Multivariate Analysis on Performance Gaps of Artificial Intelligence Models in Screening Mammography
Kennesaw State University（肯尼索州立大学）；Emory University（埃默里大学）；Washington University in St. Louis School of Medicine（圣路易斯华盛顿大学医学院）；Mayo Clinic Arizona（梅奥诊所亚利桑那分院）；Arizona State University（亚利桑那州立大学）；York University（约克大学）
Although deep learning models for abnormality classification can perform well in screening mammography, the demographic, imaging, and clinical characteristics associated with increased risk of model failure remain unclear. This retrospective study uses the Emory BrEast Imaging Dataset(EMBED) containing mammograms from 115931 patients imaged at Emory Healthcare between 2013-2020, with BI-RADS assessment, region of interest coordinates for abnormalities, imaging features, pathologic outcomes, and patient demographics. Multiple deep learning models were trained to distinguish between abnormal tissue patches and randomly selected normal tissue patches from screening mammograms. We assessed model performance by subgroups defined by age, race, pathologic outcome, tissue density, and imaging characteristics and investigated their associations with false negatives (FN) and false positives (FP). We also performed multivariate logistic regression to control for confounding between subgroups. The top-performing model, ResNet152V2, achieved accuracy of 92.6%(95%CI=92.0-93.2%), and AUC 0.975(95%CI=0.972-0.978). Before controlling for confounding, nearly all subgroups showed statistically significant differences in model performance. However, after controlling for confounding, we found lower FN risk associates with Other race(RR=0.828;p=.050), biopsy-proven benign lesions(RR=0.927;p=.011), and mass(RR=0.921;p=.010) or asymmetry(RR=0.854;p=.040); higher FN risk associates with architectural distortion (RR=1.037;p<.001). Higher FP risk associates to BI-RADS density C(RR=1.891;p<.001) and D(RR=2.486;p<.001). Our results demonstrate subgroup analysis is important in mammogram classifier performance evaluation, and controlling for confounding between subgroups elucidates the true associations between variables and model failure. These results can help guide developing future breast cancer detection models.
A key promise of AI applications in healthcare is in increasing access to quality medical care in under-served populations and emerging markets. However, deep learning models are often only trained on data from advantaged populations that have the infrastructure and resources required for large-scale data collection. In this paper, we aim to empirically investigate the potential impact of such biases on breast cancer detection in mammograms. We specifically explore how a deep learning algorithm trained on screening mammograms from the US and UK generalizes to mammograms collected at a hospital…
A Multi-Modal AI System for Screening Mammography: Integrating 2D and 3D Imaging to Improve Breast Cancer Detection in a Prospective Clinical Study
Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine（NYU Grossman医学院Vilcek研究生生物医学科学研究所）；NYU Grossman School of Medicine（NYU Grossman医学院）；Center for Data Science, New York University（纽约大学数据科学中心）；Emory University（埃默里大学）；Visage Imaging, Inc.（Visage成像公司）
DeepHealth, Inc.（深健公司）；Rhode Island Hospital（罗德岛医院）；Brown University（布朗大学）；Henan Provincial People’s Hospital（河南省人民医院）；Medford Radiology Group（梅德福放射学集团）；University of Massachusetts Medical School（马萨诸塞大学医学院）
Breast cancer remains a global challenge, causing over 1 million deaths globally in 2018. To achieve earlier breast cancer detection, screening x-ray mammography is recommended by health organizations worldwide and has been estimated to decrease breast cancer mortality by 20-40%. Nevertheless, significant false positive and false negative rates, as well as high interpretation costs, leave opportunities for improving quality and access. To address these limitations, there has been much recent interest in applying deep learning to mammography; however, obtaining large amounts of annotated data p…
A major barrier to medical imaging research and in particular the development of artificial intelligence (AI) is a lack of large databases of medical images which share images with other researchers. Without such databases it is not possible to train generalisable AI algorithms, and large amounts of time and funding is spent collecting smaller datasets at individual research centres. The OPTIMAM image database (OMI-DB) has been developed to overcome these barriers. OMI-DB consists of several relational databases and cloud storage systems, containing mammography images and associated clinical a…
Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院）；Kaiser Permanente Northern California, Division of Research（北加州凯撒永久医疗集团研究部）
A major limitation in applying deep learning to artificial intelligence (AI) systems is the scarcity of high-quality curated datasets. We investigate strong augmentation based self-supervised learning (SSL) techniques to address this problem. Using breast cancer detection as an example, we first identify a mammogram-specific transformation paradigm and then systematically compare four recent SSL methods representing a diversity of approaches. We develop a method to convert a pretrained model from making predictions on uniformly tiled patches to whole images, and an attention-based pooling meth…
VRVis Zentrum für Virtual Reality und Visualisierung Forschungs-GmbH（VRVis虚拟现实与可视化研究中心有限公司）
Machine learning and deep learning methods have become essential for computer-assisted prediction in medicine, with a growing number of applications also in the field of mammography. Typically these algorithms are trained for a specific task, e.g., the classification of lesions or the prediction of a mammogram's pathology status. To obtain a comprehensive view of a patient, models which were all trained for the same task(s) are subsequently ensembled or combined. In this work, we propose a pipeline approach, where we first train a set of individual, task-specific models and subsequently invest…
Reconsidering Explicit Longitudinal Mammography Alignment for Enhanced Breast Cancer Risk Prediction
Department of Physics and Technology, UiT The Arctic University of Norway（物理与技术系，UiT北极大学）；SPKI The Norwegian Centre for Clinical Artificial Intelligence（挪威临床人工智能中心）；Department of Computer Science and Engineering, University of Bologna（计算机科学与工程系，博洛尼亚大学）；Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering IMTE（个体化和细胞基础医学工程研究机构IMTE）；Norwegian Computing Center, Oslo, Norway（挪威计算中心，奥斯陆，挪威）；Pioneer Centre for AI, University of Copenhagen（人工智能先锋中心，哥本哈根大学）
Institute of Big Data（大数据研究所）；VinUniversity（文大大学）；Hospital 108（108医院）；Hanoi Medical University Hospital（河内医科大学医院）；Yale University（耶鲁大学）
Mammography, or breast X-ray, is the most widely used imaging modality to detect cancer and other breast diseases. Recent studies have shown that deep learning-based computer-assisted detection and diagnosis (CADe or CADx) tools have been developed to support physicians and improve the accuracy of interpreting mammography. However, most published datasets of mammography are either limited on sample size or digitalized from screen-film mammography (SFM), hindering the development of CADe and CADx tools which are developed based on full-field digital mammography (FFDM). To overcome this challeng…
Transcend Research Consultancy（transcend研究咨询公司）；School of Computer Sciences, North Maharashtra University（北马哈拉施特拉大学计算机科学学院）
Mammography is a vital screening technique for early revealing and identification of breast cancer in order to assist to decrease mortality rate. Practical applications of mammograms are not limited to breast cancer revealing, identification ,but include task based lens design, image compression, image classification, content based image retrieval and a host of others. Mammography computational analysis methods are a useful tool for specialists to reveal hidden features and extract significant information in mammograms. Digital mammograms are mammography images available along with the convent…
Data scarcity and class imbalance are two fundamental challenges in many machine learning applications to healthcare. Breast cancer classification in mammography exemplifies these challenges, with a malignancy rate of around 0.5% in a screening population, which is compounded by the relatively small size of lesions (~1% of the image) in malignant cases. Simultaneously, the prevalence of screening mammography creates a potential abundance of non-cancer exams to use for training. Altogether, these characteristics lead to overfitting on cancer cases, while under-utilizing non-cancer data. Here, w…
