performance of artificial intelligence methods for ultrasound breast cancer classification compared to state-of-the-art methods and could remarkably improve the early diagnosis of breast cancer in young women.
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Affiliation(s)
- Gelan Ayana
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi 39253, Korea
| | - Jinhyung Park
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi 39253, Korea
| | - Jin-Woo Jeong
- Department of Data Science, Seoul National University of Science and Technology, Seoul 01811, Korea
| | - Se-Woon Choe
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi 39253, Korea
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, Gumi 39253, Korea
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Marinovich ML, Wylie E, Lotter W, Pearce A, Carter SM, Lund H, Waddell A, Kim JG, Pereira GF, Lee CI, Zackrisson S, Brennan M, Houssami N. Artificial intelligence (AI) to enhance breast cancer screening: protocol for population-based cohort study of cancer detection. BMJ Open 2022; 12:e054005. [PMID: 34980622 PMCID: PMC8724814 DOI: 10.1136/bmjopen-2021-054005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Artificial intelligence (AI) algorithms for interpreting mammograms have the potential to improve the effectiveness of population breast cancer screening programmes if they can detect cancers, including interval cancers, without contributing substantially to overdiagnosis. Studies suggesting that AI has comparable or greater accuracy than radiologists commonly employ 'enriched' datasets in which cancer prevalence is higher than in population screening. Routine screening outcome metrics (cancer detection and recall rates) cannot be estimated from these datasets, and accuracy estimates may be subject to spectrum bias which limits generalisabilty to real-world screening. We aim to address these limitations by comparing the accuracy of AI and radiologists in a cohort of consecutive of women attending a real-world population breast cancer screening programme. METHODS AND ANALYSIS A retrospective, consecutive cohort of digital mammography screens from 109 000 distinct women was assembled from BreastScreen WA (BSWA), Western Australia's biennial population screening programme, from November 2016 to December 2017. The cohort includes 761 screen-detected and 235 interval cancers. Descriptive characteristics and results of radiologist double-reading will be extracted from BSWA outcomes data collection. Mammograms will be reinterpreted by a commercial AI algorithm (DeepHealth). AI accuracy will be compared with that of radiologist single-reading based on the difference in the area under the receiver operating characteristic curve. Cancer detection and recall rates for combined AI-radiologist reading will be estimated by pairing the first radiologist read per screen with the AI algorithm, and compared with estimates for radiologist double-reading. ETHICS AND DISSEMINATION This study has ethical approval from the Women and Newborn Health Service Ethics Committee (EC00350) and the Curtin University Human Research Ethics Committee (HRE2020-0316). Findings will be published in peer-reviewed journals and presented at national and international conferences. Results will also be disseminated to stakeholders in Australian breast cancer screening programmes and policy makers in population screening.
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Affiliation(s)
- M Luke Marinovich
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Alison Pearce
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Helen Lund
- BreastScreen WA, Perth, Western Australia, Australia
| | | | - Jiye G Kim
- DeepHealth Inc, Cambridge, Massachussetts, USA
| | - Gavin F Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Oslo, Norway
| | - Christoph I Lee
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Meagan Brennan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
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Breast cancer incidence by age at discovery of mammographic abnormality in women participating in French organized screening campaigns. Public Health 2021; 202:121-130. [PMID: 34952431 DOI: 10.1016/j.puhe.2021.11.012] [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: 07/06/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Statistical modeling was already predicted the occurrence/prognosis of breast cancer from previous radiological findings. This study predicts the breast cancer risk by the age at discovery of mammographic abnormality in the French breast cancer screening program. STUDY DESIGN This was a cohort study. METHODS The study included 261,083 women who meet the inclusion criteria: aged 50-74 years, living in French departments (Ain, Doubs, Haute-Saône, Jura, Territoire-de-Belfort, and Yonne), with at least two mammograms between January 1999 and December 2017, of which the first was 'normal/benign'. The incidence of each abnormality (microcalcifications, spiculated mass, obscured mass, architectural distortion, and asymmetric density) was first estimated, then the breast cancer risk was predicted secondly according to the age at discovery of each mammographic abnormality, using an actuarial life table and a Cox model. RESULTS Overall breast cancer (6326 cases) incidence was 3.3 (3.0; 3.1)/1000 person-years. The breast cancer incidence increased proportionally with the discovery age of the speculated mass and microcalcifications. The incidence was twice as high when the spiculated mass age of discovery was ≥70 (12.2 [10.4; 14.4]) compared with age 50-54 years (5.8 [5.1; 6.7]). Depending on the spiculated mass discovery age, the breast cancer risk increased by at least 40% between the age groups 55-59 years (1.4 [1.0; 1.8]) and ≥70 years (2.4 [1.9; 3.3]). Whatever the abnormality, the incidence of breast cancer was higher when it was present in only one breast. CONCLUSION The study highlights a stable incidence of breast cancer between successive mammograms, an increased risk of breast cancer with the finding age of spiculated mass and microcalcifications. The reduced delay between the abnormality discovery date and the breast cancer diagnosis date would justify a specific follow-up protocol after the finding of these two abnormalities.
