Clinical Application of Computer-Aided Diagnosis for Breast Ultrasonography: Factors That Lead to Discordant Results in Radial and Antiradial Planes

Comparative Analysis of the Diagnostic Value of S-Detect Technology in Different Planes Versus the BI-RADS Classification for Breast Lesions

RATIONALE AND OBJECTIVES

S-Detect, a deep learning-based Computer-Aided Detection system, is recognized as an important tool for diagnosing breast lesions using ultrasound imaging. However, it may exhibit inconsistent findings across multiple imaging planes. This study aims to evaluate the diagnostic performance of S-Detect in different planes and identify factors contributing to these inconsistencies.

MATERIALS AND METHODS

A retrospective cohort study was conducted on 711 patients with 756 breast lesions between January 2019 and January 2022. S-Detect was utilized to assess lesions in radial and anti-radial planes. BI-RADS classifications were employed for comparative analysis. The diagnostic performance was compared within each group, and p-values were computed for intergroup comparisons. Univariable and multivariable analyses were conducted to identify factors contributing to diagnostic inconsistency in S-Detect across planes.

RESULTS

Among 756 breast lesions, 668 (88.4%) exhibited consistent S-Detect outcomes across planes while 88 (11.6%) were inconsistent. In the consistent group, the diagnostic accuracy and area under the curve (AUC) of S-Detect were significantly higher than those of BI-RADS (accuracy: 91.2% vs. 84.9%, p = 0.045; AUC: 0.916 vs. 0.859, p = 0.036). In the inconsistent group, the diagnostic accuracy and AUC of S-Detect in radial and anti-radial planes were lower than those of BI-RADS (accuracy: 47.7% for radial, 52.2% for anti-radial vs. 69.3% for BI-RADS, p = 0.014, p-anti = 0.039; AUC: 0.503 for radial, 0.497 for anti-radial vs. 0.739 for BI-RADS, p = 0.042, p-anti <0.001). Diagnostic inconsistency in S-Detect across planes was significantly associated with lesion size, indistinct or angular margins, and enhancement posterior acoustic features (p < 0.05).

CONCLUSION

S-Detect has outperformed BI-RADS in diagnostic precision under conditions of inter-planar concordance. However, its diagnostic efficacy is compromised in scenarios of inter-planar discordance. Under these circumstances, the results of S-Detect should be carefully referenced.

Clinical Application of Computer-Aided Diagnosis System in Breast Ultrasound: A Prospective Multicenter Study

OBJECTIVES

Ultrasound tends to present very high sensitivity but relatively low specificity and positive predictive value (PPV), which would result in unnecessary breast biopsies. The purpose of this study is to analyze the diagnostic performance of computer-aided diagnosis (CAD) (S-Detect) system in differentiating breast lesions and reducing unnecessary biopsies in non-university hospitals in less-developed regions of China.

METHODS

The study was a prospective multicenter study from 8 hospitals. The ultrasound images, and cine, CAD analysis, and BI-RADS were recorded. The accuracy, sensitivity, specificity, PPV, negative predictive value (NPV), and area under the curve (AUC) were analyzed and compared between CAD and radiologists. The Youden Index (YI) was used to determine optimal cut-off for the number of planes to downgrade.

RESULTS

A total of 491 breast lesions were included in the study. Less-experienced radiologists combined CAD was superior to less-experienced radiologists alone in AUC (0.878 vs 0.712, p < 0.001), and specificity (81.3% vs 44.6%, p < 0.001). There was no statistical difference in AUC (0.891 vs 0.878, p = 0.346), and specificity (82.3% vs 81.3%, p = 0.791) between experienced radiologists and less-experienced radiologists combined CAD. With CAD assistance, the biopsy rate of less-experienced radiologists was significantly decreased (100.0% vs 25.6%, p < 0.001), and malignant rate of biopsy was significantly increased (15.0% vs 43.9%, p < 0.001).

