A New Computer-Aided Diagnosis System with Modified Genetic Feature Selection for BI-RADS Classification of Breast Masses in Mammograms

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 segmented based on the region growing technique. A total of 130 handcrafted BI-RADS features are then extrcated from the shape, margin, and density of each mass, together with the mass size and the patient's age, as mentioned in BI-RADS mammography. Then, a modified feature selection method based on the genetic algorithm (GA) is proposed to select the most clinically significant BI-RADS features. Finally, a back-propagation neural network (BPN) is employed for classification, and its accuracy is used as the fitness in GA. A set of 500 mammogram images from the digital database of screening mammography (DDSM) is used for evaluation. Our system achieves classification accuracy, positive predictive value, negative predictive value, and Matthews correlation coefficient of 84.5%, 84.4%, 94.8%, and 79.3%, respectively. To our best knowledge, this is the best current result for BI-RADS classification of breast masses in mammography, which makes the proposed system promising to support radiologists for deciding proper patient management based on the automatically assigned BI-RADS categories

Evaluation of the positive predictive value (PPV3) of ACR BI-RADS category 4 and 5 based on the outcomes of Invasive Diagnostic Office in an outpatient clinic

Purpose: The American College of Radiology (ACR) BI-RADS classification is the applicable for breast lesion assessment. BI-RADS categories 4 and 5 need to be followed by biopsy. The aim of our study was to evaluate the tissue biopsy-proven positive predictive value (PPV3) for BI-RADS 4 (and its subcategories) and for BI-RADS 5, and BI-RADS distribution, in comparison to ACR assumptions and literature. Material and methods: We retrospectively analysed biopsies performed in our outpatient clinic in 2017. Our target group of patients consisted of 797 patients at the average age of 52 years. Results: BI-RADS 5 constituted 12% of cases (95 cases), and BI-RADS 4 88% (698 cases). Within BI-RADS 4 subdivisions there were 359 cases in 4a (45.3%), 215 in 4b (27%), and 124 in 4c (15.6%). Overall PPV3 was 34.8%. BI-RADS 5 category PPV3 number was 97.89%. In category BI-RADS 4 the values of PPV3 equalled 26.22% without subdivision and 3.6%, 27.9%, and 88.7% for subcategories BI-RADS 4a, 4b, and 4c, respectively. Conclusions: BI-RADS categorisation by radiologists in the studied group matches the literature data according to achieved PPV and BI-RADS percentage distribution. The stratification of cancer risk among categories was proven with Mann-Whitney U test p value < 0.005. There was a statistically important unaccepted difference of PPV3 between core biopsy and vacuum-assisted biopsy, which needs further investigation

Mammography in asymptomatic women aged 40-49 years

OBJECTIVE To assess findings of mammography of and interventions resulting from breast cancer screening in women aged 40-49 years with no increased risk (typical risk) of breast cancer. METHODS This cross-sectional study evaluated women aged 40-49 years who underwent mammography screening in a mastology reference center in Recife, PE, Northeastern Brazil, between January 2010 and October 2011. Women with breast-related complaints, positive findings in the physical examination, or high risk of breast cancer were excluded. RESULTS The 1,000 mammograms performed were classified into the following Breast Imaging-Reporting and Data System (BI-RADS) categories BI-RADS 0, 232; BI-RADS 1, 294; BI-RADS 2, 294; BI-RADS 3, 16; BI-RADS 4A, 2; BI-RADS 5, 1. There was one case of grade II invasive ductal carcinoma and various interventions, including 469 ultrasound scans, 53 referrals to mastologists, 11 cytological examinations, and 8 biopsies. CONCLUSIONS Mammography screening in women aged 40-49 years with typical risk of breast cancer led to the performance of other interventions. However, it also resulted in increased costs without demonstrable efficacy in decreasing mortality.OBJETIVO Avaliar os achados mamográficos e as intervenções decorrentes do rastreamento em mulheres de 40 a 49 anos de idade com risco habitual para o câncer de mama. MÉTODOS Estudo transversal com mulheres de 40 a 49 anos, submetidas ao rastreamento mamográfico em centro de referência em mastologia, em Recife, PE, de janeiro de 2010 a outubro de 2011. Foram excluídas mulheres com queixas mamárias, alterações no exame físico e com alto risco para câncer de mama. RESULTADOS Das 1.000 mamografias realizadas, 232 foram BI-RADS 0, 454 BI-RADS 1, 294 BI-RADS 2, 16 BI-RADS 3, duas BI-RADS 4A, uma BI-RADS 4C e uma BI-RADS 5. Observou-se um único caso de carcinoma ductal invasivo grau II e várias intervenções: 469 ultrassonografias, 53 encaminhamentos para a mastologia, 11 citologias e oito biópsias. CONCLUSÕES O rastreamento mamográfico em mulheres de 40 a 49 anos com risco habitual para o câncer de mama leva a outras intervenções e, assim, ao aumento dos custos com eficácia não mostrada para redução da mortalidade