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Automatic Detection of Small Intestinal Hookworms in Capsule Endoscopy Images Based on a Convolutional Neural Network. Gastroenterol Res Pract 2021; 2021:5682288. [PMID: 34868306 PMCID: PMC8635910 DOI: 10.1155/2021/5682288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/05/2021] [Indexed: 02/05/2023] Open
Abstract
Ancylostomiasis is a fairly common small bowel parasite disease identified by capsule endoscopy (CE) for which a computer-aided clinical detection method has not been established. We sought to develop an artificial intelligence system with a convolutional neural network (CNN) to automatically detect hookworms in CE images. We trained a deep CNN system based on a YOLO-V4 (You Look Only Once-Version4) detector using 11236 CE images of hookworms. We assessed its performance by calculating the area under the receiver operating characteristic curve and its sensitivity, specificity, and accuracy using an independent test set of 10,529 small-bowel images including 531 images of hookworms. The trained CNN system required 403 seconds to evaluate 10,529 test images. The area under the curve for the detection of hookworms was 0.972 (95% confidence interval (CI), 0.967-0.978). The sensitivity, specificity, and accuracy of the CNN system were 92.2%, 91.1%, and 91.2%, respectively, at a probability score cut-off of 0.485. We developed and validated a CNN-based system for detecting hookworms in CE images. By combining this high-accuracy, high-speed, and oversight-preventing system with other CNN systems, we hope it will become an important supplement for detecting intestinal abnormalities in CE images. This trial is registered with ChiCTR2000034546 (a clinical research of artificial-intelligence-aided diagnosis for hookworms in small intestine by capsule endoscope images).
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Monib S. Artificial Intelligence in Breast Disease Management: No Innovation Without Evaluation. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Existing and Emerging Breast Cancer Detection Technologies and Its Challenges: A Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112210753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Breast cancer is the most leading cancer occurring in women and is a significant factor in female mortality. Early diagnosis of breast cancer with Artificial Intelligent (AI) developments for breast cancer detection can lead to a proper treatment to affected patients as early as possible that eventually help reduce the women mortality rate. Reliability issues limit the current clinical detection techniques, such as Ultra-Sound, Mammography, and Magnetic Resonance Imaging (MRI) from screening images for precise elucidation. The capability to detect a tumor in early diagnosis, expensive, relatively long waiting time due to pandemic and painful procedure for a patient to perform. This article aims to review breast cancer screening methods and recent technological advancements systematically. In addition, this paper intends to explore the progression and challenges of AI in breast cancer detection. The next state of the art between image and signal processing will be presented, and their performance is compared. This review will facilitate the researcher to insight the view of breast cancer detection technologies advancement and its challenges.
