The efficacy of using computer-aided detection (CAD) for detection of breast cancer in mammography screening: a systematic review

Evaluating the Impact of Changes in Artificial Intelligence-derived Case Scores over Time on Digital Breast Tomosynthesis Screening Outcomes

Purpose To evaluate the change in digital breast tomosynthesis artificial intelligence (DBT-AI) case scores over sequential screenings. Materials and Methods This retrospective review included 21 108 female patients (mean age ± SD, 58.1 years ± 11.5) with 31 741 DBT screening examinations performed at a single site from February 3, 2020, to September 12, 2022. Among 7000 patients with two or more DBT-AI screenings, 1799 had a 1-year follow-up and were included in the analysis. DBT-AI case scores and differences in case score over time were determined. Case scores ranged from 0 to 100. For each screening outcome (true positive [TP], false positive [FP], true negative [TN], false negative [FN]), mean and median case score change was calculated. Results The highest average case score was seen in TP examinations (average, 75; range, 7-100; n = 41), and the lowest average case score was seen in TN examinations (average, 34; range, 0-100; n = 1640). The largest positive case score change was seen in TP examinations (mean case score change, 21.1; median case score change, 17). FN examinations included mammographically occult cancers diagnosed following supplemental screening and those found at symptomatic diagnostic imaging. Differences between TP and TN mean case score change (P < .001) and between TP and FP mean case score change (P = .02) were statistically significant. Conclusion Using the combination of DBT AI case score with change in case score over time may help radiologists make recall decisions in DBT screening. All studies with high case score and/or case score changes should be carefully scrutinized to maximize screening performance. Keywords: Mammography, Breast, Computer Aided Diagnosis (CAD) Supplemental material is available for this article. © RSNA, 2025.

Efficacy of Mammographic Artificial Intelligence-Based Computer-Aided Detection in Predicting Pathologic Complete Response to Neoadjuvant Chemotherapy

This study evaluates the potential of an AI-based computer-aided detection (AI-CAD) system in digital mammography for predicting pathologic complete response (pCR) in breast cancer patients after neoadjuvant chemotherapy (NAC). A retrospective analysis of 132 patients who underwent NAC and surgery between January 2020 and December 2022 was performed. Pre- and post-NAC mammograms were analyzed using conventional CAD and AI-CAD systems, with negative exams defined by the absence of marked abnormalities. Two radiologists reviewed mammography, ultrasound, MRI, and diffusion-weighted imaging (DWI). Concordance rates between CAD and AI-CAD were calculated, and the diagnostic performance, including the area under the receiver operating characteristics curve (AUC), was assessed. The pre-NAC concordance rates were 90.9% for CAD and 97% for AI-CAD, while post-NAC rates were 88.6% for CAD and 89.4% for AI-CAD. The MRI had the highest diagnostic performance for pCR prediction, with AI-CAD performing comparably to other modalities. Univariate analysis identified significant predictors of pCR, including AI-CAD, mammography, ultrasound, MRI, histologic grade, ER, PR, HER2, and Ki-67. In multivariable analysis, negative MRI, histologic grade 3, and HER2 positivity remained significant predictors. In conclusion, this study demonstrates that AI-CAD in digital mammography shows the potential to examine the pCR of breast cancer patients following NAC.

Systematic Meta-Analysis of Computer-Aided Detection of Breast Cancer Using Hyperspectral Imaging

The most commonly occurring cancer in the world is breast cancer with more than 500,000 cases across the world. The detection mechanism for breast cancer is endoscopist-dependent and necessitates a skilled pathologist. However, in recent years many computer-aided diagnoses (CADs) have been used to diagnose and classify breast cancer using traditional RGB images that analyze the images only in three-color channels. Nevertheless, hyperspectral imaging (HSI) is a pioneering non-destructive testing (NDT) image-processing technique that can overcome the disadvantages of traditional image processing which analyzes the images in a wide-spectrum band. Eight studies were selected for systematic diagnostic test accuracy (DTA) analysis based on the results of the Quadas-2 tool. Each of these studies' techniques is categorized according to the ethnicity of the data, the methodology employed, the wavelength that was used, the type of cancer diagnosed, and the year of publication. A Deeks' funnel chart, forest charts, and accuracy plots were created. The results were statistically insignificant, and there was no heterogeneity among these studies. The methods and wavelength bands that were used with HSI technology to detect breast cancer provided high sensitivity, specificity, and accuracy. The meta-analysis of eight studies on breast cancer diagnosis using HSI methods reported average sensitivity, specificity, and accuracy of 78%, 89%, and 87%, respectively. The highest sensitivity and accuracy were achieved with SVM (95%), while CNN methods were the most commonly used but had lower sensitivity (65.43%). Statistical analyses, including meta-regression and Deeks' funnel plots, showed no heterogeneity among the studies and highlighted the evolving performance of HSI techniques, especially after 2019.

The message matters: changes to binary Computer Aided Detection recommendations affect cancer detection in low prevalence search

Computer Aided Detection (CAD) has been used to help readers find cancers in mammograms. Although these automated systems have been shown to help cancer detection when accurate, the presence of CAD also leads to an over-reliance effect where miss errors and false alarms increase when the CAD system fails. Previous research investigated CAD systems which overlayed salient exogenous cues onto the image to highlight suspicious areas. These salient cues capture attention which may exacerbate the over-reliance effect. Furthermore, overlaying CAD cues directly on the mammogram occludes sections of breast tissue which may disrupt global statistics useful for cancer detection. In this study we investigated whether an over-reliance effect occurred with a binary CAD system, which instead of overlaying a CAD cue onto the mammogram, reported a message alongside the mammogram indicating the possible presence of a cancer. We manipulated the certainty of the message and whether it was presented only to indicate the presence of a cancer, or whether a message was displayed on every mammogram to state whether a cancer was present or absent. The results showed that although an over-reliance effect still occurred with binary CAD systems miss errors were reduced when the CAD message was more definitive and only presented to alert readers of a possible cancer.

Breast Cancer Screening Using Inverse Modeling of Surface Temperatures and Steady-State Thermal Imaging

Cancer is characterized by increased metabolic activity and vascularity, leading to temperature changes in cancerous tissues compared to normal cells. This study focused on patients with abnormal mammogram findings or a clinical suspicion of breast cancer, exclusively those confirmed by biopsy. Utilizing an ultra-high sensitivity thermal camera and prone patient positioning, we measured surface temperatures integrated with an inverse modeling technique based on heat transfer principles to predict malignant breast lesions. Involving 25 breast tumors, our technique accurately predicted all tumors, with maximum errors below 5 mm in size and less than 1 cm in tumor location. Predictive efficacy was unaffected by tumor size, location, or breast density, with no aberrant predictions in the contralateral normal breast. Infrared temperature profiles and inverse modeling using both techniques successfully predicted breast cancer, highlighting its potential in breast cancer screening.

Artificial Intelligence for breast cancer detection: Technology, challenges, and prospects

PURPOSE

This review provides an overview of the current state of artificial intelligence (AI) technology for automated detection of breast cancer in digital mammography (DM) and digital breast tomosynthesis (DBT). It aims to discuss the technology, available AI systems, and the challenges faced by AI in breast cancer screening.

