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Afrin H, Larson NB, Fatemi M, Alizad A. Deep Learning in Different Ultrasound Methods for Breast Cancer, from Diagnosis to Prognosis: Current Trends, Challenges, and an Analysis. Cancers (Basel) 2023; 15:3139. [PMID: 37370748 PMCID: PMC10296633 DOI: 10.3390/cancers15123139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Breast cancer is the second-leading cause of mortality among women around the world. Ultrasound (US) is one of the noninvasive imaging modalities used to diagnose breast lesions and monitor the prognosis of cancer patients. It has the highest sensitivity for diagnosing breast masses, but it shows increased false negativity due to its high operator dependency. Underserved areas do not have sufficient US expertise to diagnose breast lesions, resulting in delayed management of breast lesions. Deep learning neural networks may have the potential to facilitate early decision-making by physicians by rapidly yet accurately diagnosing and monitoring their prognosis. This article reviews the recent research trends on neural networks for breast mass ultrasound, including and beyond diagnosis. We discussed original research recently conducted to analyze which modes of ultrasound and which models have been used for which purposes, and where they show the best performance. Our analysis reveals that lesion classification showed the highest performance compared to those used for other purposes. We also found that fewer studies were performed for prognosis than diagnosis. We also discussed the limitations and future directions of ongoing research on neural networks for breast ultrasound.
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Affiliation(s)
- Humayra Afrin
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Nicholas B. Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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Trepanier C, Huang A, Liu M, Ha R. Emerging uses of artificial intelligence in breast and axillary ultrasound. Clin Imaging 2023; 100:64-68. [PMID: 37243994 DOI: 10.1016/j.clinimag.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023]
Abstract
Breast ultrasound is a valuable adjunctive tool to mammography in detecting breast cancer, especially in women with dense breasts. Ultrasound also plays an important role in staging breast cancer by assessing axillary lymph nodes. However, its utility is limited by operator dependence, high recall rate, low positive predictive value and low specificity. These limitations present an opportunity for artificial intelligence (AI) to improve diagnostic performance and pioneer novel uses of ultrasound. Research in developing AI for radiology has flourished over the past few years. A subset of AI, deep learning, uses interconnected computational nodes to form a neural network, which extracts complex visual features from image data to train itself into a predictive model. This review summarizes several key studies evaluating AI programs' performance in predicting breast cancer and demonstrates that AI can assist radiologists and address limitations of ultrasound by acting as a decision support tool. This review also touches on how AI programs allow for novel predictive uses of ultrasound, particularly predicting molecular subtypes of breast cancer and response to neoadjuvant chemotherapy, which have the potential to change how breast cancer is managed by providing non-invasive prognostic and treatment data from ultrasound images. Lastly, this review explores how AI programs demonstrate improved diagnostic accuracy in predicting axillary lymph node metastasis. The limitations and future challenges in developing and implementing AI for breast and axillary ultrasound will also be discussed.
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Affiliation(s)
- Christopher Trepanier
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, United States of America.
| | - Alice Huang
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, United States of America.
| | - Michael Liu
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, United States of America.
| | - Richard Ha
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, United States of America.
