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Faur IF, Dobrescu A, Clim IA, Pasca P, Prodan-Barbulescu C, Tarta C, Neamtu C, Isaic A, Brebu D, Braicu V, Feier CVI, Duta C, Totolici B. Sentinel Lymph Node Biopsy in Breast Cancer Using Different Types of Tracers According to Molecular Subtypes and Breast Density-A Randomized Clinical Study. Diagnostics (Basel) 2024; 14:2439. [PMID: 39518406 PMCID: PMC11545725 DOI: 10.3390/diagnostics14212439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/18/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
Background: Sentinel lymph node biopsy (SLNB) has become a method more and more frequently used in loco-regional breast cancer in the initial stages. Starting from the first report on the technical feasibility of the sentinel node method in breast cancer, published by Krag (1993) and Giuliano (1994), the method underwent numerous improvements and was also largely used worldwide. Methods: This article is a prospective study that took place at the "SJUPBT Surgery Clinic Timisoara" over a period of 1 year between July 2023 and July 2024, during which 137 underwent sentinel lymph node biopsy (SLNB) based on the current guidelines. For the identification of sentinel lymph nodes, we used various methods, including single traces and also a dual tracer and triple tracer. Results: Breast density represents a predictive biomarker for the identification rate of a sentinel node, being directly correlated with BMI (above 30 kg/m2) and with an age of above 50 years. The classification of the patients according to breast density represents an important criterion given that an adipose breast density (Tabar-Gram I-II) represents a lower IR of SLN compared with a density of the fibro-nodular type (Tabar-Gram III-V). We did not obtain any statistically significant data for the linear correlations between IR and the molecular profile, whether referring to the luminal subtypes (Luminal A and Luminal B) or to the non-luminal ones (HER2+ and TNBC), with p > 0.05, 0.201 [0.88, 0.167]; z = 1.82.
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Affiliation(s)
- Ionut Flaviu Faur
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Multidisciplinary Doctoral School “Vasile Goldiș”, Western University of Arad, 310025 Arad, Romania
| | - Amadeus Dobrescu
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Ioana Adelina Clim
- II Obstetrics and Gynecology Clinic “Dominic Stanca”, 400124 Cluj-Napoca, Romania;
| | - Paul Pasca
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Catalin Prodan-Barbulescu
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- Department I, Discipline of Anatomy and Embriology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristi Tarta
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Carmen Neamtu
- Faculty of Dentistry, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania;
- I Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
| | - Alexandru Isaic
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Dan Brebu
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Vlad Braicu
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Catalin Vladut Ionut Feier
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- First Surgery Clinic, “Pius Brinzeu” Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Ciprian Duta
- II Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (A.D.); (P.P.); (C.P.-B.); (C.T.); (A.I.); (D.B.); (V.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Bogdan Totolici
- I Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
- Department of General Surgery, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
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Loizidou K, Elia R, Pitris C. Computer-aided breast cancer detection and classification in mammography: A comprehensive review. Comput Biol Med 2023; 153:106554. [PMID: 36646021 DOI: 10.1016/j.compbiomed.2023.106554] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Cancer is the second cause of mortality worldwide and it has been identified as a perilous disease. Breast cancer accounts for ∼20% of all new cancer cases worldwide, making it a major cause of morbidity and mortality. Mammography is an effective screening tool for the early detection and management of breast cancer. However, the identification and interpretation of breast lesions is challenging even for expert radiologists. For that reason, several Computer-Aided Diagnosis (CAD) systems are being developed to assist radiologists to accurately detect and/or classify breast cancer. This review examines the recent literature on the automatic detection and/or classification of breast cancer in mammograms, using both conventional feature-based machine learning and deep learning algorithms. The review begins with a comparison of algorithms developed specifically for the detection and/or classification of two types of breast abnormalities, micro-calcifications and masses, followed by the use of sequential mammograms for improving the performance of the algorithms. The available Food and Drug Administration (FDA) approved CAD systems related to triage and diagnosis of breast cancer in mammograms are subsequently presented. Finally, a description of the open access mammography datasets is provided and the potential opportunities for future work in this field are highlighted. The comprehensive review provided here can serve both as a thorough introduction to the field but also provide indicative directions to guide future applications.
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Affiliation(s)
- Kosmia Loizidou
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia, Cyprus.
| | - Rafaella Elia
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia, Cyprus.
| | - Costas Pitris
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia, Cyprus.