METHODS

The review examines the development of AI technology in breast cancer detection, focusing on deep learning (DL) techniques and their differences from traditional computer-aided detection (CAD) systems. It discusses data pre-processing, learning paradigms, and the need for independent validation approaches.

RESULTS

DL-based AI systems have shown significant improvements in breast cancer detection. They have the potential to enhance screening outcomes, reduce false negatives and positives, and detect subtle abnormalities missed by human observers. However, challenges like the lack of standardised datasets, potential bias in training data, and regulatory approval hinder their widespread adoption.

CONCLUSIONS

AI technology has the potential to improve breast cancer screening by increasing accuracy and reducing radiologist workload. DL-based AI systems show promise in enhancing detection performance and eliminating variability among observers. Standardised guidelines and trustworthy AI practices are necessary to ensure fairness, traceability, and robustness. Further research and validation are needed to establish clinical trust in AI. Collaboration between researchers, clinicians, and regulatory bodies is crucial to address challenges and promote AI implementation in breast cancer screening.

Detailed Image Data Quality and Cleaning Practices for Artificial Intelligence Tools for Breast Cancer

Standardizing image-data preparation practices to improve accuracy/consistency of AI diagnostic tools.

The use of artificial intelligence tools in cancer detection compared to the traditional diagnostic imaging methods: An overview of the systematic reviews

BACKGROUND AND PURPOSE

In comparison to conventional medical imaging diagnostic modalities, the aim of this overview article is to analyze the accuracy of the application of Artificial Intelligence (AI) techniques in the identification and diagnosis of malignant tumors in adult patients.

DATA SOURCES

The acronym PIRDs was used and a comprehensive literature search was conducted on PubMed, Cochrane, Scopus, Web of Science, LILACS, Embase, Scielo, EBSCOhost, and grey literature through Proquest, Google Scholar, and JSTOR for systematic reviews of AI as a diagnostic model and/or detection tool for any cancer type in adult patients, compared to the traditional diagnostic radiographic imaging model. There were no limits on publishing status, publication time, or language. For study selection and risk of bias evaluation, pairs of reviewers worked separately.

RESULTS

In total, 382 records were retrieved in the databases, 364 after removing duplicates, 32 satisfied the full-text reading criterion, and 09 papers were considered for qualitative synthesis. Although there was heterogeneity in terms of methodological aspects, patient differences, and techniques used, the studies found that several AI approaches are promising in terms of specificity, sensitivity, and diagnostic accuracy in the detection and diagnosis of malignant tumors. When compared to other machine learning algorithms, the Super Vector Machine method performed better in cancer detection and diagnosis. Computer-assisted detection (CAD) has shown promising in terms of aiding cancer detection, when compared to the traditional method of diagnosis.

CONCLUSIONS

The detection and diagnosis of malignant tumors with the help of AI seems to be feasible and accurate with the use of different technologies, such as CAD systems, deep and machine learning algorithms and radiomic analysis when compared with the traditional model, although these technologies are not capable of to replace the professional radiologist in the analysis of medical images. Although there are limitations regarding the generalization for all types of cancer, these AI tools might aid professionals, serving as an auxiliary and teaching tool, especially for less trained professionals. Therefore, further longitudinal studies with a longer follow-up duration are required for a better understanding of the clinical application of these artificial intelligence systems.

TRIAL REGISTRATION

Systematic review registration. Prospero registration number: CRD42022307403.

Nanotechnology revolutionises breast cancer treatment: harnessing lipid-based nanocarriers to combat cancer cells

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.

Framing the fallibility of Computer-Aided Detection aids cancer detection

Computer-Aided Detection (CAD) has been proposed to help operators search for cancers in mammograms. Previous studies have found that although accurate CAD leads to an improvement in cancer detection, inaccurate CAD leads to an increase in both missed cancers and false alarms. This is known as the over-reliance effect. We investigated whether providing framing statements of CAD fallibility could keep the benefits of CAD while reducing over-reliance. In Experiment 1, participants were told about the benefits or costs of CAD, prior to the experiment. Experiment 2 was similar, except that participants were given a stronger warning and instruction set in relation to the costs of CAD. The results showed that although there was no effect of framing in Experiment 1, a stronger message in Experiment 2 led to a reduction in the over-reliance effect. A similar result was found in Experiment 3 where the target had a lower prevalence. The results show that although the presence of CAD can result in over-reliance on the technology, these effects can be mitigated by framing and instruction sets in relation to CAD fallibility.

Diagnostic Performance of Artificial Intelligence-Based Computer-Aided Detection and Diagnosis in Pediatric Radiology: A Systematic Review

Artificial intelligence (AI)-based computer-aided detection and diagnosis (CAD) is an important research area in radiology. However, only two narrative reviews about general uses of AI in pediatric radiology and AI-based CAD in pediatric chest imaging have been published yet. The purpose of this systematic review is to investigate the AI-based CAD applications in pediatric radiology, their diagnostic performances and methods for their performance evaluation. A literature search with the use of electronic databases was conducted on 11 January 2023. Twenty-three articles that met the selection criteria were included. This review shows that the AI-based CAD could be applied in pediatric brain, respiratory, musculoskeletal, urologic and cardiac imaging, and especially for pneumonia detection. Most of the studies (93.3%, 14/15; 77.8%, 14/18; 73.3%, 11/15; 80.0%, 8/10; 66.6%, 2/3; 84.2%, 16/19; 80.0%, 8/10) reported model performances of at least 0.83 (area under receiver operating characteristic curve), 0.84 (sensitivity), 0.80 (specificity), 0.89 (positive predictive value), 0.63 (negative predictive value), 0.87 (accuracy), and 0.82 (F1 score), respectively. However, a range of methodological weaknesses (especially a lack of model external validation) are found in the included studies. In the future, more AI-based CAD studies in pediatric radiology with robust methodology should be conducted for convincing clinical centers to adopt CAD and realizing its benefits in a wider context.

Classification of Skin Cancer Using Novel Hyperspectral Imaging Engineering via YOLOv5

Many studies have recently used several deep learning methods for detecting skin cancer. However, hyperspectral imaging (HSI) is a noninvasive optics system that can obtain wavelength information on the location of skin cancer lesions and requires further investigation. Hyperspectral technology can capture hundreds of narrow bands of the electromagnetic spectrum both within and outside the visible wavelength range as well as bands that enhance the distinction of image features. The dataset from the ISIC library was used in this study to detect and classify skin cancer on the basis of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and seborrheic keratosis (SK). The dataset was divided into training and test sets, and you only look once (YOLO) version 5 was applied to train the model. The model performance was judged according to the generated confusion matrix and five indicating parameters, including precision, recall, specificity, accuracy, and the F1-score of the trained model. Two models, namely, hyperspectral narrowband image (HSI-NBI) and RGB classification, were built and then compared in this study to understand the performance of HSI with the RGB model. Experimental results showed that the HSI model can learn the SCC feature better than the original RGB image because the feature is more prominent or the model is not captured in other categories. The recall rate of the RGB and HSI models were 0.722 to 0.794, respectively, thereby indicating an overall increase of 7.5% when using the HSI model.