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Zhu Y, Li C, Hu K, Luo H, Zhou M, Li X, Gao X. A new two-stream network based on feature separation and complementation for ultrasound image segmentation. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Zhang G, Shi Y, Yin P, Liu F, Fang Y, Li X, Zhang Q, Zhang Z. A machine learning model based on ultrasound image features to assess the risk of sentinel lymph node metastasis in breast cancer patients: Applications of scikit-learn and SHAP. Front Oncol 2022; 12:944569. [PMID: 35957890 PMCID: PMC9359803 DOI: 10.3389/fonc.2022.944569] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to determine an optimal machine learning (ML) model for evaluating the preoperative diagnostic value of ultrasound signs of breast cancer lesions for sentinel lymph node (SLN) status. Method This study retrospectively analyzed the ultrasound images and postoperative pathological findings of lesions in 952 breast cancer patients. Firstly, the univariate analysis of the relationship between the ultrasonographic features of breast cancer morphological features and SLN metastasis. Then, based on the ultrasound signs of breast cancer lesions, we screened ten ML models: support vector machine (SVM), extreme gradient boosting (XGBoost), random forest (RF), linear discriminant analysis (LDA), logistic regression (LR), naive bayesian model (NB), k-nearest neighbors (KNN), multilayer perceptron (MLP), long short-term memory (LSTM), and convolutional neural network (CNN). The diagnostic performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), Kappa value, accuracy, F1-score, sensitivity, and specificity. Then we constructed a clinical prediction model which was based on the ML algorithm with the best diagnostic performance. Finally, we used SHapley Additive exPlanation (SHAP) to visualize and analyze the diagnostic process of the ML model. Results Of 952 patients with breast cancer, 394 (41.4%) had SLN metastasis, and 558 (58.6%) had no metastasis. Univariate analysis found that the shape, orientation, margin, posterior features, calculations, architectural distortion, duct changes and suspicious lymph node of breast cancer lesions in ultrasound signs were associated with SLN metastasis. Among the 10 ML algorithms, XGBoost had the best comprehensive diagnostic performance for SLN metastasis, with Average-AUC of 0.952, Average-Kappa of 0.763, and Average-Accuracy of 0.891. The AUC of the XGBoost model in the validation cohort was 0.916, the accuracy was 0.846, the sensitivity was 0.870, the specificity was 0.862, and the F1-score was 0.826. The diagnostic performance of the XGBoost model was significantly higher than that of experienced radiologists in some cases (P<0.001). Using SHAP to visualize the interpretation of the ML model screen, it was found that the ultrasonic detection of suspicious lymph nodes, microcalcifications in the primary tumor, burrs on the edge of the primary tumor, and distortion of the tissue structure around the lesion contributed greatly to the diagnostic performance of the XGBoost model. Conclusions The XGBoost model based on the ultrasound signs of the primary breast tumor and its surrounding tissues and lymph nodes has a high diagnostic performance for predicting SLN metastasis. Visual explanation using SHAP made it an effective tool for guiding clinical courses preoperatively.
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Affiliation(s)
- Gaosen Zhang
- Department of Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yan Shi
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, China
| | - Peipei Yin
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, China
| | - Feifei Liu
- Department of Ultrasound Medicine, Peking University People’s Hospital, Beijing, China
| | - Yi Fang
- Department of Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiang Li
- Department of Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qingyu Zhang
- College of Information Science and Engineering, Northeastern University, Shenyang, China
| | - Zhen Zhang
- Department of Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Zhen Zhang,
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Coronado-Gutiérrez D, Ganau S, Bargalló X, Úbeda B, Porta M, Sanfeliu E, Burgos-Artizzu XP. Quantitative ultrasound image analysis of axillary lymph nodes to differentiate malignancy from reactive benign changes due to COVID-19 vaccination. Eur J Radiol 2022; 154:110438. [PMID: 35820268 PMCID: PMC9259511 DOI: 10.1016/j.ejrad.2022.110438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
Purpose The aim of this study is to assess the potential of quantitative image analysis and machine learning techniques to differentiate between malignant lymph nodes and benign lymph nodes affected by reactive changes due to COVID-19 vaccination. Method In this institutional review board–approved retrospective study, we improved our previously published artificial intelligence model, by retraining it with newly collected images and testing its performance on images containing benign lymph nodes affected by COVID-19 vaccination. All the images were acquired and selected by specialized breast-imaging radiologists and the nature of each node (benign or malignant) was assessed through a strict clinical protocol using ultrasound-guided biopsies. Results A total of 180 new images from 154 different patients were recruited: 71 images (10 cases and 61 controls) were used to retrain the old model and 109 images (36 cases and 73 controls) were used to evaluate its performance. The achieved accuracy of the proposed method was 92.7% with 77.8% sensitivity and 100% specificity at the optimal cut-off point. In comparison, the visual node inspection made by radiologists from ultrasound images reached 69.7% accuracy with 41.7% sensitivity and 83.6% specificity. Conclusions The results obtained in this study show the potential of the proposed techniques to differentiate between malignant lymph nodes and benign nodes affected by reactive changes due to COVID-19 vaccination. These techniques could be useful to non-invasively diagnose lymph node status in patients with suspicious reactive nodes, although larger multicenter studies are needed to confirm and validate the results.
