Comparison of medical image interpretation time between conventional and automated methods of breast ultrasound

Abstract Objective: To compare the medical image interpretation's time between the conventional and automated methods of breast ultrasound in patients with breast lesions. Secondarily, to evaluate the agreement between the two methods and interobservers. Methods: This is a cross-sectional study with prospective data collection. The agreement's degrees were established in relation to the breast lesions's ultrasound descriptors. To determine the accuracy of each method, a biopsy of suspicious lesions was performed, considering the histopathological result as the diagnostic gold standard. Results: We evaluated 27 women. Conventional ultrasound used an average medical time of 10.77 minutes (± 2.55) greater than the average of 7.38 minutes (± 2.06) for automated ultrasound (p<0.001). The degrees of agreement between the methods ranged from 0.75 to 0.95 for researcher 1 and from 0.71 to 0.98 for researcher 2. Among the researchers, the degrees of agreement were between 0.63 and 1 for automated ultrasound and between 0.68 and 1 for conventional ultrasound. The area of the ROC curve for the conventional method was 0.67 (p=0.003) for researcher 1 and 0.72 (p<0.001) for researcher 2. The area of the ROC curve for the automated method was 0. 69 (p=0.001) for researcher 1 and 0.78 (p<0.001) for researcher 2. Conclusion: We observed less time devoted by the physician to automated ultrasound compared to conventional ultrasound, maintaining accuracy. There was substantial or strong to perfect interobserver agreement and substantial or strong to almost perfect agreement between the methods.

Application value of a new lesion positioning stickers in breast lesion surface localization / 中南大学学报(医学版)

OBJECTIVES@#Accurate breast lesion surface localization can guarantee accurate biopsy and local treatment. But there is no guideline to regular equipment and methods for the localization of breast lesions. The conventional non-invasive localization method is marker-based localization. The advantages of this method are simple and efficient. The disadvantages are that markers disappear easily under coupling agents; the positioning length of markers cannot last long on skin; and healthcare associated infection due to many patients using the same marker pen is potentially unavoidable. Breast lesion sticker (called sticker for short) is a new-type localization medical instrument in 2020. Our study aims to explore the clinical value of a new lesion stickers in breast lesion surface localization via comparison of the sticker and marker pen localization methods.@*METHODS@#This was a prospective cohort study. It was conducted in 67 patients who needed breast lesion surface localization before biopsy. The patients were randomly assigned into 2 groups. One group of patients used marker pen to mark breast lesion surface location by ultrasonography. The other group of patients used stickers. Patients labeled with markers on skin were swabbed agents before marking. Then the markers were checked by ultrasound scan. If the surface positions of breast lesion were not correct, the above procedure was repeated. In the sticker group, the stickers were released synchronously after the lesions were detected by ultrasound scan. Then locations were checked via scanning hole. If the surface positions of breast lesion were not correct, the above procedure was repeated. The accuracy of positioning, the length of positioning time and satisfaction of patients between the 2 groups were compared. The length of positioning time was calculated from the time when ultrasound detected the lesion to the time when the surface position of breast lesion was confirmed. The total score of patients' satisfaction was 5 points according to Service Quality Evaluation of SERVQUAL Scale, including sonographers' service attitude and their technical proficiency, other medical staffs' service attitude and their technical proficiency, hospital service procedures, positioning comfort, and positioning effects.@*RESULTS@#All 67 patients were females, aged 18-66 (39.73±13.10). There were 35 patients in the marker pen group and 32 patients in the sticker group. The time length of group used marker pen to localization was 22-88 (52.20±2.90) s, and the sticker group was 3-15 (9.22±0.58) s in length. The length of positioning time for the stickers was significantly shorter than that of the marker (P<0.01). Both methods were accurate in the surface localization of lesions before operation. The total scores of patients' satisfaction was 4-5 (4.92±0.02) in the stickers group, and 1-5 (3.35±0.10) in the marker pen group. The patients' satisfaction scores with the sticker were significantly higher than those with the marker pen (P<0.01). The length of positioning time and patients' satisfication scores for sonographer with 20 years' working experience were shorter and higher than those of sonographer with 10 years' working experience, respectively (both P<0.05).@*CONCLUSIONS@#The new breast lesion positioning stickers have more advantages than the marker pen in localization efficiency. It could reduce the workload of medical workers and increase patients' satisfaction to some extent. The stickers can be used not only in the breast lesions surface localization, but also in the skin location of pleural effusion and ascites, the skin location of surface masses, the skin location of thyroid nodule, and many other clinical marker areas, to further expand the scope of clinical application and value of the stickers.