Artificial intelligence for digital breast tomosynthesis: Impact on diagnostic performance, reading times, and workload in the era of personalized screening

The ultimate goals of the application of artificial intelligence (AI) to digital breast tomosynthesis (DBT) are the reduction of reading times, the increase of diagnostic performance, and the reduction of interval cancer rates. In this review, after outlining the journey from computer-aided detection/diagnosis systems to AI applied to digital mammography (DM), we summarize the results of studies where AI was applied to DBT, noting that long-term advantages of DBT screening and its crucial ability to decrease the interval cancer rate are still under scrutiny. AI has shown the capability to overcome some shortcomings of DBT in the screening setting by improving diagnostic performance and by reducing recall rates (from -2 % to -27 %) and reading times (up to -53 %, with an average 20 % reduction), but the ability of AI to reduce interval cancer rates has not yet been clearly investigated. Prospective validation is needed to assess the cost-effectiveness and real-world impact of AI models assisting DBT interpretation, especially in large-scale studies with low breast cancer prevalence. Finally, we focus on the incoming era of personalized and risk-stratified screening that will first see the application of contrast-enhanced breast imaging to screen women with extremely dense breasts. As the diagnostic advantage of DBT over DM was concentrated in this category, we try to understand if the application of AI to DM in the remaining cohorts of women with heterogeneously dense or non-dense breast could close the gap in diagnostic performance between DM and DBT, thus neutralizing the usefulness of AI application to DBT.

Contextual Features and Information Bottleneck-Based Multi-Input Network for Breast Cancer Classification from Contrast-Enhanced Spectral Mammography

In computer-aided diagnosis methods for breast cancer, deep learning has been shown to be an effective method to distinguish whether lesions are present in tissues. However, traditional methods only classify masses as benign or malignant, according to their presence or absence, without considering the contextual features between them and their adjacent tissues. Furthermore, for contrast-enhanced spectral mammography, the existing studies have only performed feature extraction on a single image per breast. In this paper, we propose a multi-input deep learning network for automatic breast cancer classification. Specifically, we simultaneously input four images of each breast with different feature information into the network. Then, we processed the feature maps in both horizontal and vertical directions, preserving the pixel-level contextual information within the neighborhood of the tumor during the pooling operation. Furthermore, we designed a novel loss function according to the information bottleneck theory to optimize our multi-input network and ensure that the common information in the multiple input images could be fully utilized. Our experiments on 488 images (256 benign and 232 malignant images) from 122 patients show that the method's accuracy, precision, sensitivity, specificity, and f1-score values are 0.8806, 0.8803, 0.8810, 0.8801, and 0.8806, respectively. The qualitative, quantitative, and ablation experiment results show that our method significantly improves the accuracy of breast cancer classification and reduces the false positive rate of diagnosis. It can reduce misdiagnosis rates and unnecessary biopsies, helping doctors determine accurate clinical diagnoses of breast cancer from multiple CESM images.

Breast cancer detection and classification in mammogram using a three-stage deep learning framework based on PAA algorithm

In recent years, deep learning has been used to develop an automatic breast cancer detection and classification tool to assist doctors. In this paper, we proposed a three-stage deep learning framework based on an anchor-free object detection algorithm, named the Probabilistic Anchor Assignment (PAA) to improve diagnosis performance by automatically detecting breast lesions (i.e., mass and calcification) and further classifying mammograms into benign or malignant. Firstly, a single-stage PAA-based detector roundly finds suspicious breast lesions in mammogram. Secondly, we designed a two-branch ROI detector to further classify and regress these lesions that aim to reduce the number of false positives. Besides, in this stage, we introduced a threshold-adaptive post-processing algorithm with dense breast information. Finally, the benign or malignant lesions would be classified by an ROI classifier which combines local-ROI features and global-image features. In addition, considering the strong correlation between the task of detection head of PAA and the task of whole mammogram classification, we added an image classifier that utilizes the same global-image features to perform image classification. The image classifier and the ROI classifier jointly guide to enhance the feature extraction ability and further improve the performance of classification. We integrated three public datasets of mammograms (CBIS-DDSM, INbreast, MIAS) to train and test our model and compared our framework with recent state-of-the-art methods. The results show that our proposed method can improve the diagnostic efficiency of radiologists by automatically detecting and classifying breast lesions and classifying benign and malignant mammograms.

Computer-aided detection improves brain metastasis identification on non-enhanced CT in less experienced radiologists

Background

Brain metastases (BMs) are the most common intracranial tumors causing neurological complications associated with significant morbidity and mortality.

Purpose

To evaluate the effect of computer-aided detection (CAD) on the performance of observers in detecting BMs on non-enhanced computed tomography (NECT).

Material and Methods

Three less experienced and three experienced radiologists interpreted 30 NECT scans with 89 BMs in 25 cases to detect BMs with and without the assistance of CAD. The observers’ sensitivity, number of false positives (FPs), positive predictive value (PPV), and reading time with and without CAD were compared using paired t-tests. The sensitivity of CAD and the observers were compared using a one-sample t-test

Results

With CAD, less experienced radiologists’ sensitivity significantly increased from 27.7% ± 4.6% to 32.6% ± 4.8% ( P = 0.007), while the experienced radiologists’ sensitivity did not show a significant difference (from 33.3% ± 3.5% to 31.9% ± 3.7%; P = 0.54). There was no significant difference between conditions with CAD and without CAD for FPs (less experienced radiologists: 23.0 ± 10.4 and 25.0 ± 9.3; P = 0.32; experienced radiologists: 18.3 ± 7.4 and 17.3 ± 6.7; P = 0.76) and PPVs (less experienced radiologists: 57.9% ± 8.3% and 50.9% ± 7.0%; P = 0.14; experienced radiologists: 61.8% ± 12.7% and 64.0% ± 12.1%; P = 0.69). There were no significant differences in reading time with and without CAD (85.0 ± 45.6 s and 73.7 ± 36.7 s; P = 0.09). The sensitivity of CAD was 47.2% (with a PPV of 8.9%), which was significantly higher than that of any radiologist ( P < 0.001).

Conclusion

CAD improved BM detection sensitivity on NECT without increasing FPs or reading time among less experienced radiologists, but this was not the case among experienced radiologists.

Artificial Intelligence in Breast Cancer Screening and Diagnosis

Cancer is a disease that continues to plague our modern society. Among all types of cancer, breast cancer is now the most common type of cancer occurring in women worldwide. Various factors, including genetics, lifestyle, and the environment, have contributed to the rise in the prevalence of breast cancer among women of all socioeconomic strata. Therefore, proper screening for early diagnosis and treatment becomes a major factor when fighting the disease. Artificial intelligence (AI) continues to revolutionize various spheres of our lives with its numerous applications. Using AI in the existing screening process makes obtaining results even easier and more convenient. Faster, more accurate results are some of the benefits of AI methods in breast cancer screening. Nonetheless, there are many challenges in the process of the integration of AI that needs to be addressed systematically. The following is a review of the application of AI in breast cancer screening.