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Affiliation(s)
- David Coronado-Gutiérrez
- Transmural Biotech S. L., Barcelona, Spain; BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic de Barcelona (University of Barcelona) and Hospital Sant Joan de Deu, Barcelona, Spain.
| | - Sergi Ganau
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Xavier Bargalló
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Belén Úbeda
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Marta Porta
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Esther Sanfeliu
- Radiology Department, Hospital Clinic de Barcelona (University of Barcelona), Barcelona, Spain
| | - Xavier P Burgos-Artizzu
- Transmural Biotech S. L., Barcelona, Spain; BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic de Barcelona (University of Barcelona) and Hospital Sant Joan de Deu, Barcelona, Spain
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Cario J, Coila A, Zhao Y, Miller RJ, L Oelze M. Identifying and overcoming limitations with in situ calibration beads for quantitative ultrasound. J Acoust Soc Am 2022; 151:2701. [PMID: 35461481 PMCID: PMC9023090 DOI: 10.1121/10.0010286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
Ensuring the consistency of spectral-based quantitative ultrasound estimates in vivo necessitates accounting for diffraction, system effects, and propagation losses encountered in the tissue. Accounting for diffraction and system effects is typically achieved through planar reflector or reference phantom methods; however, neither of these is able to account for the tissue losses present in vivo between the ultrasound probe and the region of interest. In previous work, the feasibility of small titanium beads as in situ calibration targets (0.5-2 mm in diameter) was investigated. In this study, the importance of bead size for the calibration signal, the role of multiple echoes coming from the calibration bead, and sampling of the bead signal laterally through beam translation were examined. This work demonstrates that although the titanium beads naturally produce multiple reverberant echoes, time-windowing of the first echo provides the smoothest calibration spectrum for backscatter coefficient calculation. When translating the beam across the bead, the amplitude of the echo decreases rapidly as the beam moves across and past the bead. Therefore, to obtain consistent calibration signals from the bead, lateral interpolation is needed to approximate signals coming from the center of the bead with respect to the beam.
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Affiliation(s)
- Jenna Cario
- Department of Electrical and Computer Engineering, Beckman Institute for Advanced Science and Technology, Univerity of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - Andres Coila
- Department of Electrical and Computer Engineering, Beckman Institute for Advanced Science and Technology, Univerity of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - Yuning Zhao
- Department of Electrical and Computer Engineering, Beckman Institute for Advanced Science and Technology, Univerity of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - Rita J Miller
- Department of Electrical and Computer Engineering, Beckman Institute for Advanced Science and Technology, Univerity of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - Michael L Oelze
- Department of Electrical and Computer Engineering, Beckman Institute for Advanced Science and Technology, Univerity of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
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Balkenende L, Teuwen J, Mann RM. Application of Deep Learning in Breast Cancer Imaging. Semin Nucl Med 2022; 52:584-596. [PMID: 35339259 DOI: 10.1053/j.semnuclmed.2022.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022]
Abstract
This review gives an overview of the current state of deep learning research in breast cancer imaging. Breast imaging plays a major role in detecting breast cancer at an earlier stage, as well as monitoring and evaluating breast cancer during treatment. The most commonly used modalities for breast imaging are digital mammography, digital breast tomosynthesis, ultrasound and magnetic resonance imaging. Nuclear medicine imaging techniques are used for detection and classification of axillary lymph nodes and distant staging in breast cancer imaging. All of these techniques are currently digitized, enabling the possibility to implement deep learning (DL), a subset of Artificial intelligence, in breast imaging. DL is nowadays embedded in a plethora of different tasks, such as lesion classification and segmentation, image reconstruction and generation, cancer risk prediction, and prediction and assessment of therapy response. Studies show similar and even better performances of DL algorithms compared to radiologists, although it is clear that large trials are needed, especially for ultrasound and magnetic resonance imaging, to exactly determine the added value of DL in breast cancer imaging. Studies on DL in nuclear medicine techniques are only sparsely available and further research is mandatory. Legal and ethical issues need to be considered before the role of DL can expand to its full potential in clinical breast care practice.
