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Muscogiuri G, Chiesa M, Baggiano A, Spadafora P, De Santis R, Guglielmo M, Scafuri S, Fusini L, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Ricci F, Ariano FP, Spiritigliozzi L, Babbaro M, Mollace R, Maragna R, Giacari CM, Andreini D, Guaricci AI, Colombo GI, Rabbat MG, Pepi M, Sardanelli F, Pontone G. Diagnostic performance of deep learning algorithm for analysis of computed tomography myocardial perfusion. Eur J Nucl Med Mol Imaging 2022; 49:3119-3128. [PMID: 35194673 DOI: 10.1007/s00259-022-05732-w] [Citation(s) in RCA: 2] [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] [Received: 10/31/2021] [Accepted: 02/12/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of a deep learning (DL) algorithm predicting hemodynamically significant coronary artery disease (CAD) by using a rest dataset of myocardial computed tomography perfusion (CTP) as compared to invasive evaluation. METHODS One hundred and twelve consecutive symptomatic patients scheduled for clinically indicated invasive coronary angiography (ICA) underwent CCTA plus static stress CTP and ICA with invasive fractional flow reserve (FFR) for stenoses ranging between 30 and 80%. Subsequently, a DL algorithm for the prediction of significant CAD by using the rest dataset (CTP-DLrest) and stress dataset (CTP-DLstress) was developed. The diagnostic accuracy for identification of significant CAD using CCTA, CCTA + CTP stress, CCTA + CTP-DLrest, and CCTA + CTP-DLstress was measured and compared. The time of analysis for CTP stress, CTP-DLrest, and CTP-DLStress was recorded. RESULTS Patient-specific sensitivity, specificity, NPV, PPV, accuracy, and area under the curve (AUC) of CCTA alone and CCTA + CTPStress were 100%, 33%, 100%, 54%, 63%, 67% and 86%, 89%, 89%, 86%, 88%, 87%, respectively. Patient-specific sensitivity, specificity, NPV, PPV, accuracy, and AUC of CCTA + DLrest and CCTA + DLstress were 100%, 72%, 100%, 74%, 84%, 96% and 93%, 83%, 94%, 81%, 88%, 98%, respectively. All CCTA + CTP stress, CCTA + CTP-DLRest, and CCTA + CTP-DLStress significantly improved detection of hemodynamically significant CAD compared to CCTA alone (p < 0.01). Time of CTP-DL was significantly lower as compared to human analysis (39.2 ± 3.2 vs. 379.6 ± 68.0 s, p < 0.001). CONCLUSION Evaluation of myocardial ischemia using a DL approach on rest CTP datasets is feasible and accurate. This approach may be a useful gatekeeper prior to CTP stress..
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Affiliation(s)
| | - Mattia Chiesa
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133, Milan, Italy
| | | | - Pierino Spadafora
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rossella De Santis
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital "Policlinico Consorziale" of Bari, Bari, Italy
| | | | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA.,Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesco Sardanelli
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Nicosia L, Addante F, Bozzini AC, Latronico A, Montesano M, Meneghetti L, Tettamanzi F, Frassoni S, Bagnardi V, De Santis R, Pesapane F, Fodor CI, Mastropasqua MG, Cassano E. Evaluation of computer-aided diagnosis in breast ultrasonography: Improvement in diagnostic performance of inexperienced radiologists. Clin Imaging 2021; 82:150-155. [PMID: 34826773 DOI: 10.1016/j.clinimag.2021.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/02/2021] [Revised: 09/11/2021] [Accepted: 11/07/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate if a computer-aided diagnosis (CAD) system on ultrasound (US) can improve the diagnostic performance of inexperienced radiologists. METHODS We collected ultrasound images of 256 breast lesions taken between March and May 2020. We asked two experienced and two inexperienced radiologists to retrospectively review the US features of each breast lesion according to the Breast Imaging Reporting and Data System (BI-RADS) categories. A CAD examination with S-Detect™ software (Samsung Healthcare, Seoul, South Korea) was conducted retrospectively by another uninvolved radiologist blinded to the BIRADS values previously attributed to the lesions. Diagnostic performances of experienced and inexperienced radiologists and CAD were compared and the inter-observer agreement among radiologists was calculated. RESULTS The diagnostic performance of the experienced group in terms of sensitivity was significantly higher than CAD (p < 0.001). Conversely, the diagnostic performance of inexperienced group in terms of both sensitivity and specificity was significantly lower than CAD (p < 0.001). We obtained an excellent agreement in the evaluation of the lesions among the two expert radiologists (Kappa coefficient: 88.7%), and among the two non-expert radiologists (Kappa coefficient: 84.9%). CONCLUSION The US CAD system is a useful additional tool to improve the diagnostic performance of the inexperienced radiologists, eventually reducing the number of unnecessary biopsies. Moreover, it is a valid second opinion in case of experienced radiologists.
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Affiliation(s)
- Luca Nicosia
- Division of Breast imaging IEO; European institute of Oncology, IRCCS, Via Ripamonti 435, Milan Italy.
| | - Francesca Addante
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University "Aldo Moro", 70124 Bari, Italy
| | - Anna Carla Bozzini
- Division of Breast imaging IEO; European institute of Oncology, IRCCS, Via Ripamonti 435, Milan Italy
| | - Antuono Latronico
- Division of Breast imaging IEO; European institute of Oncology, IRCCS, Via Ripamonti 435, Milan Italy
| | - Marta Montesano
- Division of Breast imaging IEO; European institute of Oncology, IRCCS, Via Ripamonti 435, Milan Italy
| | - Lorenza Meneghetti
- Division of Breast imaging IEO; European institute of Oncology, IRCCS, Via Ripamonti 435, Milan Italy
| | - Francesca Tettamanzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy
| | - Rossella De Santis
- Postgraduate School in Radiology, University of Milan, 20122 Milan, Italy
| | - Filippo Pesapane
- Division of Breast imaging IEO; European institute of Oncology, IRCCS, Via Ripamonti 435, Milan Italy
| | - Cristiana Iuliana Fodor
- Division of Radiation Oncology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Mauro Giuseppe Mastropasqua
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University "Aldo Moro", 70124 Bari, Italy
| | - Enrico Cassano
- Division of Breast imaging IEO; European institute of Oncology, IRCCS, Via Ripamonti 435, Milan Italy
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Nicosia L, Latronico A, Addante F, De Santis R, Bozzini AC, Montesano M, Frassoni S, Bagnardi V, Mazzarol G, Pala O, Lazzeroni M, Lissidini G, Mastropasqua MG, Cassano E. Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate? Diagnostics (Basel) 2021; 11:diagnostics11061120. [PMID: 34205428 PMCID: PMC8259513 DOI: 10.3390/diagnostics11061120] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/02/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients’ characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.
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Affiliation(s)
- Luca Nicosia
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Antuono Latronico
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Francesca Addante
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70124 Bari, Italy;
| | - Rossella De Santis
- Postgraduate School in Radiology, University of Milan, 20122 Milan, Italy;
| | - Anna Carla Bozzini
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Marta Montesano
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Giovanni Mazzarol
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.M.); (O.P.)
| | - Oriana Pala
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.M.); (O.P.)
| | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Germana Lissidini
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Mauro Giuseppe Mastropasqua
- Department of Emergency and Organ Transplantation, Section of Anatomic Pathology, School of Medicine, University “Aldo Moro”, 70124 Bari, Italy;
- Correspondence: ; Tel.: +39-0805594414
| | - Enrico Cassano
- Department of Breast Radiology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy; (L.N.); (A.L.); (A.C.B.); (M.M.); (E.C.)
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