Applying artificial intelligence technology to assist with breast cancer diagnosis and prognosis prediction

Breast cancer remains the most diagnosed cancer in women. Advances in medical imaging modalities and technologies have greatly aided in the early detection of breast cancer and the decline of patient mortality rates. However, reading and interpreting breast images remains difficult due to the high heterogeneity of breast tumors and fibro-glandular tissue, which results in lower cancer detection sensitivity and specificity and large inter-reader variability. In order to help overcome these clinical challenges, researchers have made great efforts to develop computer-aided detection and/or diagnosis (CAD) schemes of breast images to provide radiologists with decision-making support tools. Recent rapid advances in high throughput data analysis methods and artificial intelligence (AI) technologies, particularly radiomics and deep learning techniques, have led to an exponential increase in the development of new AI-based models of breast images that cover a broad range of application topics. In this review paper, we focus on reviewing recent advances in better understanding the association between radiomics features and tumor microenvironment and the progress in developing new AI-based quantitative image feature analysis models in three realms of breast cancer: predicting breast cancer risk, the likelihood of tumor malignancy, and tumor response to treatment. The outlook and three major challenges of applying new AI-based models of breast images to clinical practice are also discussed. Through this review we conclude that although developing new AI-based models of breast images has achieved significant progress and promising results, several obstacles to applying these new AI-based models to clinical practice remain. Therefore, more research effort is needed in future studies.

A Survey on Human Cancer Categorization Based on Deep Learning

In recent years, we have witnessed the fast growth of deep learning, which involves deep neural networks, and the development of the computing capability of computer devices following the advance of graphics processing units (GPUs). Deep learning can prototypically and successfully categorize histopathological images, which involves imaging classification. Various research teams apply deep learning to medical diagnoses, especially cancer diseases. Convolutional neural networks (CNNs) detect the conventional visual features of disease diagnoses, e.g., lung, skin, brain, prostate, and breast cancer. A CNN has a procedure for perfectly investigating medicinal science images. This study assesses the main deep learning concepts relevant to medicinal image investigation and surveys several charities in the field. In addition, it covers the main categories of imaging procedures in medication. The survey comprises the usage of deep learning for object detection, classification, and human cancer categorization. In addition, the most popular cancer types have also been introduced. This article discusses the Vision-Based Deep Learning System among the dissimilar sorts of data mining techniques and networks. It then introduces the most extensively used DL network category, which is convolutional neural networks (CNNs) and investigates how CNN architectures have evolved. Starting with Alex Net and progressing with the Google and VGG networks, finally, a discussion of the revealed challenges and trends for upcoming research is held.

AI-CAD for differentiating lesions presenting as calcifications only on mammography: outcome analysis incorporating the ACR BI-RADS descriptors for calcifications

OBJECTIVES

To evaluate how AI-CAD triages calcifications and to compare its performance to an experienced breast radiologist.

METHODS

Among routine mammography performed between June 2016 and May 2018, 535 lesions detected as calcifications only on mammography in 500 women (mean age, 48.8 years) that were additionally interpreted with additional magnification views were included in this study. One dedicated breast radiologist retrospectively reviewed the magnification mammograms to assess morphology, distribution, and final assessment category according to ACR BI-RADS. AI-CAD analyzed routine mammograms providing AI-CAD marks and corresponding AI-CAD scores (ranging from 0 to 100%), for which values ≥ 10% were considered positive. Ground truth in terms of malignancy or benignity was confirmed with a histopathologic diagnosis or at least 1 year of imaging follow - up.

RESULTS

Of the 535 calcifications, 215 (40.2%) were malignant. Calcifications with positive AI-CAD scores showed significantly higher PPVs compared to calcifications with negative scores for all morphology (all p < 0.05). PPVs were significantly higher in calcifications with positive AI-CAD scores compared to those with negative scores for BI-RADS 3, 4a, or 4b assessments (all p < 0.05). AI-CAD and the experienced radiologist did not show significant difference in diagnostic performance; sensitivity 92.1% vs 95.4% (p = 0.125), specificity 71.9% vs 72.5% (p = 0.842), and accuracy 80.0% vs 81.7% (p = 0.413).

CONCLUSION

Among calcifications with same morphology or BI-RADS assessment, those with positive AI-CAD scores had significantly higher PPVs. AI-CAD showed similar diagnostic performances to the experienced radiologist for calcifications detected on mammography.

KEY POINTS

• Among calcifications with same morphology or BI-RADS assessment, those with positive AI-CAD scores had significantly higher PPVs. • AI-CAD showed similar diagnostic performance to an experienced radiologist in assessing lesions detected as calcifications only on mammography. • Among malignant calcifications, calcifications with positive AI-CAD scores showed higher rates of invasive cancers than calcifications with negative scores (all p > 0.05).

A Comparison of Computer-Aided Diagnosis Schemes Optimized Using Radiomics and Deep Transfer Learning Methods

Objective: Radiomics and deep transfer learning are two popular technologies used to develop computer-aided detection and diagnosis (CAD) schemes of medical images. This study aims to investigate and to compare the advantages and the potential limitations of applying these two technologies in developing CAD schemes. Methods: A relatively large and diverse retrospective dataset including 3000 digital mammograms was assembled in which 1496 images depicted malignant lesions and 1504 images depicted benign lesions. Two CAD schemes were developed to classify breast lesions. The first scheme was developed using four steps namely, applying an adaptive multi-layer topographic region growing algorithm to segment lesions, computing initial radiomics features, applying a principal component algorithm to generate an optimal feature vector, and building a support vector machine classifier. The second CAD scheme was built based on a pre-trained residual net architecture (ResNet50) as a transfer learning model to classify breast lesions. Both CAD schemes were trained and tested using a 10-fold cross-validation method. Several score fusion methods were also investigated to classify breast lesions. CAD performances were evaluated and compared by the areas under the ROC curve (AUC). Results: The ResNet50 model-based CAD scheme yielded AUC = 0.85 ± 0.02, which was significantly higher than the radiomics feature-based CAD scheme with AUC = 0.77 ± 0.02 (p < 0.01). Additionally, the fusion of classification scores generated by the two CAD schemes did not further improve classification performance. Conclusion: This study demonstrates that using deep transfer learning is more efficient to develop CAD schemes and it enables a higher lesion classification performance than CAD schemes developed using radiomics-based technology.

Deep learning for automated detection and numbering of permanent teeth on panoramic images

OBJECTIVE

This study aimed to evaluate an automated detection system to detect and classify permanent teeth on orthopantomogram (OPG) images using convolutional neural networks (CNNs).

METHODS

In total, 591 digital OPGs were collected from patients older than 18 years. Three qualified dentists performed individual teeth labelling on images to generate the ground truth annotations. A three-step procedure, relying upon CNNs, was proposed for automated detection and classification of teeth. Firstly, U-Net, a type of CNN, performed preliminary segmentation of tooth regions or detecting regions of interest (ROIs) on panoramic images. Secondly, the Faster R-CNN, an advanced object detection architecture, identified each tooth within the ROI determined by the U-Net. Thirdly, VGG-16 architecture classified each tooth into 32 categories, and a tooth number was assigned. A total of 17,135 teeth cropped from 591 radiographs were used to train and validate the tooth detection and tooth numbering modules. 90% of OPG images were used for training, and the remaining 10% were used for validation. 10-folds cross-validation was performed for measuring the performance. The intersection over union (IoU), F1 score, precision, and recall (i.e. sensitivity) were used as metrics to evaluate the performance of resultant CNNs.