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Loizidou K, Skouroumouni G, Nikolaou C, Pitris C. A Review of Computer-Aided Breast Cancer Diagnosis Using Sequential Mammograms. Tomography 2022; 8:2874-2892. [PMID: 36548533 PMCID: PMC9785714 DOI: 10.3390/tomography8060241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Radiologists assess the results of mammography, the key screening tool for the detection of breast cancer, to determine the presence of malignancy. They, routinely, compare recent and prior mammographic views to identify changes between the screenings. In case a new lesion appears in a mammogram, or a region is changing rapidly, it is more likely to be suspicious, compared to a lesion that remains unchanged and it is usually benign. However, visual evaluation of mammograms is challenging even for expert radiologists. For this reason, various Computer-Aided Diagnosis (CAD) algorithms are being developed to assist in the diagnosis of abnormal breast findings using mammograms. Most of the current CAD systems do so using only the most recent mammogram. This paper provides a review of the development of methods to emulate the radiological approach and perform automatic segmentation and/or classification of breast abnormalities using sequential mammogram pairs. It begins with demonstrating the importance of utilizing prior views in mammography, through the review of studies where the performance of expert and less-trained radiologists was compared. Following, image registration techniques and their application to mammography are presented. Subsequently, studies that implemented temporal analysis or subtraction of temporally sequential mammograms are summarized. Finally, a description of the open access mammography datasets is provided. This comprehensive review can serve as a thorough introduction to the use of prior information in breast cancer CAD systems but also provides indicative directions to guide future applications.
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Affiliation(s)
- Kosmia Loizidou
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia 2109, Cyprus
| | | | - Christos Nikolaou
- Radiology Department, Limassol General Hospital, Limassol 3304, Cyprus
| | - Costas Pitris
- KIOS Research and Innovation Center of Excellence, Department of Electrical and Computer Engineering, University of Cyprus, Nicosia 2109, Cyprus
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Implementing Multilabeling, ADASYN, and ReliefF Techniques for Classification of Breast Cancer Diagnostic through Machine Learning: Efficient Computer-Aided Diagnostic System. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5577636. [PMID: 33859807 PMCID: PMC8009715 DOI: 10.1155/2021/5577636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/19/2021] [Accepted: 02/27/2021] [Indexed: 11/17/2022]
Abstract
Multilabel recognition of morphological images and detection of cancerous areas are difficult to locate in the scenario of the image redundancy and less resolution. Cancerous tissues are incredibly tiny in various scenarios. Therefore, for automatic classification, the characteristics of cancer patches in the X-ray image are of critical importance. Due to the slight variation between the textures, using just one feature or using a few features contributes to inaccurate classification outcomes. The present study focuses on five different algorithms for extracting features that can extract further different features. The algorithms are GLCM, LBGLCM, LBP, GLRLM, and SFTA from 8 image groups, and then, the extracted feature spaces are combined. The dataset used for classification is most probably imbalanced. Additionally, another focal point is to eradicate the unbalanced data problem by creating more samples using the ADASYN algorithm so that the error rate is minimized and the accuracy is increased. By using the ReliefF algorithm, it skips less contributing features that relieve the burden on the process. Finally, the feedforward neural network is used for the classification of data. The proposed method showed 99.5% micro, 99.5% macro, 0.5% misclassification, 99.5% recall rats, specificity 99.4%, precision 99.5%, and accuracy 99.5%, showing its robustness in these results. To assess the feasibility of the new system, the INbreast database was used.
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Fully Automated Breast Density Segmentation and Classification Using Deep Learning. Diagnostics (Basel) 2020; 10:diagnostics10110988. [PMID: 33238512 PMCID: PMC7700286 DOI: 10.3390/diagnostics10110988] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/16/2023] Open
Abstract
Breast density estimation with visual evaluation is still challenging due to low contrast and significant fluctuations in the mammograms’ fatty tissue background. The primary key to breast density classification is to detect the dense tissues in the mammographic images correctly. Many methods have been proposed for breast density estimation; nevertheless, most of them are not fully automated. Besides, they have been badly affected by low signal-to-noise ratio and variability of density in appearance and texture. This study intends to develop a fully automated and digitalized breast tissue segmentation and classification using advanced deep learning techniques. The conditional Generative Adversarial Networks (cGAN) network is applied to segment the dense tissues in mammograms. To have a complete system for breast density classification, we propose a Convolutional Neural Network (CNN) to classify mammograms based on the standardization of Breast Imaging-Reporting and Data System (BI-RADS). The classification network is fed by the segmented masks of dense tissues generated by the cGAN network. For screening mammography, 410 images of 115 patients from the INbreast dataset were used. The proposed framework can segment the dense regions with an accuracy, Dice coefficient, Jaccard index of 98%, 88%, and 78%, respectively. Furthermore, we obtained precision, sensitivity, and specificity of 97.85%, 97.85%, and 99.28%, respectively, for breast density classification. This study’s findings are promising and show that the proposed deep learning-based techniques can produce a clinically useful computer-aided tool for breast density analysis by digital mammography.