Differential diagnosis of benign and malignant breast lesions using quantitative synthetic magnetic resonance imaging / 南方医科大学学报

OBJECTIVE@#To investigate the value of quantitative synthetic magnetic resonance imaging (SyMRI) in distinguishing between benign and malignant breast lesions.@*METHODS@#We retrospectively collected data of preoperative conventional MRI and multi-dynamic multi-echo sequences from 95 patients with breast lesions showing mass-type enhancement on DCE-MRI, including 27 patients with benign lesions and 68 with malignant lesions. The MRI features of the lesions (shape, margin, internal enhancement pattern, time-signal intensity curve, and T2WI signal) were analyzed, and for each lesion, SyMRI-generated quantitative parameters including T1 and T2 relaxation time and proton density (PD) were measured before and after enhancement and recorded as T1p, T2p, PDp and T1e, T2e, and PDe, respectively. The relative change rate of each parameter was calculated. Logistic regression and all-subset regression analyses were performed for variable selection to construct diagnostic models of the breast lesions, and receiver-operating characteristic (ROC) analysis was used to assess the performance of each model for differentiation of benign and malignant lesions.@*RESULTS@#There were significant differences in the MRI features between benign and malignant lesions (P < 0.05). All the SyMRI-generated quantitative parameters, with the exception of T2e and Pdp, showed significant differences between benign and malignant lesions (P < 0.05). Among the constructed diagnostic models, the model based on all the DCE-MRI features combined with SyMRI parameters T2p and T1e (DCE-MRI+T2p+T1e) showed the best performance in the differential diagnosis malignant breast masses with an AUC of 0.995 (95% CI: 0.983-1.000).@*CONCLUSION@#Quantitative SyMRI can be used for differential diagnosis of benign and malignant breast lesions.

Value of ultrasonic S-Detect technique in diagnosis of breast masses / 南方医科大学学报

OBJECTIVE@#To evaluate the value of ultrasound S-Detect in the diagnosis of breast masses.@*METHODS@#A total of 85 breast masses in 62 female patients were diagnosed by S-Detect technique and conventional ultrasound. The diagnostic efficacy of conventional ultrasound and S-Detect technique was analyzed and compared with postoperative pathological results as the gold standard.@*RESULTS@#When operated by junior physicians, the diagnostic efficacy of conventional ultrasound was significantly lower than that of S-Detect technique (P < 0.05), but this difference was not observed in moderately experienced and senior physicians (P>0.05). S-Detect technique was positively correlated with the diagnostic results of senior physicians (r=0.97). Using S-Detect technique, the diagnostic efficacy did not differ significantly between the long axis section and its vertical section (P>0.05). Routine ultrasound showed a better diagnostic efficacy than S-Detect for breast masses with a diameter below 20 mm (P < 0.05), but for larger breast masses, its diagnostic efficacy was significantly lower than that of SDetect (P < 0.05).@*CONCLUSION@#S-Detect can be used in differential diagnosis of benign and malignant breast masses, and its diagnostic efficiency can be comparable with that of BI-RADS classification for moderately experienced and senior physicians, but its diagnostic efficacy can be low for breast masses less than 20 mm in diameter.