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Affiliation(s)
- Luuk Balkenende
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands; Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonas Teuwen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands; Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
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Azzouz A, Hejji L, Kim KH, Kukkar D, Souhail B, Bhardwaj N, Brown RJC, Zhang W. Advances in surface plasmon resonance-based biosensor technologies for cancer biomarker detection. Biosens Bioelectron 2022; 197:113767. [PMID: 34768064 DOI: 10.1016/j.bios.2021.113767] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 01/25/2023]
Abstract
Surface plasmon resonance approach is a highly useful option to offer optical and label-free detection of target bioanalytes with numerous advantages (e.g., low-cost fabrication, appreciable sensitivity, label-free detection, and outstanding accuracy). As such, it allows early diagnosis of cancer biomarkers to monitor tumor progression and to prevent the recurrence of oncogenic tumors. This work highlights the recent progress in SPR biosensing technology for the diagnosis of various cancer types (e.g., lung, breast, prostate, and ovarian). Further, the performance of various SPR biosensors is also evaluated in terms of the basic quality assurance criteria (e.g., limit of detection (LOD), selectivity, sensor response time, and reusability). Finally, the limitations and future challenges associated with SPR biosensors are also discussed with respect to cancer biomarker detection.
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Affiliation(s)
- Abdelmonaim Azzouz
- Department of Chemistry, Faculty of Science, University of Abdelmalek Essaadi, B.P. 2121, M'Hannech II, 93002, Tétouan, Morocco
| | - Lamia Hejji
- Department of Chemistry, Faculty of Science, University of Abdelmalek Essaadi, B.P. 2121, M'Hannech II, 93002, Tétouan, Morocco
| | - Ki-Hyun Kim
- Department of Civil and Environmental Engineering, Hanyang University, 222 Wangsimni-Ro, Seoul, 04763, South Korea.
| | - Deepak Kukkar
- Department of Nanotechnology, Sri Guru Granth Sahib World University, Fatehgarh Sahib, 140406, Punjab, India
| | - Badredine Souhail
- Department of Chemistry, Faculty of Science, University of Abdelmalek Essaadi, B.P. 2121, M'Hannech II, 93002, Tétouan, Morocco
| | - Neha Bhardwaj
- Department of Biotechnology, University Institute of Engineering Technology (UIET), Panjab University, Chandigarh, India
| | - Richard J C Brown
- Environment Department, National Physical Laboratory, Teddington, TW11 0LW, UK
| | - Wei Zhang
- School of Ecology and Environmental Science, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan, 450001, PR China
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Liu F, Li G, Lin L. A novel method for selecting the set optimal wavelength combination in multi-spectral transmission image. Spectrochim Acta A Mol Biomol Spectrosc 2021; 261:120080. [PMID: 34147734 DOI: 10.1016/j.saa.2021.120080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 06/12/2023]
Abstract
In the process of detecting heterogeneity in breast tissue based on multi-spectral transmission imaging, the detection accuracy will be affected due to the high redundancy degree of information between bands. In order to select the reasonable wavelength combination, this paper uses various nonlinear transformations to convert the multi-spectral images into spectral data for the first time, so as to select the set optimal wavelength combination based on the successive projections algorithm (SPA). Firstly, we design the collection experiment of 4-wavelength multi-spectral image. And then, K-SVD dictionary learning method, texture extraction method and gray correlation analysis method are used to obtain the feature spectral information. Finally, the set optimal wavelength combination is selected based on SPA. The experimental results show that random forest (RF) classification model and Faster-RCNN recognition models effectively verify that the combination of wavelengths 1,2,4 selected has the highest accuracy in the heterogeneous detection. In conclusion, this paper uses modulation-frame accumulation technique to improve the quality of multi-spectral transmission images. And based on the RF and Faster-RCNN models, the effectiveness of SPA-based optimal wavelength combination method proposed is verified, which will provide a new idea of feature wavelength selection for screening early breast masses through multi-spectral transmission imaging.
