Objective: Accurate detection and classification of breast lesions in early stage is crucial to timely formulate effective treatments for patients. We aim to develop a fully automatic system to detect and classify bre...Objective: Accurate detection and classification of breast lesions in early stage is crucial to timely formulate effective treatments for patients. We aim to develop a fully automatic system to detect and classify breast lesions using multiple contrast-enhanced mammography(CEM) images.Methods: In this study, a total of 1,903 females who underwent CEM examination from three hospitals were enrolled as the training set, internal testing set, pooled external testing set and prospective testing set. Here we developed a CEM-based multiprocess detection and classification system(MDCS) to perform the task of detection and classification of breast lesions. In this system, we introduced an innovative auxiliary feature fusion(AFF)algorithm that could intelligently incorporates multiple types of information from CEM images. The average freeresponse receiver operating characteristic score(AFROC-Score) was presented to validate system’s detection performance, and the performance of classification was evaluated by area under the receiver operating characteristic curve(AUC). Furthermore, we assessed the diagnostic value of MDCS through visual analysis of disputed cases,comparing its performance and efficiency with that of radiologists and exploring whether it could augment radiologists’ performance.Results: On the pooled external and prospective testing sets, MDCS always maintained a high standalone performance, with AFROC-Scores of 0.953 and 0.963 for detection task, and AUCs for classification were 0.909[95% confidence interval(95% CI): 0.822-0.996] and 0.912(95% CI: 0.840-0.985), respectively. It also achieved higher sensitivity than all senior radiologists and higher specificity than all junior radiologists on pooled external and prospective testing sets. Moreover, MDCS performed superior diagnostic efficiency with an average reading time of 5 seconds, compared to the radiologists’ average reading time of 3.2 min. The average performance of all radiologists was also improved to varying degrees with MDCS assistance.Conclusions: MDCS demonstrated excellent performance in the detection and classification of breast lesions,and greatly enhanced the overall performance of radiologists.展开更多
Mammograms are the mainstay of diagnostic breast imaging and cancer</span><span style="font-family:""><span style="font-family:Verdana;"> screening. Despite advances in techn...Mammograms are the mainstay of diagnostic breast imaging and cancer</span><span style="font-family:""><span style="font-family:Verdana;"> screening. Despite advances in technology such as Full Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT), these imaging techniques are purely structural, and are unable to overcome shortcomings in mammo</span><span style="font-family:Verdana;">graphy posed by dense breast parenchyma. Magnetic Resonance Imaging</span><span style="font-family:Verdana;"> (MRI) </span><span style="font-family:Verdana;">is the most sensitive modality in breast imaging, due to </span></span><span style="font-family:Verdana;">its </span><span style="font-family:Verdana;">functional aspect</span><span style="font-family:Verdana;">s in addition to structural imaging with this modality. The use of MRI is however constrained by cost and availability. </span><span style="font-family:Verdana;">The </span><span style="font-family:""><span style="font-family:Verdana;">utilization of intravenous contrast with mammograms introduces a functional ele</span><span style="font-family:Verdana;">ment to imaging. This greatly improves the sensitivity of the examination,</span><span style="font-family:Verdana;"> approaching sensitivity levels of Magnetic Resonance Imaging (MRI) in the detection of primary breast can</span><span style="font-family:Verdana;">cer. With increased sensitivity afforded by assessment of tumor neo</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">vascularity, as well as its low cost, low energy</span><span style="font-family:Verdana;"> <span style="font-family:Verdana;">imaging that is more readily available than MRI, Contrast</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">Enhanced Mammography (CEM) if more readily available than MRI, this imaging modality is a potential</span><span style="font-family:Verdana;"> game</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">changer in breast imaging. In this article, we share our experience in the use of CEM, for indications previously reserved for MRI, with </span><span style="font-family:Verdana;">the </span><span style="font-family:""><span style="font-family:Verdana;">literature review of t</span><span style="font-family:Verdana;">hese indications. In resonance with prior studies, we echo the ease of performing and reporting of CEM as well as greater patient comfort as the distinct advantages of CEM. In spite of slightly higher radiation dose and some risk</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> related to contrast media, functional results at </span><span style="font-family:Verdana;">a </span><span style="font-family:Verdana;">significantly lower cost may change h</span><span style="font-family:Verdana;">ow we practice breast imaging in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">future using CEM.展开更多