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Freeman K, Geppert J, Stinton C, Todkill D, Johnson S, Clarke A, Taylor-Phillips S. Use of artificial intelligence for image analysis in breast cancer screening programmes: systematic review of test accuracy. BMJ 2021; 374:n1872. [PMID: 34470740 PMCID: PMC8409323 DOI: 10.1136/bmj.n1872] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the accuracy of artificial intelligence (AI) for the detection of breast cancer in mammography screening practice. DESIGN Systematic review of test accuracy studies. DATA SOURCES Medline, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 1 January 2010 to 17 May 2021. ELIGIBILITY CRITERIA Studies reporting test accuracy of AI algorithms, alone or in combination with radiologists, to detect cancer in women's digital mammograms in screening practice, or in test sets. Reference standard was biopsy with histology or follow-up (for screen negative women). Outcomes included test accuracy and cancer type detected. STUDY SELECTION AND SYNTHESIS Two reviewers independently assessed articles for inclusion and assessed the methodological quality of included studies using the QUality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A single reviewer extracted data, which were checked by a second reviewer. Narrative data synthesis was performed. RESULTS Twelve studies totalling 131 822 screened women were included. No prospective studies measuring test accuracy of AI in screening practice were found. Studies were of poor methodological quality. Three retrospective studies compared AI systems with the clinical decisions of the original radiologist, including 79 910 women, of whom 1878 had screen detected cancer or interval cancer within 12 months of screening. Thirty four (94%) of 36 AI systems evaluated in these studies were less accurate than a single radiologist, and all were less accurate than consensus of two or more radiologists. Five smaller studies (1086 women, 520 cancers) at high risk of bias and low generalisability to the clinical context reported that all five evaluated AI systems (as standalone to replace radiologist or as a reader aid) were more accurate than a single radiologist reading a test set in the laboratory. In three studies, AI used for triage screened out 53%, 45%, and 50% of women at low risk but also 10%, 4%, and 0% of cancers detected by radiologists. CONCLUSIONS Current evidence for AI does not yet allow judgement of its accuracy in breast cancer screening programmes, and it is unclear where on the clinical pathway AI might be of most benefit. AI systems are not sufficiently specific to replace radiologist double reading in screening programmes. Promising results in smaller studies are not replicated in larger studies. Prospective studies are required to measure the effect of AI in clinical practice. Such studies will require clear stopping rules to ensure that AI does not reduce programme specificity. STUDY REGISTRATION Protocol registered as PROSPERO CRD42020213590.
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Affiliation(s)
- Karoline Freeman
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Julia Geppert
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chris Stinton
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Daniel Todkill
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Samantha Johnson
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Division of Health Sciences, University of Warwick, Coventry, UK
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Ali M, Ali R. Multi-Input Dual-Stream Capsule Network for Improved Lung and Colon Cancer Classification. Diagnostics (Basel) 2021; 11:1485. [PMID: 34441419 PMCID: PMC8393706 DOI: 10.3390/diagnostics11081485] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Lung and colon cancers are two of the most common causes of death and morbidity in humans. One of the most important aspects of appropriate treatment is the histopathological diagnosis of such cancers. As a result, the main goal of this study is to use a multi-input capsule network and digital histopathology images to build an enhanced computerized diagnosis system for detecting squamous cell carcinomas and adenocarcinomas of the lungs, as well as adenocarcinomas of the colon. Two convolutional layer blocks are used in the proposed multi-input capsule network. The CLB (Convolutional Layers Block) employs traditional convolutional layers, whereas the SCLB (Separable Convolutional Layers Block) employs separable convolutional layers. The CLB block takes unprocessed histopathology images as input, whereas the SCLB block takes uniquely pre-processed histopathological images. The pre-processing method uses color balancing, gamma correction, image sharpening, and multi-scale fusion as the major processes because histopathology slide images are typically red blue. All three channels (Red, Green, and Blue) are adequately compensated during the color balancing phase. The dual-input technique aids the model's ability to learn features more effectively. On the benchmark LC25000 dataset, the empirical analysis indicates a significant improvement in classification results. The proposed model provides cutting-edge performance in all classes, with 99.58% overall accuracy for lung and colon abnormalities based on histopathological images.