Mammographic calcifications undergoing percutaneous biopsy: outcome in women with and without a personal history of breast cancer

PURPOSE To compare the positive predictive values (PPVs) of BI-RADS categories used to assess pure mammographic calcifications in women with and without a previous history of breast cancer (PHBC). MATERIALS AND METHODS In this retrospective study, all consecutive pure mammographic calcifications (n = 320) undergoing a stereotactic biopsy between 2016 and 2018 were identified. Mammograms were evaluated in consensus by two radiologists according to BI-RADS and blinded to patient history and pathology results. Final pathologic results were used as the standard of reference. PPV of BI-RADS categories were compared between the two groups. Data were evaluated using standard statistics, Mann-Whitney U tests and Chi-square tests. RESULTS Two hundred sixty-eight patients (274 lesions, median age 54 years, inter-quartile range, 50-65 years) with a PHBC (n = 46) and without a PHBC (n = 222) were included. Overall PPVs were the following: BI-RADS 2, 0% (0 of 56); BI-RADS 3, 9.1% (1 of 11); BI-RADS 4a, 16.2% (6 of 37); BI-RADS 4b, 37.5% (48 of 128); BI-RADS 4c, 47.3% (18 of 38) and BI-RADS 5, 100% (4 of 4). The PPV of BI-RADS categories was similar in patients with and without a PHBC (P = .715). Calcifications were more often malignant in patients with a PHBC older than 10 years (47.3%, 9 of 19) compared to 1-2 years (25%, 1 of 4), 2-5 years (20%, 2 of 10) and 5-10 years (0%, of 13) from the first breast cancer (P = .005). CONCLUSION PPV of mammographic calcifications is similar in women with or without PHBC when BI-RADS classification is strictly applied. A higher risk of malignancy was observed in patients with a PHBC longer than 10 years

Asociación entre características de las calcificaciones mamográficas y neoplasia maligna en un hospital nacional, 2017: Association between characteristics of mammographic calcifications and malignie Neoplasia in a national hospital – 2017

Introduction: The presence of calcifications may be useful for the diagnosis of breast neoplasia. Objective: To determine the association between the characteristics of mammographic calcifications and malignant neoplasia. Methods: Observational, analytical, retrospective of cases and controls. Developed in the Gynecology Breast Pathology Unit. Female patients with mammogram suggestive of malignant neoplasm with a positive malignancy biopsy were included as cases, and 67 patients without histological evidence of malignancy as controls. Results: The average age of the cases was 54.12 years, in the controls 50.34. 50,.9% (59) are older than or equal to 50 years, OR 2,399 95% CI (1,125-5,114) p = 0.022, of these 52.5% (31) had breast cancer. 9.5% (11) had calcifications suspicious of malignancy, the most frequent, the amorphous and the pleomorphic fine. 37.1% (43) of the total cases have the BI-RADS 0 category, 6.9% (8) BI-RADS 1, 8.6% (10) BI-RADS 2, 7.8 % (9) BI-RADS 3, 28.4% (33) BI-RADS 4, 8.6% (10) BI-RADS 5 and 2.6% (3) BI-RADS 6. 72, 7% (8) of patients with calcifications suspected of malignancy presented breast cancer. In the bivariate analysis, an OR of 4,163 was obtained. 95% CI (1,043-16,606) p = 0,031. In the multivariate analysis the association remained unchanged regardless of age and BI-RADS. Conclusion: Age 50 years or older and mammographic calcifications suspected of malignancy are associated factors for breast cancer.Introducción: La presencia de calcificaciones puede ser útil para el diagnóstico de neoplasia de mama. Objetivo: Determinar la asociación entre las características de las calcificaciones mamográficas y neoplasia maligna. Métodos: Estudio observacional, analítico, retrospectivo de casos y controles. Desarrollado en la Unidad de Patología Mamaria de ginecología. Se incluyeron como casos a pacientes mujeres con mamografía sugerente de neoplasia maligna con biopsia positiva a malignidad y como controles a 67 pacientes sin evidencia histológica de neoplasia. Resultados: La edad media de los casos fue de 54,12 años, en los controles 50,34. El 50,9%(59) son mayores o iguales a 50 años, OR 2,399 IC 95% (1,125 – 5,114) p=0,022, de estos el 52,5% (31) tenían cáncer de mama. El 9,5%(11) presentaron calcificaciones sospechosas de malignidad, las más frecuentes, la amorfa y la fina pleomórfica. El 37,1% (43) de los casos totales correspondieron a la categoría BI-RADS 0, el 6,9% (8) a BI-RADS 1, el 8,6% (10) a BI-RADS 2, el 7,8% (9) a BI-RADS 3, el 28,4% (33)a BI-RADS 4, el 8,6% (10) a BI-RADS 5 y el 2,6% (3) a BI-RADS 6. El 72,7% (8) de pacientes con calcificaciones sospechosas de malignidad presentó cáncer de mama. En el análisis bivariado se obtuvo un OR de 4,163. IC 95% (1,043 – 16,606) p = 0,031. En el análisis multivariado la asociación permaneció inalterada independientemente de la edad y BI-RADS. Conclusión: La edad mayor o igual de 50 años y las calcificaciones mamográficas sospechosas de malignidad son factores asociados para el cáncer de mama