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Affiliation(s)
- Fulong Liu
- State Key Laboratory of Precision Measuring Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin 300072, China
| | - Gang Li
- State Key Laboratory of Precision Measuring Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin 300072, China
| | - Ling Lin
- State Key Laboratory of Precision Measuring Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin 300072, China.
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Zhu Y, Fan X, Yang D, Dong T, Jia Y, Nie F. Contrast-Enhanced Ultrasound for Precise Sentinel Lymph Node Biopsy in Women with Early Breast Cancer: A Preliminary Study. Diagnostics (Basel) 2021; 11:2104. [PMID: 34829452 DOI: 10.3390/diagnostics11112104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB), as a common method for axillary staging of early breast cancer, has gradually attracted people's attention to the false-negative rate and postoperative complications. The aim of the study is to investigate the clinical value of preoperative contrast-enhanced ultrasound (CEUS) for intraoperative SLNB in early breast cancer patients. METHODS A total of 201 patients scheduled for SLNB from September 2018 to April 2021 were collected consecutively. Preoperative CEUS was used to identify sentinel lymph nodes (SLN) and lymphatic drainage in breast cancer patients. RESULTS The SLN identification rate of CEUS was 93.0% (187/201) and four lymphatic drainage patterns were found: single LC to single SLN (70.0%), multiple LCs to single SLN (8.0%), single LC to multiple SLNs (10.2%), and multiple LCs to multiple SLNs (11.8%). The Sen, Spe, PPV, NPV, AUC of CEUS, US and CEUS + US in diagnosis of SLNs were 82.7%, 80.4%, 73.8%, 87.4%, 0.815; 70.7%, 77.7%, 68.0%, 79.8%, 0.742; and 86.7%, 77.7%, 72.2%, 89.7%, 0.822, respectively. There was no statistically significant difference between the diagnostic performance of CEUS and CEUS + US (p = 0.630). CONCLUSIONS CEUS can be used to preoperatively assess the lymphatic drainage patterns and the status of the SLNs in early breast cancer to assist precision intraoperative SLNB.
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Tahmasebi A, Qu E, Sevrukov A, Liu JB, Wang S, Lyshchik A, Yu J, Eisenbrey JR. Assessment of Axillary Lymph Nodes for Metastasis on Ultrasound Using Artificial Intelligence. Ultrason Imaging 2021; 43:329-336. [PMID: 34416827 DOI: 10.1177/01617346211035315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to evaluate an artificial intelligence (AI) system for the classification of axillary lymph nodes on ultrasound compared to radiologists. Ultrasound images of 317 axillary lymph nodes from patients referred for ultrasound guided fine needle aspiration or core needle biopsy and corresponding pathology findings were collected. Lymph nodes were classified into benign and malignant groups with histopathological result serving as the reference. Google Cloud AutoML Vision (Mountain View, CA) was used for AI image classification. Three experienced radiologists also classified the images and gave a level of suspicion score (1-5). To test the accuracy of AI, an external testing dataset of 64 images from 64 independent patients was evaluated by three AI models and the three readers. The diagnostic performance of AI and the humans were then quantified using receiver operating characteristics curves. In the complete set of 317 images, AutoML achieved a sensitivity of 77.1%, positive predictive value (PPV) of 77.1%, and an area under the precision recall curve of 0.78, while the three radiologists showed a sensitivity of 87.8% ± 8.5%, specificity of 50.3% ± 16.4%, PPV of 61.1% ± 5.4%, negative predictive value (NPV) of 84.1% ± 6.6%, and accuracy of 67.7% ± 5.7%. In the three external independent test sets, AI and human readers achieved sensitivity of 74.0% ± 0.14% versus 89.9% ± 0.06% (p = .25), specificity of 64.4% ± 0.11% versus 50.1 ± 0.20% (p = .22), PPV of 68.3% ± 0.04% versus 65.4 ± 0.07% (p = .50), NPV of 72.6% ± 0.11% versus 82.1% ± 0.08% (p = .33), and accuracy of 69.5% ± 0.06% versus 70.1% ± 0.07% (p = .90), respectively. These preliminary results indicate AI has comparable performance to trained radiologists and could be used to predict the presence of metastasis in ultrasound images of axillary lymph nodes.