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Affiliation(s)
- Mumtaz Ali
- School of Computer Science, Huazhong University of Science and Technology, Wuhan 430074, China
- Department of Computer Systems Engineering, Sukkur IBA University, Sukkur 65200, Pakistan
| | - Riaz Ali
- Department of Computer Science, Sukkur IBA University, Sukkur 65200, Pakistan;
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Kerschke L, Weigel S, Rodriguez-Ruiz A, Karssemeijer N, Heindel W. Using deep learning to assist readers during the arbitration process: a lesion-based retrospective evaluation of breast cancer screening performance. Eur Radiol 2021; 32:842-852. [PMID: 34383147 PMCID: PMC8794989 DOI: 10.1007/s00330-021-08217-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate if artificial intelligence (AI) can discriminate recalled benign from recalled malignant mammographic screening abnormalities to improve screening performance. Methods A total of 2257 full-field digital mammography screening examinations, obtained 2011–2013, of women aged 50–69 years which were recalled for further assessment of 295 malignant out of 305 truly malignant lesions and 2289 benign lesions after independent double-reading with arbitration, were included in this retrospective study. A deep learning AI system was used to obtain a score (0–95) for each recalled lesion, representing the likelihood of breast cancer. The sensitivity on the lesion level and the proportion of women without false-positive ratings (non-FPR) resulting under AI were estimated as a function of the classification cutoff and compared to that of human readers. Results Using a cutoff of 1, AI decreased the proportion of women with false-positives from 89.9 to 62.0%, non-FPR 11.1% vs. 38.0% (difference 26.9%, 95% confidence interval 25.1–28.8%; p < .001), preventing 30.1% of reader-induced false-positive recalls, while reducing sensitivity from 96.7 to 91.1% (5.6%, 3.1–8.0%) as compared to human reading. The positive predictive value of recall (PPV-1) increased from 12.8 to 16.5% (3.7%, 3.5–4.0%). In women with mass-related lesions (n = 900), the non-FPR was 14.2% for humans vs. 36.7% for AI (22.4%, 19.8–25.3%) at a sensitivity of 98.5% vs. 97.1% (1.5%, 0–3.5%). Conclusion The application of AI during consensus conference might especially help readers to reduce false-positive recalls of masses at the expense of a small sensitivity reduction. Prospective studies are needed to further evaluate the screening benefit of AI in practice. Key Points • Integrating the use of artificial intelligence in the arbitration process reduces benign recalls and increases the positive predictive value of recall at the expense of some sensitivity loss. • Application of the artificial intelligence system to aid the decision to recall a woman seems particularly beneficial for masses, where the system reaches comparable sensitivity to that of the readers, but with considerably reduced false-positives. • About one-fourth of all recalled malignant lesions are not automatically marked by the system such that their evaluation (AI score) must be retrieved manually by the reader. A thorough reading of screening mammograms by readers to identify suspicious lesions therefore remains mandatory.
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Affiliation(s)
- Laura Kerschke
- Institute of Biostatistics and Clinical Research, IBKF, University of Muenster, Schmeddingstrasse 56, 48149, Muenster, Germany.
| | - Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography Muenster, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | | | - Nico Karssemeijer
- ScreenPoint Medical BV, Toernooiveld 300, 6525, EC, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands
| | - Walter Heindel
- Clinic for Radiology and Reference Center for Mammography Muenster, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Frazer HM, Qin AK, Pan H, Brotchie P. Evaluation of deep learning-based artificial intelligence techniques for breast cancer detection on mammograms: Results from a retrospective study using a BreastScreen Victoria dataset. J Med Imaging Radiat Oncol 2021; 65:529-537. [PMID: 34212526 PMCID: PMC8456839 DOI: 10.1111/1754-9485.13278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
Introduction This study aims to evaluate deep learning (DL)‐based artificial intelligence (AI) techniques for detecting the presence of breast cancer on a digital mammogram image. Methods We evaluated several DL‐based AI techniques that employ different approaches and backbone DL models and tested the effect on performance of using different data‐processing strategies on a set of digital mammographic images with annotations of pathologically proven breast cancer. Results Our evaluation uses the area under curve (AUC) and accuracy (ACC) for performance measurement. The best evaluation result, based on 349 test cases (930 test images), was an AUC of 0.8979 [95% confidence interval (CI) 0.873, 0.923] and ACC of 0.8178 [95% CI 0.785, 0.850]. This was achieved by an AI technique that utilises a certain family of DL models, namely ResNet, as its backbone, combines the global features extracted from the whole mammogram and the local features extracted from the automatically detected cancer and non‐cancer local regions in the whole image, and leverages background cropping and text removal, contrast adjustment and more training data. Conclusion DL‐based AI techniques have shown promising results in retrospective studies for many medical image analysis applications. Our study demonstrates a significant opportunity to boost the performance of such techniques applied to breast cancer detection by exploring different types of approaches, backbone DL models and data‐processing strategies. The promising results we have obtained suggest further development of AI reading services could transform breast cancer screening in the future.
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Affiliation(s)
- Helen Ml Frazer
- St Vincent's BreastScreen, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alex K Qin
- Department of Computer Science and Software Engineering, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Hong Pan
- Department of Computer Science and Software Engineering, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Peter Brotchie
- Department of Medical Imaging, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Elmore JG, Lee CI. Keeping Pace With Technology Advances in Breast Cancer Screening: Synthetic 2D Images Outperform Digital Mammography. J Natl Cancer Inst 2021; 113:645-646. [PMID: 33372678 PMCID: PMC8168230 DOI: 10.1093/jnci/djaa208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joann G Elmore
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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Chua IS, Gaziel-Yablowitz M, Korach ZT, Kehl KL, Levitan NA, Arriaga YE, Jackson GP, Bates DW, Hassett M. Artificial intelligence in oncology: Path to implementation. Cancer Med 2021; 10:4138-4149. [PMID: 33960708 PMCID: PMC8209596 DOI: 10.1002/cam4.3935] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022] Open
Abstract
In recent years, the field of artificial intelligence (AI) in oncology has grown exponentially. AI solutions have been developed to tackle a variety of cancer‐related challenges. Medical institutions, hospital systems, and technology companies are developing AI tools aimed at supporting clinical decision making, increasing access to cancer care, and improving clinical efficiency while delivering safe, high‐value oncology care. AI in oncology has demonstrated accurate technical performance in image analysis, predictive analytics, and precision oncology delivery. Yet, adoption of AI tools is not widespread, and the impact of AI on patient outcomes remains uncertain. Major barriers for AI implementation in oncology include biased and heterogeneous data, data management and collection burdens, a lack of standardized research reporting, insufficient clinical validation, workflow and user‐design challenges, outdated regulatory and legal frameworks, and dynamic knowledge and data. Concrete actions that major stakeholders can take to overcome barriers to AI implementation in oncology include training and educating the oncology workforce in AI; standardizing data, model validation methods, and legal and safety regulations; funding and conducting future research; and developing, studying, and deploying AI tools through multidisciplinary collaboration.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michal Gaziel-Yablowitz
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Zfania T Korach
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kenneth L Kehl
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Gretchen P Jackson
- IBM Watson Health, Cambridge, MA, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Hassett
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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48
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Lyell D, Coiera E, Chen J, Shah P, Magrabi F. How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices. BMJ Health Care Inform 2021; 28:bmjhci-2020-100301. [PMID: 33853863 PMCID: PMC8054073 DOI: 10.1136/bmjhci-2020-100301] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/10/2021] [Accepted: 03/02/2021] [Indexed: 12/20/2022] Open