CONCLUSIONS

CAD system can be an effective auxiliary tool in differentiating breast lesions and reducing unnecessary biopsies for radiologists from non-university hospitals in less-developed regions of China.

Diagnostic performance of ultrasound with computer-aided diagnostic system in detecting breast cancer

Purpose

This study aims to examine the performance of breast ultrasound with a computer-aided diagnostic (CAD) system in detecting malignant breast cancer compared to conventional ultrasound and investigate the effects on smaller tumor sizes (≤20 mm).

Methods

This retrospective analysis included 123 patients with breast masses between March 2021 and July 2023. By using pathology results from biopsies or surgeries as the gold standard, we calculated and compared the diagnostic performances of conventional ultrasound and CAD, including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve (AUC). A subgroup analysis of masses ≤20 mm in size was performed.

Results

Twenty-seven patients were pathologically diagnosed with malignant breast cancer. CAD had a higher specificity (92.71 % vs. 62.5 %) and accuracy (93.5 % vs. 69.92 %) than conventional ultrasound. The AUC of CAD was significantly greater than that of conventional ultrasonography (0.9450 vs. 0.7940, p < 0.0001). The agreement between the CAD and pathology results was almost perfect (kappa = 0.82, p < 0.0001). In patients with masses ≤20 mm, the effect was consistent: CAD had higher specificity (91.43 % vs. 51.43 %), higher accuracy (90.70 % vs. 58.14 %), and a higher AUC (0.8946 vs. 0.6946, p < 0.0001) than conventional ultrasound. Thirty-one downgrades were observed in BI-RADS 4A and 4B based on CAD, all of which were proven to be benign.

Conclusion

Compared to conventional breast ultrasound, CAD had better diagnostic performance, with higher specificity, accuracy, and AUC. CAD can help recognize benign lesions, especially in patients with BI-RADS 4A, and avoid unnecessary invasive procedures.

Diagnostic accuracy of S-Detect to breast cancer on ultrasonography: A meta-analysis (PRISMA)

BACKGROUND

Computer-aided diagnosis (CAD) systems have shown great potential as an effective auxiliary diagnostic tool in breast imaging. Previous studies have shown that S-Detect technology has a high accuracy in the differential diagnosis of breast masses. However, the application of S-Detect in clinical practice remains controversial, and the results vary among different clinical trials. This meta-analysis aimed to determine the diagnostic accuracy of S-Detect for distinguishing between benign and malignant breast masses.

METHODS

We searched PubMed, Cochrane Library, and CBM databases from inception to April 1, 2021. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 softwares. We calculated the summary statistics for sensitivity (Sen), specificity (Spe), positive, and negative likelihood ratio (LR+/LR-), diagnostic odds ratio(DOR), and summary receiver operating characteristic (SROC) curves. Cochran Q-statistic and I2 test were used to evaluate the potential heterogeneity between studies. Sensitivity analysis was performed to evaluate the influence of single studies on the overall estimate. We also performed meta-regression analyses to investigate potential sources of heterogeneity.

RESULTS

Eleven studies that met all the inclusion criteria were included in the meta-analysis. A total of 951 malignant and 1866 benign breast masses were assessed. All breast masses were histologically confirmed using S-Detect. The pooled Sen was 0.82 (95% confidence interval(CI) = 0.74-0.88); the pooled Spe was 0.83 (95%CI = 0.78-0.88). The pooled LR + was 4.91 (95%CI = 3.75-6.41); the pooled negative LR - was 0.21 (95%CI = 0.15-0.31). The pooled DOR of S-Detect in the diagnosis of breast nodules was 23.12 (95% CI = 14.53-36.77). The area under the SROC curve was 0.90 (SE = 0.0166). No evidence of publication bias was found (t = 0.54, P = .61).

CONCLUSIONS

Our meta-analysis indicates that S-Detect may have high diagnostic accuracy in distinguishing benign and malignant breast masses.