RESULTS

The ROI detection module had an IoU of 0.70. The tooth detection module achieved a recall of 0.99 and a precision of 0.99. The tooth numbering module had a recall, precision and F1 score of 0.98.

CONCLUSION

The resultant automated method achieved high performance for automated tooth detection and numbering from OPG images. Deep learning can be helpful in the automatic filing of dental charts in general dentistry and forensic medicine.

Deep learning-based breast region extraction of mammographic images combining pre-processing methods and semantic segmentation supported by Deeplab v3

BACKGROUND

Breast cancer has long been one of the major global life-threatening illnesses among women. Surgery and adjuvant therapy, coupled with early detection, could save many lives. This underscores the importance of mammography, a cost-effective and accurate method for early detection. Due to the poor contrast, noise and artifacts which results in difficulty for radiologists to diagnose, Computer-Aided Diagnosis (CAD) systems are hence developed. The extraction of breast region is a fundamental and crucial preparation step for further development of CAD systems.

OBJECTIVE

The proposed method aims to extract breast region accurately from mammographic images where noise is suppressed, contrast is enhanced and pectoral muscle region is removed.

METHODS

This paper presents a new deep learning-based breast region extraction method that combines pre-processing methods containing noise suppression using median filter, contrast enhancement using CLAHE and semantic segmentation using Deeplab v3+ model.

RESULTS

The method is trained and evaluated on mini-MIAS dataset. It has also been evaluated on INbreast dataset. The results outperform those generated by other recent researches and are indicative of the capacity of the model to retain its accuracy and runtime advantage across different databases with different image resolutions.

CONCLUSIONS

The proposed method shows state-of-the-art performance at extracting breast region from mammographic images. Wide range of evaluation on two commonly used mammography datasets proves the ability and adaptability of the method.

Artificial Intelligence Detection of Missed Cancers at Digital Mammography That Were Detected at Digital Breast Tomosynthesis

Purpose

To investigate how an artificial intelligence (AI) system performs at digital mammography (DM) from a screening population with ground truth defined by digital breast tomosynthesis (DBT), and whether AI could detect breast cancers at DM that had originally only been detected at DBT.

Materials and Methods

In this secondary analysis of data from a prospective study, DM examinations from 14 768 women (mean age, 57 years), examined with both DM and DBT with independent double reading in the Malmӧ Breast Tomosynthesis Screening Trial (MBTST) (ClinicalTrials.gov: NCT01091545; data collection, 2010-2015), were analyzed with an AI system. Of 136 screening-detected cancers, 95 cancers were detected at DM and 41 cancers were detected only at DBT. The system identifies suspicious areas in the image, scored 1-100, and provides a risk score of 1 to 10 for the whole examination. A cancer was defined as AI detected if the cancer lesion was correctly localized and scored at least 62 (threshold determined by the AI system developers), therefore resulting in the highest examination risk score of 10. Data were analyzed with descriptive statistics, and detection performance was analyzed with receiver operating characteristics.

Results

The highest examination risk score was assigned to 10% (1493 of 14 786) of the examinations. With 90.8% specificity, the AI system detected 75% (71 of 95) of the DM-detected cancers and 44% (18 of 41) of cancers at DM that had originally been detected only at DBT. The majority were invasive cancers (17 of 18).

Conclusion

Almost half of the additional DBT-only screening-detected cancers in the MBTST were detected at DM with AI. AI did not reach double reading performance; however, if combined with double reading, AI has the potential to achieve a substantial portion of the benefit of DBT screening.Keywords: Computer-aided Diagnosis, Mammography, Breast, Diagnosis, Classification, Application DomainClinical trial registration no. NCT01091545© RSNA, 2021.

Connected-UNets: a deep learning architecture for breast mass segmentation

Breast cancer analysis implies that radiologists inspect mammograms to detect suspicious breast lesions and identify mass tumors. Artificial intelligence techniques offer automatic systems for breast mass segmentation to assist radiologists in their diagnosis. With the rapid development of deep learning and its application to medical imaging challenges, UNet and its variations is one of the state-of-the-art models for medical image segmentation that showed promising performance on mammography. In this paper, we propose an architecture, called Connected-UNets, which connects two UNets using additional modified skip connections. We integrate Atrous Spatial Pyramid Pooling (ASPP) in the two standard UNets to emphasize the contextual information within the encoder–decoder network architecture. We also apply the proposed architecture on the Attention UNet (AUNet) and the Residual UNet (ResUNet). We evaluated the proposed architectures on two publically available datasets, the Curated Breast Imaging Subset of Digital Database for Screening Mammography (CBIS-DDSM) and INbreast, and additionally on a private dataset. Experiments were also conducted using additional synthetic data using the cycle-consistent Generative Adversarial Network (CycleGAN) model between two unpaired datasets to augment and enhance the images. Qualitative and quantitative results show that the proposed architecture can achieve better automatic mass segmentation with a high Dice score of 89.52%, 95.28%, and 95.88% and Intersection over Union (IoU) score of 80.02%, 91.03%, and 92.27%, respectively, on CBIS-DDSM, INbreast, and the private dataset.

SCREENING MAMMOGRAPHY: DIAGNOSTIC EFFICACY-ISSUES AND CONSIDERATIONS FOR THE 2020S

Diagnostic efficacy in medical imaging is ultimately a reflection of radiologist performance. This can be influenced by numerous factors, some of which are patient related, such as the physical size and density of the breast, and machine related, where some lesions are difficult to visualise on traditional imaging techniques. Other factors are human reader errors that occur during the diagnostic process, which relate to reader experience and their perceptual and cognitive oversights. Given the large-scale nature of breast cancer screening, even small increases in diagnostic performance equate to large numbers of women saved. It is important to identify the causes of diagnostic errors and how detection efficacy can be improved. This narrative review will therefore explore the various factors that influence mammographic performance and the potential solutions used in an attempt to ameliorate the errors made.

Are We Overdoing It? Changes in Diagnostic Imaging Workload during the Years 2010-2020 including the Impact of the SARS-CoV-2 Pandemic

Since the 1990s, there has been a significant increase in the number of imaging examinations as well as a related increase in the healthcare expenditure and the exposure of the population to X-rays. This study aimed to analyze the workload trends in radiology during the last decade, including the impact of COVID-19 in a single university hospital in Poland and to identify possible solutions to the challenges that radiology could face in the future. We compared the annual amount of computed tomography (CT), radiography (X-ray), and ultrasound (US) examinations performed between the years 2010 and 2020 and analyzed the changes in the number of practicing radiologists in Poland. The mean number of patients treated in our hospital was 60,727 per year. During the last decade, the number of CT and US examinations nearly doubled (from 87.4 to 155.7 and from 52.1 to 86.5 per 1000 patients in 2010 and 2020 respectively), while X-ray examinations decreased from 115.1 to 96.9 per 1000 patients. The SARS-CoV-2 pandemic did not change the workload trends as more chest examinations were performed. AI, which contributed to the COVID-19 diagnosis, could aid radiologists in the future with the growing workload by increasing the efficiency of radiology departments as well as by potentially minimizing the related costs.