Age estimation has attracted attention for its various medical applications. There are many studies on human age estimation from biomedical images. However, there is no research done on mammograms for age estimation, as far as we know. The purpose of this study is to devise an AI-based model for estimating age from mammogram images. Due to lack of public mammography data sets that have the age attribute, we resort to using a web crawler to download thumbnail mammographic images and their age fields from the public data set; the Digital Database for Screening Mammography. The original images in…
Beijing Institute of Technology（北京理工大学）；Université 8 Mai 1945 Guelma（盖勒马8 Mai 1945大学）；National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College（中国医学科学院北京协和医学院肿瘤医院国家癌症中心国家肿瘤临床研究中心）
Mammography remains the most prevalent imaging tool for early breast cancer screening. The language used to describe abnormalities in mammographic reports is based on the breast Imaging Reporting and Data System (BI-RADS). Assigning a correct BI-RADS category to each examined mammogram is a strenuous and challenging task for even experts. This paper proposes a new and effective computer-aided diagnosis (CAD) system to classify mammographic masses into four assessment categories in BI-RADS. The mass regions are first enhanced by means of histogram equalization and then semiautomatically segment…
Universidad Técnica Particular de Loja（洛哈技术大学）；Universitat Politécnica de Valencia（瓦伦西亚理工大学）；University of Waterloo（滑铁卢大学）
Breast cancer is the most common invasive cancer in women, and the second main cause of death. Breast cancer screening is an efficient method to detect indeterminate breast lesions early. The common approaches of screening for women are tomosynthesis and mammography images. However, the traditional manual diagnosis requires an intense workload by pathologists, who are prone to diagnostic errors. Thus, the aim of this study is to build a deep convolutional neural network method for automatic detection, segmentation, and classification of breast lesions in mammography images. Based on deep learn…
Knowledge of x-ray attenuation is essential for developing and evaluating x-ray imaging technologies. For instance, techniques to better characterize cysts at mammography screening would be highly desirable to reduce recalls, but the development is hampered by the lack of attenuation data for cysts. We have developed a method to measure x-ray attenuation of tissue samples using a prototype photon-counting spectral mammography unit. The method was applied to measure the attenuation of 50 samples of breast cyst fluid and 50 samples of water. Spectral (energy-resolved) images of the samples were …
DeepTek Inc（DeepTek公司）；University of Southern California（南加州大学）；DY Patil Hospital（DY Patil医院）
Edge devices are revolutionizing diagnostics. Edge devices can reside within or adjacent to imaging tools such as digital Xray, CT, MRI, or ultrasound equipment. These devices are either CPUs or GPUs with advanced processing deep and machine learning (artificial intelligence) algorithms that assist in classification and triage solutions to flag studies as either normal or abnormal, TB or healthy (in case of TB screening), suspected COVID-19/other pneumonia or unremarkable (in hospital or hotspot settings). These can be deployed as screening point-of-care (PoC) solutions; this is particularly t…
Automatic identification of patients with luminal and non-luminal subtypes during a routine mammography screening can support clinicians in streamlining breast cancer therapy planning. Recent machine learning techniques have shown promising results in molecular subtype classification in mammography; however, they are highly dependent on pixel-level annotations, handcrafted, and radiomic features. In this work, we provide initial insights into the luminal subtype classification in full mammogram images trained using only image-level labels. Transfer learning is applied from a breast abnormality…
Knowledge of x-ray attenuation is essential for developing and evaluating x-ray imaging technologies. For instance, techniques to distinguish between cysts and solid tumours at mammography screening would be highly desirable to reduce recalls, but the development requires knowledge of the x-ray attenuation for cysts and tumours. We have previously measured the attenuation of cyst fluid using photon-counting spectral mammography. Data on x-ray attenuation for solid breast lesions are available in the literature, but cover a relatively wide range, likely caused by natural spread between samples,…