Abstract
Objective To examine how and to what extent medical devices using machine learning (ML) support clinician decision making. Methods We searched for medical devices that were (1) approved by the US Food and Drug Administration (FDA) up till February 2020; (2) intended for use by clinicians; (3) in clinical tasks or decisions and (4) used ML. Descriptive information about the clinical task, device task, device input and output, and ML method were extracted. The stage of human information processing automated by ML-based devices and level of autonomy were assessed. Results Of 137 candidates, 59 FDA approvals for 49 unique devices were included. Most approvals (n=51) were since 2018. Devices commonly assisted with diagnostic (n=35) and triage (n=10) tasks. Twenty-three devices were assistive, providing decision support but left clinicians to make important decisions including diagnosis. Twelve automated the provision of information (autonomous information), such as quantification of heart ejection fraction, while 14 automatically provided task decisions like triaging the reading of scans according to suspected findings of stroke (autonomous decisions). Stages of human information processing most automated by devices were information analysis, (n=14) providing information as an input into clinician decision making, and decision selection (n=29), where devices provide a decision. Conclusion Leveraging the benefits of ML algorithms to support clinicians while mitigating risks, requires a solid relationship between clinician and ML-based devices. Such relationships must be carefully designed, considering how algorithms are embedded in devices, the tasks supported, information provided and clinicians’ interactions with them.
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Affiliation(s)
- David Lyell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jessica Chen
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Parina Shah
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Farah Magrabi
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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49
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Cui M, Zhang DY. Artificial intelligence and computational pathology. J Transl Med 2021; 101:412-422. [PMID: 33454724 PMCID: PMC7811340 DOI: 10.1038/s41374-020-00514-0] [Citation(s) in RCA: 174] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
Data processing and learning has become a spearhead for the advancement of medicine, with pathology and laboratory medicine has no exception. The incorporation of scientific research through clinical informatics, including genomics, proteomics, bioinformatics, and biostatistics, into clinical practice unlocks innovative approaches for patient care. Computational pathology is burgeoning subspecialty in pathology that promises a better-integrated solution to whole-slide images, multi-omics data, and clinical informatics. However, computational pathology faces several challenges, including the ability to integrate raw data from different sources, limitation of hardware processing capacity, and a lack of specific training programs, as well as issues on ethics and larger societal acceptable practices that are still solidifying. The establishment of the entire industry of computational pathology requires far-reaching changes of the three essential elements connecting patients and doctors: the local laboratory, the scan center, and the central cloud hub/portal for data processing and retrieval. Computational pathology, unlocked through information integration and advanced digital communication networks, has the potential to improve clinical workflow efficiency, diagnostic quality, and ultimately create personalized diagnosis and treatment plans for patients. This review describes clinical perspectives and discusses the statistical methods, clinical applications, potential obstacles, and future directions of computational pathology.
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Affiliation(s)
- Miao Cui
- St. Luke's Roosevelt Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY, 10025, USA
| | - David Y Zhang
- Pathology and Laboratory Services, VA Medical Center, New York, NY, 10010, USA.
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50
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A New Argument for No-Fault Compensation in Health Care: The Introduction of Artificial Intelligence Systems. HEALTH CARE ANALYSIS 2021; 29:171-188. [PMID: 33745121 PMCID: PMC8321978 DOI: 10.1007/s10728-021-00430-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/08/2022]
Abstract
Artificial intelligence (AI) systems advising healthcare professionals will be widely introduced into healthcare settings within the next 5–10 years. This paper considers how this will sit with tort/negligence based legal approaches to compensation for medical error. It argues that the introduction of AI systems will provide an additional argument pointing towards no-fault compensation as the better legal solution to compensation for medical error in modern health care systems. The paper falls into four parts. The first part rehearses the main arguments for and against no-fault compensation. The second explains why it is likely that AI systems will be widely introduced. The third part analyses why it is difficult to fit AI systems into fault-based compensation systems while the final part suggests how no-fault compensation could provide a possible solution to such challenges.
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