Emergence of teleradiology, PACS, and other radiology IT solutions in Acta Radiologica

For this historical review, we searched a database containing all the articles published in Acta Radiologica during its 100-year history to find those on the use of information technology (IT) in radiology. After reading the full texts, we selected the presented articles according to major radiology IT domains such as teleradiology, picture archiving and communication systems, image processing, image analysis, and computer-aided diagnostics in order to describe the development as it appeared in the journal. Publications generally follow IT megatrends, but because the contents of Acta Radiologica are mainly clinically oriented, some technology achievements appear later than they do in journals discussing mainly imaging informatics topics.

Automated Segmentation of Abnormal Tissues in Medical Images

Nowadays, medical image modalities are almost available everywhere. These modalities are bases of diagnosis of various diseases sensitive to specific tissue type. Usually physicians look for abnormalities in these modalities in diagnostic procedures. Count and volume of abnormalities are very important for optimal treatment of patients. Segmentation is a preliminary step for these measurements and also further analysis. Manual segmentation of abnormalities is cumbersome, error prone, and subjective. As a result, automated segmentation of abnormal tissue is a need. In this study, representative techniques for segmentation of abnormal tissues are reviewed. Main focus is on the segmentation of multiple sclerosis lesions, breast cancer masses, lung nodules, and skin lesions. As experimental results demonstrate, the methods based on deep learning techniques perform better than other methods that are usually based on handy feature engineering techniques. Finally, the most common measures to evaluate automated abnormal tissue segmentation methods are reported

Prospective Deployment of Deep Learning in MRI: A Framework for Important Considerations, Challenges, and Recommendations for Best Practices

Artificial intelligence algorithms based on principles of deep learning (DL) have made a large impact on the acquisition, reconstruction, and interpretation of MRI data. Despite the large number of retrospective studies using DL, there are fewer applications of DL in the clinic on a routine basis. To address this large translational gap, we review the recent publications to determine three major use cases that DL can have in MRI, namely, that of model-free image synthesis, model-based image reconstruction, and image or pixel-level classification. For each of these three areas, we provide a framework for important considerations that consist of appropriate model training paradigms, evaluation of model robustness, downstream clinical utility, opportunities for future advances, as well recommendations for best current practices. We draw inspiration for this framework from advances in computer vision in natural imaging as well as additional healthcare fields. We further emphasize the need for reproducibility of research studies through the sharing of datasets and software. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 2.

DCANet: Dual contextual affinity network for mass segmentation in whole mammograms

PURPOSE

Breast mass segmentation in mammograms remains a crucial yet challenging topic in computer-aided diagnosis systems. Existing algorithms mainly used mass-centered patches to achieve mass segmentation, which is time-consuming and unstable in clinical diagnosis. Therefore, we aim to directly perform fully automated mass segmentation in whole mammograms with deep learning solutions.

METHODS

In this work, we propose a novel dual contextual affinity network (a.k.a., DCANet) for mass segmentation in whole mammograms. Based on the encoder-decoder structure, two lightweight yet effective contextual affinity modules including the global-guided affinity module (GAM) and the local-guided affinity module (LAM) are proposed. The former aggregates the features integrated by all positions and captures long-range contextual dependencies, aiming to enhance the feature representations of homogeneous regions. The latter emphasizes semantic information around each position and exploits contextual affinity based on the local field-of-view, aiming to improve the indistinction among heterogeneous regions.

RESULTS

The proposed DCANet is greatly demonstrated on two public mammographic databases including the DDSM and the INbreast, achieving the Dice similarity coefficient (DSC) of 85.95% and 84.65%, respectively. Both segmentation performance and computational efficiency outperform the current state-of-the-art methods.

CONCLUSION

According to extensive qualitative and quantitative analyses, we believe that the proposed fully automated approach has sufficient robustness to provide fast and accurate diagnoses for possible clinical breast mass segmentation.

Improved Inception V3 method and its effect on radiologists' performance of tumor classification with automated breast ultrasound system

BACKGROUND

The automated breast ultrasound system (ABUS) is recognized as a valuable detection tool in addition to mammography. The purpose of this study was to propose a novel computer-aided diagnosis (CAD) system by extracting the textural features from ABUS images and to investigate the efficiency of using this CAD for breast cancer detection.

METHODS

This retrospective study involved 149 breast nodules [maximum diameter: mean size 18.89 mm, standard deviation (SD) 10.238, and range 5-59 mm] in 135. We assigned 3 novice readers (<3 years of experience and 3 experienced readers (≥10 years of experience to review the imaging data and stratify the 149 breast nodules as either malignant or benign. The Improved Inception V3 (II3) method was developed and used as an assistant tool to help the 6 readers to re-interpret the images.

RESULTS

Our method (II3) achieved an accuracy of 88.6% for the final result. The 3 novice readers had an average accuracy of 71.37%±4.067% while the 3 experienced readers was 83.03%±3.371% on the first-reading. With the help of II3 on the second-reading, the average accuracy of the novice readers increased to 84.13%±1.662% and the experienced readers increased to 89.50%±0.346%.The areas under the curve (AUCs) were similar compared with linear algorithms. The mean AUC of the novice readers was improved from 0.7751 (without II3) to 0.8232 (with II3). The mean AUC of the experienced readers was improved from 0.8939 (without II3) to 0.9211 (with II3). The mean AUC for all readers improved in both the second-reading mode (from 0.8345 to 0.8722, P=0.0081<0.05).

CONCLUSIONS

With the help of the II3, the diagnostic accuracy of the two groups were both improved, and II3 was more helpful for novice readers than for experienced readers. Our results showed that II3 is valuable in the differentiation of benign and malignant breast nodules and it also improves the experience and skill of some novice radiologists. The II3 cannot completely replace the influence of experience in the diagnostic process and will retain an auxiliary role in the clinic at present.

Mini review: The FDA-approved prescription drugs that target the MAPK signaling pathway in women with breast cancer

Breast cancer (BC) is the most common cancer and the prevalent type of malignancy among women. Multiple risk factors, including genetic changes, biological age, dense breast tissue, and obesity are associated with BC. The mitogen-activated protein kinases (MAPK) signaling pathway has a pivotal role in regulating biological functions such as cell proliferation, differentiation, apoptosis, and survival. It has become evident that the MAPK pathway is associated with tumorigenesis and may promote breast cancer development. The MAPK/RAS/RAF cascade is closely associated with breast cancer. RAS signaling can enhance BC cell growth and progression. B-Raf is an important kinase and a potent RAF isoform involved in breast tumor initiation and differentiation. Depending on the reasons for cancer, there are different strategies for treatment of women with BC. Till now, several FDA-approved treatments have been investigated that inhibit the MAPK pathway and reduce metastatic progression in breast cancer. The most common breast cancer drugs that regulate or inhibit the MAPK pathway may include Farnesyltransferase inhibitors (FTIs), Sorafenib, Vemurafenib, PLX8394, Dabrafenib, Ulixertinib, Simvastatin, Alisertib, and Teriflunomide. In this review, we will discuss the roles of the MAPK/RAS/RAF/MEK/ERK pathway in BC and summarize the FDA-approved prescription drugs that target the MAPK signaling pathway in women with BC.

Deep learning in breast radiology: current progress and future directions

This review provides an overview of current applications of deep learning methods within breast radiology. The diagnostic capabilities of deep learning in breast radiology continue to improve, giving rise to the prospect that these methods may be integrated not only into detection and classification of breast lesions, but also into areas such as risk estimation and prediction of tumor responses to therapy. Remaining challenges include limited availability of high-quality data with expert annotations and ground truth determinations, the need for further validation of initial results, and unresolved medicolegal considerations. KEY POINTS: • Deep learning (DL) continues to push the boundaries of what can be accomplished by artificial intelligence (AI) in breast imaging with distinct advantages over conventional computer-aided detection. • DL-based AI has the potential to augment the capabilities of breast radiologists by improving diagnostic accuracy, increasing efficiency, and supporting clinical decision-making through prediction of prognosis and therapeutic response. • Remaining challenges to DL implementation include a paucity of prospective data on DL utilization and yet unresolved medicolegal questions regarding increasing AI utilization.

Robust breast cancer detection in mammography and digital breast tomosynthesis using an annotation-efficient deep learning approach

Breast cancer remains a global challenge, causing over 600,000 deaths in 2018 (ref. ¹). To achieve earlier cancer detection, health organizations worldwide recommend screening mammography, which is estimated to decrease breast cancer mortality by 20-40% (refs. ^2,3). Despite the clear value of screening mammography, significant false positive and false negative rates along with non-uniformities in expert reader availability leave opportunities for improving quality and access^4,5. To address these limitations, there has been much recent interest in applying deep learning to mammography^6-18, and these efforts have highlighted two key difficulties: obtaining large amounts of annotated training data and ensuring generalization across populations, acquisition equipment and modalities. Here we present an annotation-efficient deep learning approach that (1) achieves state-of-the-art performance in mammogram classification, (2) successfully extends to digital breast tomosynthesis (DBT; '3D mammography'), (3) detects cancers in clinically negative prior mammograms of patients with cancer, (4) generalizes well to a population with low screening rates and (5) outperforms five out of five full-time breast-imaging specialists with an average increase in sensitivity of 14%. By creating new 'maximum suspicion projection' (MSP) images from DBT data, our progressively trained, multiple-instance learning approach effectively trains on DBT exams using only breast-level labels while maintaining localization-based interpretability. Altogether, our results demonstrate promise towards software that can improve the accuracy of and access to screening mammography worldwide.

Comparison of segmentation-free and segmentation-dependent computer-aided diagnosis of breast masses on a public mammography dataset

PURPOSE

To compare machine learning methods for classifying mass lesions on mammography images that use predefined image features computed over lesion segmentations to those that leverage segmentation-free representation learning on a standard, public evaluation dataset.

METHODS

We apply several classification algorithms to the public Curated Breast Imaging Subset of the Digital Database for Screening Mammography (CBIS-DDSM), in which each image contains a mass lesion. Segmentation-free representation learning techniques for classifying lesions as benign or malignant include both a Bag-of-Visual-Words (BoVW) method and a Convolutional Neural Network (CNN). We compare classification performance of these techniques to that obtained using two different segmentation-dependent approaches from the literature that rely on specific combinations of end classifiers (e.g. linear discriminant analysis, neural networks) and predefined features computed over the lesion segmentation (e.g. spiculation measure, morphological characteristics, intensity metrics).

RESULTS

We report area under the receiver operating characteristic curve (AZ) values for malignancy classification on CBIS-DDSM for each technique. We find average AZ values of 0.73 for a segmentation-free BoVW method, 0.86 for a segmentation-free CNN method, 0.75 for a segmentation-dependent linear discriminant analysis of Rubber-Band Straightening Transform features, and 0.58 for a hybrid rule-based neural network classification using a small number of hand-designed features.

CONCLUSIONS

We find that malignancy classification performance on the CBIS-DDSM dataset using segmentation-free BoVW features is comparable to that of the best segmentation-dependent methods we study, but also observe that a common segmentation-free CNN model substantially and significantly outperforms each of these (p < 0.05). These results reinforce recent findings suggesting that representation learning techniques such as BoVW and CNNs are advantageous for mammogram analysis because they do not require lesion segmentation, the quality and specific characteristics of which can vary substantially across datasets. We further observe that segmentation-dependent methods achieve performance levels on CBIS-DDSM inferior to those achieved on the original evaluation datasets reported in the literature. Each of these findings reinforces the need for standardization of datasets, segmentation techniques, and model implementations in performance assessments of automated classifiers for medical imaging.

Deep-Learning-Based Computer-Aided Systems for Breast Cancer Imaging: A Critical Review

This paper provides a critical review of the literature on deep learning applications in breast tumor diagnosis using ultrasound and mammography images. It also summarizes recent advances in computer-aided diagnosis/detection (CAD) systems, which make use of new deep learning methods to automatically recognize breast images and improve the accuracy of diagnoses made by radiologists. This review is based upon published literature in the past decade (January 2010–January 2020), where we obtained around 250 research articles, and after an eligibility process, 59 articles were presented in more detail. The main findings in the classification process revealed that new DL-CAD methods are useful and effective screening tools for breast cancer, thus reducing the need for manual feature extraction. The breast tumor research community can utilize this survey as a basis for their current and future studies.

Staying abreast of imaging - Current status of breast cancer detection in high density breast

OBJECTIVES

The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions.

KEY FINDINGS

Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available.

CONCLUSION

Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma.

IMPLICATIONS FOR PRACTICE

It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer.

Automated mammographic mass detection using deformable convolution and multiscale features

Designing computer-assisted diagnosis (CAD) systems that can precisely identify lesions from mammography images would be useful for clinicians. Considering the morphological variation in breast cancer, it is necessary to extract robust features from the mammogram. Here, we propose a mass detection CAD system that is based on Faster R-CNN. First, we applied a novel convolution network in the backbone of Faster R-CNN, namely deformable convolution network (DCN), which improves the detection of lesions with varying shapes and sizes. Second, the original Faster R-CNN uses the output of the last layer of the backbone as a single-scale feature map. To facilitate the detection of small lesions, we used a multiscale feature pyramid network of multiple cross-scale connections between the different output layers of the backbone, called the neural architecture search-feature pyramid network (NAS-FPN). Thus, we were able to integrate the best features into the model. We then evaluated our method by using the datasets the Curated Breast Imaging Subset of Digital Database for Screening Mammography (CBIS-DDSM) and INbreast, respectively. Our method yielded a true positive rate of 0.9345 at 2.2805 false positive per image on CBIS-DDSM and a true positive rate of 0.9554 at 0.3829 false positive per image on INbreast. Graphical abstract.

Multiple analyte profiling (MAP) index as a powerful diagnostic and therapeutic monitoring tool

A robust data mining algorithm is presented as a critical solution to the challenge of managing intensive data generated from the recently developed multiplexing techniques, which allow simultaneous detection of up to 500 biomarkers in a few microliters of a single sample. Furthermore, detailed methodology is provided for exploiting the new algorithm along with examples for description of the first application as a powerful diagnostic and therapeutic monitoring tool in the management of breast cancer, as a disease model.