Center for Data Science, New York University（纽约大学数据科学中心）；Department of Radiology, New York University School of Medicine（纽约大学医学院放射科）；Perlmutter Cancer Center, NYU Langone Health（纽约大学朗格尼医学中心珀尔马特癌症中心）；Center for Advanced Imaging Innovation and Research, NYU Langone Health（纽约大学朗格尼医学中心先进成像创新与研究中心）；Department of Computer Science, Courant Institute of Mathematical Sciences, New York University（纽约大学库朗数学科学研究所计算机科学系）
Breast cancer is the most common cancer in women, and hundreds of thousands of unnecessary biopsies are done around the world at a tremendous cost. It is crucial to reduce the rate of biopsies that turn out to be benign tissue. In this study, we build deep neural networks (DNNs) to classify biopsied lesions as being either malignant or benign, with the goal of using these networks as second readers serving radiologists to further reduce the number of false positive findings. We enhance the performance of DNNs that are trained to learn from small image patches by integrating global context prov…
Mayo Clinic（梅奥诊所）；Ohio State University（俄亥俄州立大学）；West Virginia University School of Medicine（西弗吉尼亚大学医学院）；NVIDIA Inc.（英伟达公司）
Screening mammograms are a routine imaging exam performed to detect breast cancer in its early stages to reduce morbidity and mortality attributed to this disease. In order to maximize the efficacy of breast cancer screening programs, proper mammographic positioning is paramount. Proper positioning ensures adequate visualization of breast tissue and is necessary for effective breast cancer detection. Therefore, breast-imaging radiologists must assess each mammogram for the adequacy of positioning before providing a final interpretation of the examination; this often necessitates return patient…
Institute of Information and Communication Technology, Bangladesh University of Engineering and Technology（孟加拉工程技术大学信息与通信技术学院）
Breast cancer is a common fatal disease for women. Early diagnosis and detection is necessary in order to improve the prognosis of breast cancer affected people. For predicting breast cancer, several automated systems are already developed using different medical imaging modalities. This paper provides a systematic review of the literature on artificial neural network (ANN) based models for the diagnosis of breast cancer via mammography. The advantages and limitations of different ANN models including spiking neural network (SNN), deep belief network (DBN), convolutional neural network (CNN), …
Institute for Systems and Robotics（系统与机器人研究所）；Interactive Technologies Institute（交互技术研究所）
This paper describes the field research, design and comparative deployment of a multimodal medical imaging user interface for breast screening. The main contributions described here are threefold: 1) The design of an advanced visual interface for multimodal diagnosis of breast cancer (BreastScreening); 2) Insights from the field comparison of single vs multimodality screening of breast cancer diagnosis with 31 clinicians and 566 images, and 3) The visualization of the two main types of breast lesions in the following image modalities: (i) MammoGraphy (MG) in both Craniocaudal (CC) and Mediolat…
Artificial Intelligence-Informed Handheld Breast Ultrasound for Screening: A Systematic Review of Diagnostic Test Accuracy
University of Hawai’i at Mānoa（夏威夷大学马诺阿分校）；University of Hawai’i Cancer Center（夏威夷大学癌症中心）；Karolinska Institutet（卡罗林斯卡学院）；Karolinska University Hospital（卡罗林斯卡大学医院）
University of Pennsylvania（宾夕法尼亚大学）；Mayo Clinic（梅奥诊所）
Breast density is an important risk factor for breast cancer that also affects the specificity and sensitivity of screening mammography. Current federal legislation mandates reporting of breast density for all women undergoing breast screening. Clinically, breast density is assessed visually using the American College of Radiology Breast Imaging Reporting And Data System (BI-RADS) scale. Here, we introduce an artificial intelligence (AI) method to estimate breast percentage density (PD) from digital mammograms. Our method leverages deep learning (DL) using two convolutional neural network arch…
Augmented Intelligence for Multimodal Virtual Biopsy in Breast Cancer Using Generative Artificial Intelligence
Department of Radiology, Fondazione Policlinico Campus Bio-Medico（放射学系，政策临床医学院）；Department of Radiology, Università Campus Bio-Medico di Roma（放射学系，罗马生物医学大学）；Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University（诊断与介入系，辐射物理，生物医学工程，乌梅拉大学）