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Affiliation(s)
- Aylin Tahmasebi
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Enze Qu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Alexander Sevrukov
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shuo Wang
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua Yu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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Johnson L, Huppe A, Wagner JL, Amin AL, Balanoff CR, Larson KE. Is image-guided core needle biopsy of borderline axillary lymph nodes in breast cancer patients clinically helpful? Am J Surg 2021:S0002-9610(21)00402-5. [PMID: 34311951 DOI: 10.1016/j.amjsurg.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND When borderline axillary lymph nodes (bALN) are identified on ultrasound (US) for breast cancer (BC) patients, preoperative management is unclear. We aimed to evaluate if core needle biopsy (CNB) for bALN is clinically helpful or disruptive. METHODS Retrospective review of BC patients with bALN from 2014 to 2019 was performed. Clinicopathologic data were compared for those who did and did not have CNB. RESULTS CNB (n = 34) and no CNB (n = 31) were similar with respect to clinicopathologic factors. Surgical LN-positive rate was the same between cohorts (p = 0.26). CNB was disruptive in 58.8 %; all had CNB for pN0 disease. CNB was helpful in 34.2 %: 14.7 % proceeded directly to axillary dissection; 17.6 % had positive LN localized after neoadjuvant chemotherapy. CONCLUSIONS CNB for bALN is more likely clinically disruptive and did not impact surgical LN positive rate. BC patients with bALN should undergo CNB only if it will change clinical management.
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Wang J, Ben Z, Gao S, Lyu S, Wei X. The role of ultrasound elastography and virtual touch tissue imaging in the personalized prediction of lymph node metastasis of breast cancer. Gland Surg 2021; 10:1460-1469. [PMID: 33968697 DOI: 10.21037/gs-21-199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study examined the effects of different ultrasound imaging technologies in the identification and prediction of axillary lymph node metastasis of breast cancer. It also investigated the relationship between human papilloma virus (HPV) infection and axillary lymph node metastasis. Methods Eighty-five female patients diagnosed with breast masses participated in this study. Each patient underwent a conventional ultrasound, ultrasonic elastography, and virtual touch tissue imaging quantification (VTIQ). The differential diagnosis efficiency of a conventional ultrasound, ultrasound elastography, VTIQ, and ultrasound elastography combined with VTIQ technology was compared with a pathological diagnosis, which represents the gold standard. 85 axillary lymph node tissues and 25 normal breast tissues were used to detect HPV positive infection rate differences in different tissues. Results The results showed that metastatic lymph nodes and reactive lymph node hyperplasia accounted for 54.12% and 45.88% of the 85 axillary lymph nodes of breast cancer, respectively. The conventional ultrasound, ultrasound elastography, and VTIQ scores of metastatic lymph nodes were significantly higher than those of reactive lymph node hyperplasia (P<0.05). The diagnostic sensitivity (Se) (91.30%), specificity (Sp) (92.31%), accuracy (Ac) (91.76%), positive predictive value (PPV) (93.33%), and negative predictive value (NPV) (90.00%) of ultrasound elastography combined with VTIQ technology were the highest among the diagnostic efficiency test results of different computer ultrasound imaging technologies. The positive infection rate of HPV in metastatic lymph node tissues was significantly higher than that in reactive lymph node hyperplasia and normal breast tissues (P<0.05). Conclusions Combining ultrasound elastography with VTIQ technology has high value in the differential diagnosis of axillary lymph nodes of breast cancer. Further, it appears that HPV infection may have an etiological role in lymph node metastasis in breast cancer patients.