We have examined ten human subjects with a previously developed instrument for near-infrared diffuse spectral imaging of the female breast.The instrument is based on a tandem,planar scan of two collinear optical fiber...We have examined ten human subjects with a previously developed instrument for near-infrared diffuse spectral imaging of the female breast.The instrument is based on a tandem,planar scan of two collinear optical fibers(one for illumination and one for collection)to image a gently compressed breast in a transmission geometry.The optical data collection features a spatial sampling of 25 points/cm2 over the whole breast,and a spectral sampling of 2 points/nm in the 650-900nm wavelength range.Of the ten human subjects examined,eight are healthy subjects and two are cancer patients with unilateral invasive ductal carcinoma and ductal carcinoma in situ,respectively.For each subject,we generate second-derivative images that identify a network of highly absorbing structures in the breast that we assign to blood vessels.A previously developed paired-wavelength spectral method assigns oxygenation values to the absorbing structures displayed in the second-derivative images.The resulting oxygenation images feature average values over the whole breast that are significantly lower in cancerous breasts(69±14%,n=2)than in healthy breasts(85±7%,n=18)(p<0.01).Furthermore,in the two patients with breast cancer,the average oxygenation values in the cancerous regions are also significantly lower than in the remainder of the breast(invasive ductal carcinoma:49±11%vs 61±16%,p<0.01;ductal carcinoma in situ:58±8%vs 77±11%,p<0.001).展开更多
目的探讨对比增强能谱乳腺X线摄影(Contrast-enhanced energy spectrum mammography,CESM)针对可疑性钙化的临床价值与意义。方法回顾性研究2017年至2018年常规数字化乳腺X线成像(FFDM)摄影显示有可疑性钙化(诊断报告定义为BI-RADS4类)5...目的探讨对比增强能谱乳腺X线摄影(Contrast-enhanced energy spectrum mammography,CESM)针对可疑性钙化的临床价值与意义。方法回顾性研究2017年至2018年常规数字化乳腺X线成像(FFDM)摄影显示有可疑性钙化(诊断报告定义为BI-RADS4类)57例患者资料,均行CESM检查,通过CESM减影图像观察钙化区是否有强化征象,研究此影像特征与病理的相关性,最终以病理结果为金标准,评估出CESM对可疑性钙化的影像学诊断价值和鉴别诊断能力。结果CESM在判断可疑性钙化的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为94.7%(18/19),92.1%(35/38),85.7%(18/21),97.2(35/36),92.9%(53/57)。与病理结果比较差异无统计学意义(=0.000,P=1.00)。结论CESM检查技术对乳腺可疑性钙化有较高的诊断效能,采用此方法获得的影像,对致密性乳腺内钙化病灶的判定,可疑性钙化的穿刺定位,手术前病灶性质的评估等方面,具有准确可靠的临床实用价值。展开更多
基金supported by the National Natural Science Foundation of China (No.82001775, 82371933)the Natural Science Foundation of Shandong Province of China (No.ZR2021MH120)+1 种基金the Special Fund for Breast Disease Research of Shandong Medical Association (No.YXH2021ZX055)the Taishan Scholar Foundation of Shandong Province of China (No.tsgn202211378)。
文摘Objective: Accurate detection and classification of breast lesions in early stage is crucial to timely formulate effective treatments for patients. We aim to develop a fully automatic system to detect and classify breast lesions using multiple contrast-enhanced mammography(CEM) images.Methods: In this study, a total of 1,903 females who underwent CEM examination from three hospitals were enrolled as the training set, internal testing set, pooled external testing set and prospective testing set. Here we developed a CEM-based multiprocess detection and classification system(MDCS) to perform the task of detection and classification of breast lesions. In this system, we introduced an innovative auxiliary feature fusion(AFF)algorithm that could intelligently incorporates multiple types of information from CEM images. The average freeresponse receiver operating characteristic score(AFROC-Score) was presented to validate system’s detection performance, and the performance of classification was evaluated by area under the receiver operating characteristic curve(AUC). Furthermore, we assessed the diagnostic value of MDCS through visual analysis of disputed cases,comparing its performance and efficiency with that of radiologists and exploring whether it could augment radiologists’ performance.Results: On the pooled external and prospective testing sets, MDCS always maintained a high standalone performance, with AFROC-Scores of 0.953 and 0.963 for detection task, and AUCs for classification were 0.909[95% confidence interval(95% CI): 0.822-0.996] and 0.912(95% CI: 0.840-0.985), respectively. It also achieved higher sensitivity than all senior radiologists and higher specificity than all junior radiologists on pooled external and prospective testing sets. Moreover, MDCS performed superior diagnostic efficiency with an average reading time of 5 seconds, compared to the radiologists’ average reading time of 3.2 min. The average performance of all radiologists was also improved to varying degrees with MDCS assistance.Conclusions: MDCS demonstrated excellent performance in the detection and classification of breast lesions,and greatly enhanced the overall performance of radiologists.