Deep learning applied to two-dimensional color Doppler flow imaging ultrasound images significantly improves diagnostic performance in the classification of breast masses: a multicenter study / 中华医学杂志(英文版)

BACKGROUND@#The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images.@*METHODS@#Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists.@*RESULTS@#The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%).@*CONCLUSIONS@#The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists.@*TRIAL REGISTRATION@#Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.

Value of Elastography Strain Ratio Combined with Breast Ultrasound Imaging Reporting and Data System in the Diagnosis of Breast Nodules / 中国医学科学院学报

Objective To explore the value of elastography strain ratio(SR)combined with breast ultrasound imaging reporting and data system(BI-RADS-US)in the differential diagnosis of breast nodules.Methods A total of 471 breast nodules(from 471 patients)were reclassified by SR combined with BI-RADS-US.With the pathology results as gold standard,the area under the receiver operating characteristic(ROC)curve(AUC)was employed to evaluate the diagnostic performance,and the sensitivity,specificity,and accuracy were compared between the combined method and BI-RADS-US.Results Among the 471 breast nodules,180 nodules were benign and 291 were malignant.The AUC of the combined method was statistically significantly higher than that of BI-RADS-US(0.798 vs. 0.730;Z= 2.583, P= 0.010).SR,BI-RADS-US,and the combined method for diagnosing breast nodules had the sensitivity of 86.6%,99.0%,and 96.6%,the specificity of 67.2%,47.2%,and 63.3%,and the accuracy of 79.2%,79.2%,and 83.9%,respectively.The combined method increased the specificity from 47.2%(BI-RADS-US)to 63.3%(χ

Analysis and Enlightenment of Foreign Open Breast Image Datasets / 中国医学科学院学报

With the upsurge of medical artificial intelligence,the use of computer vision technology to study medical images,which can effectively help doctors to identify and screen diseases,has become a focus of researchers.This paper summarizes the basic situation,specific information,related research,and data sharing and utilizing ways of foreign breast image datasets.This review provides inspirations for the opening of Chinese medical and health data.

Development of a software for radiological breast mammography anatomy and technical procedures study / Desenvolvimento de un software para estudio de anatomia y procedimientos técnicos en mamografia radiológica de mama

The aim of this study was to develop a software for radiological breast mammography anatomy study. A descriptive and exploratory study was carried out using mammography images database. The software was created using well-known open source image J software. Eight mammographic images were selected including standard views: craniocaudal (CC) and mediolateral oblique (MLO) views, and supplementary views. The software was created as an image J plugin-in. The virtual environment presented multiple choice questions related to radiological breast anatomy and patient positioning criteria. The software launches by requiring the user to register their profile ( user ID) followed by the selection of mammography projection technique. As the second step, a screen with multiple choice questions opens according to the technique selected by the user. At the end of the evaluation, a report is presented containing date and time of evaluation, username and the score achieved. The report also provide feedback to the user and highlight where the user incorrectly identified the anatomy. The software allowed assist on multifactor mammography learning process for radiographers. However, It is necessary the improvement of software including high quality images and case study.

El objetivo de este estudio fue de el desarrollo de un software para estudio de anatomía y procedimientos en mamografía de mama. Se realizó un estudio descriptivo y exploratorio utilizando una base de datos de imágenes mamográficas. La aplicación se creó utilizando un conocido software (imagen J) de código abierto. Se seleccionaron ocho imágenes mamográficas que incluían proyecciones estándar: proyecciones craneocaudal (CC) y mediolateral oblicua (MLO) y proyecciones complementarias. El software fue creado como un complemento de imagen J. El entorno virtual presentó preguntas de múltiple opción relacionadas con la anatomía radiológica de la mama y los criterios de posicionamiento del paciente. El software se inicia solicitando al usuario que registre su perfil (ID de usuario) seguido de la selección de la técnica de proyección de mamografía. Como segundo paso, se abre una pantalla con preguntas de opción múltiple según la técnica seleccionada por el usuario. