Determination of mammographic breast density using a deep convolutional neural network

British Journal of Radiology - Tập 92 Số 1093 - 2019
Alexander Ciritsis1, Cristina Rossi1, Isabella Martini1, Matthias Eberhard1, Magda Marcon1, Anton S. Becker1, Nicole Berger1, Andreas Boss1
1Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland

Tóm tắt

Objective: High breast density is a risk factor for breast cancer. The aim of this study was to develop a deep convolutional neural network (dCNN) for the automatic classification of breast density based on the mammographic appearance of the tissue according to the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) Atlas. Methods: In this study, 20,578 mammography single views from 5221 different patients (58.3 ± 11.5 years) were downloaded from the picture archiving and communications system of our institution and automatically sorted according to the ACR density (a-d) provided by the corresponding radiological reports. A dCNN with 11 convolutional layers and 3 fully connected layers was trained and validated on an augmented dataset. The model was finally tested on two different datasets against: i) the radiological reports and ii) the consensus decision of two human readers. None of the test datasets was part of the dataset used for the training and validation of the algorithm. Results: The optimal number of epochs was 91 for medio-lateral oblique (MLO) projections and 94 for cranio-caudal projections (CC), respectively. Accuracy for MLO projections obtained on the validation dataset was 90.9% (CC: 90.1%). Tested on the first test dataset of mammographies (850 MLO and 880 CC), the algorithm showed an accordance with the corresponding radiological reports of 71.7% for MLO and of 71.0% for CC. The agreement with the radiological reports improved in the differentiation between dense and fatty breast for both projections (MLO = 88.6% and CC = 89.9%). In the second test dataset of 200 mammographies, a good accordance was found between the consensus decision of the two readers on both, the MLO-model (92.2%) and the right craniocaudal-model (87.4%). In the differentiation between fatty (ACR A/B) and dense breasts (ACR C/D), the agreement reached 99% for the MLO and 96% for the CC projections, respectively. Conclusions: The dCNN allows for accurate classification of breast density based on the ACR BI-RADS system. The proposed technique may allow accurate, standardized, and observer independent breast density evaluation of mammographies. Advances in knowledge: Standardized classification of mammographies by a dCNN could lead to a reduction of falsely classified breast densities, thereby allowing for a more accurate breast cancer risk assessment for the individual patient and a more reliable decision, whether additional ultrasound is recommended.

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Tài liệu tham khảo

Advani, 2014, Current strategies for the prevention of breast cancer, Breast Cancer, 6, 59

Lee, 2018, Automated mammographic breast density estimation using a fully convolutional network, Med Phys, 45, 1178, 10.1002/mp.12763

Kamangar, 2006, Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world, J Clin Oncol, 24, 2137, 10.1200/JCO.2005.05.2308

Boyd, 2007, Mammographic density and the risk and detection of breast cancer, N Engl J Med, 356, 227, 10.1056/NEJMoa062790

Lam, 2000, The association of increased weight, body mass index, and tissue density with the risk of breast carcinoma in Vermont, Cancer, 89, 369, 10.1002/1097-0142(20000715)89:2<369::AID-CNCR23>3.0.CO;2-J

Burton, 2017, Mammographic density and ageing: a collaborative pooled analysis of cross-sectional data from 22 countries worldwide, PLoS Med, 14, 10.1371/journal.pmed.1002335

Rice, 2015, Reproductive and lifestyle risk factors and mammographic density in Mexican women, Ann Epidemiol, 25, 868, 10.1016/j.annepidem.2015.08.006

Boyd, 2013, Mammographic density and risk of breast cancer, Am Soc Clin Oncol Educ Book, 33, e57, 10.14694/EdBook_AM.2013.33.e57

Berg, 2008, Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer, JAMA, 299, 2151, 10.1001/jama.299.18.2151

Melnikow, 2016, Supplemental screening for breast cancer in women with dense breasts: a systematic review for the U.S. preventive services task force, Ann Intern Med, 164, 268, 10.7326/M15-1789

Nesterov, 1983, A method of solving a convex programming problem with convergence rate O (1/k2), Soviet Mathematics Doklady, 27, 372

Beleites, 2013, Sample size planning for classification models, Anal Chim Acta, 760, 25, 10.1016/j.aca.2012.11.007

Cohen, 1968, Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit, Psychol Bull, 70, 213, 10.1037/h0026256

Landis, 1977, The measurement of observer agreement for categorical data, Biometrics, 33, 159, 10.2307/2529310

DeLong, 1988, Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach, Biometrics, 44, 837, 10.2307/2531595

Ekpo, 2016, Assessment of interradiologist agreement regarding mammographic breast density classification using the fifth edition of the BI-RADS atlas, AJR Am J Roentgenol, 206, 1119, 10.2214/AJR.15.15049

Winkel, 2015, Inter-observer agreement according to three methods of evaluating mammographic density and parenchymal pattern in a case control study: impact on relative risk of breast cancer, BMC Cancer, 15, 10.1186/s12885-015-1256-3

Ciatto, 2012, A first evaluation of breast radiological density assessment by QUANTRA software as compared to visual classification, Breast, 21, 503, 10.1016/j.breast.2012.01.005

Berg, 2000, Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment, AJR Am J Roentgenol, 174, 1769, 10.2214/ajr.174.6.1741769

Gard, 2015, Misclassification of breast imaging reporting and data system (BI-RADS) mammographic density and implications for breast density reporting legislation, Breast J, 21, 481, 10.1111/tbj.12443

Lobbes, 2012, Density is in the eye of the beholder: visual versus semi-automated assessment of breast density on standard mammograms, Insights Imaging, 3, 91, 10.1007/s13244-011-0139-7

Kang, 2016, Reliability of computer-assisted breast density estimation: comparison of interactive thresholding, semiautomated, and fully automated methods, AJR Am J Roentgenol, 207, 126, 10.2214/AJR.15.15469

Harvey, 2004, Quantitative assessment of mammographic breast density: relationship with breast cancer risk, Radiology, 230, 29, 10.1148/radiol.2301020870

Kolb, 2002, Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations, Radiology, 225, 165, 10.1148/radiol.2251011667

Mohamed, 2018, A deep learning method for classifying mammographic breast density categories, Med Phys, 45, 314, 10.1002/mp.12683

Mandelblatt, 2016, Collaborative modeling of the benefits and harms associated with different U.S. breast cancer screening strategies, Ann Intern Med, 164, 215, 10.7326/M15-1536