New Frontiers: An Update on Computer-Aided Diagnosis for Breast Imaging in the Age of Artificial Intelligence

OBJECTIVE

The purpose of this article is to compare traditional versus machine learning-based computer-aided detection (CAD) platforms in breast imaging with a focus on mammography, to underscore limitations of traditional CAD, and to highlight potential solutions in new CAD systems under development for the future.

CONCLUSION

CAD development for breast imaging is undergoing a paradigm shift based on vast improvement of computing power and rapid emergence of advanced deep learning algorithms, heralding new systems that may hold real potential to improve clinical care.

Deep Learning-Based Classification of Liver Cancer Histopathology Images Using Only Global Labels

Liver cancer is a leading cause of cancer deaths worldwide due to its high morbidity and mortality. Histopathological image analysis (HIA) is a crucial step in the early diagnosis of liver cancer and is routinely performed manually. However, this process is time-consuming, error-prone, and easily affected by the expertise of pathologists. Recently, computer-aided methods have been widely applied to medical image analysis; however, the current medical image analysis studies have not yet focused on the histopathological morphology of liver cancer due to its complex features and the insufficiency of training images with detailed annotations. This paper proposes a deep learning method for liver cancer histopathological image classification using only global labels. To compensate for the lack of detailed cancer region annotations in those images, patch features are extracted and fully utilized. Transfer learning is used to obtain the patch-level features and then combined with multiple-instance learning to acquire the image-level features for classification. The method proposed here solves the processing of large-scale images and training sample insufficiency in liver cancer histopathological images for image classification. The proposed method can distinguish and classify liver histopathological images as abnormal or normal with high accuracy, thus providing support for the early diagnosis of liver cancer.

Classification of Microcalcification Clusters in Digital Mammograms Using a Stack Generalization Based Classifier

This paper presents a machine learning based approach for the discrimination of malignant and benign microcalcification (MC) clusters in digital mammograms. A series of morphological operations was carried out to facilitate the feature extraction from segmented microcalcification. A combination of morphological, texture, and distribution features from individual MC components and MC clusters were extracted and a correlation-based feature selection technique was used. The clinical relevance of the selected features is discussed. The proposed method was evaluated using three different databases: Optimam Mammography Image Database (OMI-DB), Digital Database for Screening Mammography (DDSM), and Mammographic Image Analysis Society (MIAS) database. The best classification accuracy (95.00±0.57%) was achieved for OPTIMAM using a stack generalization classifier with 10-fold cross validation obtaining an Az value equal to 0.97±0.01.

Multiscale connected chain topological modelling for microcalcification classification

Computer-aided diagnosis (CAD) systems can be employed to help classify mammographic microcalcification clusters. In this paper, a novel method for the classification of the microcalcification clusters based on topology/connectivity has been introduced. The proposed method is distinct from existing techniques which concentrate on morphology and texture of microcalcifications and surrounding tissue. The proposed approach used multiscale morphological relationship of connectivity between microcalcifications where connected chains between nearest microcalcifications were generated at each scale. Subsequently, graph connectivity features at each scale were extracted to estimate the topological connectivity structure of microcalcification clusters for benign versus malignant classification. The proposed approach was evaluated using publicly available digitized datasets: MIAS and DDSM, in addition to the digital OPTIMAM dataset. The classification of features using KNN obtained a classification accuracy of 86.47±1.30%, 90.0±0.00%, 82.5±2.63%, 76.75±0.66% for the DDSM, MIAS-manual, MIAS-auto and OPTIMAM datasets respectively. The study showed that topological/connectivity modelling using a multiscale approach was appropriate for microcalcification cluster analysis and classification; topological connectivity and distribution can be linked to clinical understanding of microcalcification spatial distribution.

Screening mammography beyond breast cancer: breast arterial calcifications as a sex-specific biomarker of cardiovascular risk

PURPOSE

To highlight the importance of quantitative breast arterial calcifications (BAC) assessment for an effective stratification of cardiovascular (CV) risk in women, for whom current preventive strategies are inadequate. BAC, easily detectable on mammograms, are associated with CV disease and represent a potential imaging biomarker for CV disease prevention in women.

METHOD

We summarized the available evidence on this topic.

RESULTS

Age, parity, diabetes, and hyperlipidemia were found to positively correlate with BAC. Women with BAC have a higher CV risk than those without BAC: the relative risk was reported to be 1.4 for transient ischemic attack/stroke, 1.5 for thrombosis, 1.8 for myocardial infarction; the reported hazard ratio was 1.32 for coronary artery disease (CAD), 1.52 for heart failure, 1.29 for CV death, 1.44 for death from CAD. However, BAC do not alarm radiologists; when reported, they are commonly mentioned as "present", not impacting on CV decision-making. Of 18 published studies, 9 reported only presence/absence of BAC, 4 used a semi-quantitative scale, and 5 a continuous scale (with manual, automatic or semiautomatic segmentation). Various appearance, topological complexity, and vessels overlap make BAC quantification difficult to standardize. Nevertheless, machine learning approaches showed promising results in BAC quantification on mammograms.

CONCLUSIONS

There is a strong rationale for mammography to become a dual test for breast cancer screening and CV disease prevention. However, robust and automated quantification methods are needed for a deeper insight on the association between BAC and CV disease, to stratifying CV risk and define personalized preventive actions.

Comparison Analysis of Linear Discriminant Analysis and Cuckoo-Search Algorithm in the Classification of Breast Cancer from Digital Mammograms

Objective:

Breast cancer is the most common invasive severity which leads to the second primary cause of death among women. The objective of this paper is to propose a computer-aided approach for the breast cancer classification from the digital mammograms.

Methods:

Designing an effective classification approach will assist in resolving the difficulties in analyzing digital mammograms. The proposed work utilized the Mammogram Image Analysis Society (MIAS) database for the analysis of breast cancer. Five distinct wavelet families are used for extraction of features from the mammograms of MIAS database. These extracted features are statistical in nature and served as input to the Linear Discriminant Analysis (LDA) and Cuckoo-Search Algorithm (CSA) classifiers.

Results:

Error rate, Sensitivity, Specificity and Accuracy are the performance measures used and the obtained results clearly state that the CSA used as a classifier affords an accuracy of 97.5% while compared with the LDA classifier.

Conclusion:

The results of comparative performance analysis show that the CSA classifier outperforms the performance of LDA in terms of breast cancer classification.

Digital Analysis in Breast Imaging

Breast imaging is a multimodal approach that plays an essential role in the diagnosis of breast cancer. Mammography, sonography, magnetic resonance, and image-guided biopsy are imaging techniques used to search for malignant changes in the breast or precursors of malignant changes in, e.g., screening programs or follow-ups after breast cancer treatment. However, these methods still have some disadvantages such as interobserver variability and the mammography sensitivity in women with radiologically dense breasts. In order to overcome these difficulties and decrease the number of false positive findings, improvements in imaging analysis with the help of artificial intelligence are constantly being developed and tested. In addition, the extraction and correlation of imaging features with special tumor characteristics and genetics of the patients in order to get more information about treatment response, prognosis, and also cancer risk are coming more and more in focus. The aim of this review is to address recent developments in digital analysis of images and demonstrate their potential value in multimodal breast imaging.