文摘Mammograms are the mainstay of diagnostic breast imaging and cancer</span><span style="font-family:""><span style="font-family:Verdana;"> screening. Despite advances in technology such as Full Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT), these imaging techniques are purely structural, and are unable to overcome shortcomings in mammo</span><span style="font-family:Verdana;">graphy posed by dense breast parenchyma. Magnetic Resonance Imaging</span><span style="font-family:Verdana;"> (MRI) </span><span style="font-family:Verdana;">is the most sensitive modality in breast imaging, due to </span></span><span style="font-family:Verdana;">its </span><span style="font-family:Verdana;">functional aspect</span><span style="font-family:Verdana;">s in addition to structural imaging with this modality. The use of MRI is however constrained by cost and availability. </span><span style="font-family:Verdana;">The </span><span style="font-family:""><span style="font-family:Verdana;">utilization of intravenous contrast with mammograms introduces a functional ele</span><span style="font-family:Verdana;">ment to imaging. This greatly improves the sensitivity of the examination,</span><span style="font-family:Verdana;"> approaching sensitivity levels of Magnetic Resonance Imaging (MRI) in the detection of primary breast can</span><span style="font-family:Verdana;">cer. With increased sensitivity afforded by assessment of tumor neo</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">vascularity, as well as its low cost, low energy</span><span style="font-family:Verdana;"> <span style="font-family:Verdana;">imaging that is more readily available than MRI, Contrast</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">Enhanced Mammography (CEM) if more readily available than MRI, this imaging modality is a potential</span><span style="font-family:Verdana;"> game</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">changer in breast imaging. In this article, we share our experience in the use of CEM, for indications previously reserved for MRI, with </span><span style="font-family:Verdana;">the </span><span style="font-family:""><span style="font-family:Verdana;">literature review of t</span><span style="font-family:Verdana;">hese indications. In resonance with prior studies, we echo the ease of performing and reporting of CEM as well as greater patient comfort as the distinct advantages of CEM. In spite of slightly higher radiation dose and some risk</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> related to contrast media, functional results at </span><span style="font-family:Verdana;">a </span><span style="font-family:Verdana;">significantly lower cost may change h</span><span style="font-family:Verdana;">ow we practice breast imaging in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">future using CEM.
基金supported by the National Institutes of Health,Grant CA95885.
文摘We have examined ten human subjects with a previously developed instrument for near-infrared diffuse spectral imaging of the female breast.The instrument is based on a tandem,planar scan of two collinear optical fibers(one for illumination and one for collection)to image a gently compressed breast in a transmission geometry.The optical data collection features a spatial sampling of 25 points/cm2 over the whole breast,and a spectral sampling of 2 points/nm in the 650-900nm wavelength range.Of the ten human subjects examined,eight are healthy subjects and two are cancer patients with unilateral invasive ductal carcinoma and ductal carcinoma in situ,respectively.For each subject,we generate second-derivative images that identify a network of highly absorbing structures in the breast that we assign to blood vessels.A previously developed paired-wavelength spectral method assigns oxygenation values to the absorbing structures displayed in the second-derivative images.The resulting oxygenation images feature average values over the whole breast that are significantly lower in cancerous breasts(69±14%,n=2)than in healthy breasts(85±7%,n=18)(p<0.01).Furthermore,in the two patients with breast cancer,the average oxygenation values in the cancerous regions are also significantly lower than in the remainder of the breast(invasive ductal carcinoma:49±11%vs 61±16%,p<0.01;ductal carcinoma in situ:58±8%vs 77±11%,p<0.001).
文摘目的探讨对比增强能谱乳腺X线摄影(Contrast-enhanced energy spectrum mammography,CESM)针对可疑性钙化的临床价值与意义。方法回顾性研究2017年至2018年常规数字化乳腺X线成像(FFDM)摄影显示有可疑性钙化(诊断报告定义为BI-RADS4类)57例患者资料,均行CESM检查,通过CESM减影图像观察钙化区是否有强化征象,研究此影像特征与病理的相关性,最终以病理结果为金标准,评估出CESM对可疑性钙化的影像学诊断价值和鉴别诊断能力。结果CESM在判断可疑性钙化的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为94.7%(18/19),92.1%(35/38),85.7%(18/21),97.2(35/36),92.9%(53/57)。与病理结果比较差异无统计学意义(=0.000,P=1.00)。结论CESM检查技术对乳腺可疑性钙化有较高的诊断效能,采用此方法获得的影像,对致密性乳腺内钙化病灶的判定,可疑性钙化的穿刺定位,手术前病灶性质的评估等方面,具有准确可靠的临床实用价值。