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Affiliation(s)
- Jue Wang
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhifei Ben
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Shanshan Gao
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Shuyi Lyu
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Xiuzhi Wei
- Department of Ultrasound, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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Ou WC, Polat D, Dogan BE. Deep learning in breast radiology: current progress and future directions. Eur Radiol 2021; 31:4872-4885. [PMID: 33449174 DOI: 10.1007/s00330-020-07640-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/30/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- William C Ou
- Department of Radiology, Seay Biomedical Building, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 75390, USA.
| | - Dogan Polat
- Department of Radiology, Seay Biomedical Building, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 75390, USA
| | - Basak E Dogan
- Department of Radiology, Seay Biomedical Building, University of Texas Southwestern Medical Center, 2201 Inwood Road, Dallas, TX, 75390, USA
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15
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Zheng Q, Yang L, Zeng B, Li J, Guo K, Liang Y, Liao G. Artificial intelligence performance in detecting tumor metastasis from medical radiology imaging: A systematic review and meta-analysis. EClinicalMedicine 2021; 31:100669. [PMID: 33392486 PMCID: PMC7773591 DOI: 10.1016/j.eclinm.2020.100669] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early diagnosis of tumor metastasis is crucial for clinical treatment. Artificial intelligence (AI) has shown great promise in the field of medicine. We therefore aimed to evaluate the diagnostic accuracy of AI algorithms in detecting tumor metastasis using medical radiology imaging. METHODS We searched PubMed and Web of Science for studies published from January 1, 1997, to January 30, 2020. Studies evaluating an AI model for the diagnosis of tumor metastasis from medical images were included. We excluded studies that used histopathology images or medical wave-form data and those focused on the region segmentation of interest. Studies providing enough information to construct contingency tables were included in a meta-analysis. FINDINGS We identified 2620 studies, of which 69 were included. Among them, 34 studies were included in a meta-analysis with a pooled sensitivity of 82% (95% CI 79-84%), specificity of 84% (82-87%) and AUC of 0·90 (0·87-0·92). Analysis for different AI algorithms showed a pooled sensitivity of 87% (83-90%) for machine learning and 86% (82-89%) for deep learning, and a pooled specificity of 89% (82-93%) for machine learning, and 87% (82-91%) for deep learning. INTERPRETATION AI algorithms may be used for the diagnosis of tumor metastasis using medical radiology imaging with equivalent or even better performance to health-care professionals, in terms of sensitivity and specificity. At the same time, rigorous reporting standards with external validation and comparison to health-care professionals are urgently needed for AI application in the medical field. FUNDING College students' innovative entrepreneurial training plan program .
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Affiliation(s)
- Qiuhan Zheng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Le Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Bin Zeng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jiahao Li
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Kaixin Guo
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yujie Liang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
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16
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Fujioka T, Mori M, Kubota K, Oyama J, Yamaga E, Yashima Y, Katsuta L, Nomura K, Nara M, Oda G, Nakagawa T, Kitazume Y, Tateishi U. The Utility of Deep Learning in Breast Ultrasonic Imaging: A Review. Diagnostics (Basel) 2020; 10:diagnostics10121055. [PMID: 33291266 PMCID: PMC7762151 DOI: 10.3390/diagnostics10121055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is the most frequently diagnosed cancer in women; it poses a serious threat to women's health. Thus, early detection and proper treatment can improve patient prognosis. Breast ultrasound is one of the most commonly used modalities for diagnosing and detecting breast cancer in clinical practice. Deep learning technology has made significant progress in data extraction and analysis for medical images in recent years. Therefore, the use of deep learning for breast ultrasonic imaging in clinical practice is extremely important, as it saves time, reduces radiologist fatigue, and compensates for a lack of experience and skills in some cases. This review article discusses the basic technical knowledge and algorithms of deep learning for breast ultrasound and the application of deep learning technology in image classification, object detection, segmentation, and image synthesis. Finally, we discuss the current issues and future perspectives of deep learning technology in breast ultrasound.
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Affiliation(s)
- Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
- Correspondence: ; Tel.: +81-3-5803-5311; Fax: +81-3-5803-0147
| | - Kazunori Kubota
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
- Department of Radiology, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Jun Oyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
| | - Yuka Yashima
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
| | - Leona Katsuta
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
| | - Kyoko Nomura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
| | - Miyako Nara
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Goshi Oda
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (G.O.); (T.N.)
| | - Tsuyoshi Nakagawa
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (G.O.); (T.N.)
| | - Yoshio Kitazume
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (T.F.); (K.K.); (J.O.); (E.Y.); (Y.Y.); (L.K.); (K.N.); (M.N.); (Y.K.); (U.T.)
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