Metabolomic analysis of plasma from breast tumour patients. A pilot study

Background: Patients at risk of breast cancer are submitted to mammography, resulting in a classification of the lesions following the Breast Imaging Reporting and Data System (BI-RADS®). Due to BI-RADS 3 classification problems and the great uncertainty of the possible evolution of this kind of tumours, the integration of mammographic imaging with other techniques and markers of pathology, as metabolic information, may be advisable.Design and Methods: Our study aims to evaluate the possibility to quantify by gas chromatography-mass spectrometry (GC-MS) specific metabolites in the plasma of patients with mammograms classified from BI-RADS 3 to BI-RADS 5, to find similarities or differences in their metabolome. Samples from BI-RADS 3 to 5 patients were compared with samples from a healthy control group. This pilot project aimed at establishing the sensitivity of the metabolomic classification of blood samples of patients undergoing breast radiological analysis and to support a better classification of mammographic cases.Results: Metabolomic analysis revealed a panel of metabolites more abundant in healthy controls, as 3-aminoisobutyric acid, cholesterol, cysteine, stearic, linoleic and palmitic fatty acids. The comparison between samples from BI-RADS 3 and BI-RADS 5 patients, revealed the importance of 4-hydroxyproline, found in higher amount in BI-RADS 3 subjects.Conclusion: Although the low sample number did not allow the attainment of high validated statistical models, some interesting data were obtained, revealing the potential of metabolomics for an improvement in the classification of different mammographic lesions

AI: Can It Make a Difference to the Predictive Value of Ultrasound Breast Biopsy?

(1) Background: This study aims to compare the ground truth (pathology results) against the BI-RADS classification of images acquired while performing breast ultrasound diagnostic examinations that led to a biopsy and against the result of processing the same images through the AI algorithm KOIOS DS TM (KOIOS). (2) Methods: All results of biopsies performed with ultrasound guidance during 2019 were recovered from the pathology department. Readers selected the image which better represented the BI-RADS classification, confirmed correlation to the biopsied image, and submitted it to the KOIOS AI software. The results of the BI-RADS classification of the diagnostic study performed at our institution were set against the KOIOS classification and both were compared to the pathology reports. (3) Results: 403 cases were included in this study. Pathology rendered 197 malignant and 206 benign reports. Four biopsies on BI-RADS 0 and two images are included. Of fifty BI-RADS 3 cases biopsied, only seven rendered cancers. All but one had a positive or suspicious cytology; all were classified as suspicious by KOIOS. Using KOIOS, 17 B3 biopsies could have been avoided. Of 347 BI-RADS 4, 5, and 6 cases, 190 were malignant (54.7%). Because only KOIOS suspicious and probably malignant categories should be biopsied, 312 biopsies would have resulted in 187 malignant lesions (60%), but 10 cancers would have been missed. (4) Conclusions: KOIOS had a higher ratio of positive biopsies in this selected case study vis-à-vis the BI-RADS 4, 5 and 6 categories. A large number of biopsies in the BI-RADS 3 category could have been avoided

Breast ultrasound diagnostic performance and outcomes for mass lesions using Breast Imaging Reporting and Data System category 0 mammogram

PURPOSE: To evaluate the outcomes and diagnostic performance of ultrasonography after a Breast Imaging Reporting and Data System (Bi-RADS) category 0 mammogram. MATERIAL AND METHODS: This retrospective study reviewed 4,384 consecutive patients who underwent a screening mammography from January 2005 to July 2006; 391 of the 4,384 exams were classified as Bi-RADS category 0. After exclusions, 241 patients received subsequent sonogram. Ultrasonography was considered diagnostic when the Bi-RADS category was changed to 2, 4, or 5, and it was considered indeterminate (Bi-RADS 3) when the results indicated that the patients should return for a mammographic follow-up. The outcomes of these patients were assessed to evaluate the diagnostic performance of ultrasonography. RESULTS: The mean age of the patients was 53.3 years (ranging from 35 to 81). Of the 241 patients, ultrasonography was considered diagnostic in 146 (60.6%) patients and indeterminate in 95 (39.4%) patients. In the diagnostic group, 111 out of 146 patients (70.2%) had a sonogram result of Bi-RADS category 2 after a 2-year follow-up without evidence of malignancy. Furthermore, 35 out of 146 patients (29.8%) had a suspicious sonogram with a result of Bi-RADS category 4. After a tissue sampling procedure, 10 patients were confirmed to have breast cancer, and 25 had benign histopathological features without any evidence of malignancy after a 2-year follow-up. The sensitivity of ultrasonography was 100%, specificity was 89.1%, and overall accuracy was 89.6%. CONCLUSIONS: Based on the degree of resolution and its diagnostic performance, ultrasonography was determined to be an excellent method for the subsequent evaluation of Bi-RADS 0 mammograms