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Breast Cancer Detection in Thermal Infrared Images Using Representation Learning and Texture Analysis Methods. ELECTRONICS 2019. [DOI: 10.3390/electronics8010100] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nowadays, breast cancer is one of the most common cancers diagnosed in women. Mammography is the standard screening imaging technique for the early detection of breast cancer. However, thermal infrared images (thermographies) can be used to reveal lesions in dense breasts. In these images, the temperature of the regions that contain tumors is warmer than the normal tissue. To detect that difference in temperature between normal and cancerous regions, a dynamic thermography procedure uses thermal infrared cameras to generate infrared images at fixed time steps, obtaining a sequence of infrared images. In this paper, we propose a novel method to model the changes on temperatures in normal and abnormal breasts using a representation learning technique called learning-to-rank and texture analysis methods. The proposed method generates a compact representation for the infrared images of each sequence, which is then exploited to differentiate between normal and cancerous cases. Our method produced competitive (AUC = 0.989) results when compared to other studies in the literature.
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Abdel-Nasser M, Moreno A, A. Rashwan H, Puig D. Analyzing the evolution of breast tumors through flow fields and strain tensors. Pattern Recognit Lett 2017. [DOI: 10.1016/j.patrec.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Casti P, Mencattini A, Salmeri M, Ancona A, Lorusso M, Pepe ML, Natale CD, Martinelli E. Towards localization of malignant sites of asymmetry across bilateral mammograms. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 140:11-18. [PMID: 28254066 DOI: 10.1016/j.cmpb.2016.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/17/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The analysis of patterns of asymmetry between the left and right mammograms of a patient can provide meaningful insights into the presence of an underlying tumor in its early stage. However, the identification of breast cancer by investigating bilateral asymmetry is difficult to perform due to the indistinct and borderline nature of the asymmetric signs as they appear on mammograms. METHODS In this study, to increase the positive-predictive value of asymmetry in mammographic screening, a novel computerized approach for the automatic localization of malignant sites of asymmetry in mammograms is proposed. The sites of anatomical correspondence between the right and left regions of each radiographic projection were extracted by means of two bilateral masking procedures, inspired by radiologists' criteria in interpreting mammograms and based on the use of detected landmarking structures. Relative variations of spatial patterns of intensity values and of orientations of directional components within each site were quantified by combining multidirectional Gabor filters and indices of structural similarity. The localization of the sites of malignant asymmetry was performed by coupling two quadratic discriminant analysis classifiers, one for each masking procedure, that assigned the likelihood of malignancy to each site of correspondence. RESULTS The performance of the proposed method was assessed on 94 mammographic images from two publicly available databases and containing at least one asymmetric site. Sensitivity, specificity and balanced accuracy levels of 0.83 (0.09), 0.75 (0.06), and 0.79 (0.04), respectively were obtained in the classification of malignant asymmetric sites vs benign/normal sites using cross-validation. In addition, a further blind test on a dataset of Full Field Digital Mammograms achieved levels of sensitivity, specificity, and balanced accuracy of 0.86, 0.65, and 0.75, respectively. CONCLUSIONS The achieved performance indicates that the proposed system is effective in localizing sites of malignant asymmetry and it is expected to improve computer-aided diagnosis of breast cancer.
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Affiliation(s)
- P Casti
- University of Rome Tor Vergata, Via del Politecnico 1, Rome 00133, Italy
| | - A Mencattini
- University of Rome Tor Vergata, Via del Politecnico 1, Rome 00133, Italy.
| | - M Salmeri
- University of Rome Tor Vergata, Via del Politecnico 1, Rome 00133, Italy
| | - A Ancona
- Radiology Unit, San Paolo Hospital of Bari, Bari, Italy
| | - M Lorusso
- Radiology Unit, San Paolo Hospital of Bari, Bari, Italy
| | - M L Pepe
- S.C. di Diagnostica per Immagini, P.O. Occidentale, Castellaneta-Massafra-Mottola, Azienda Unitá Sanitaria Locale, Taranto, Italy
| | - C Di Natale
- University of Rome Tor Vergata, Via del Politecnico 1, Rome 00133, Italy
| | - E Martinelli
- University of Rome Tor Vergata, Via del Politecnico 1, Rome 00133, Italy
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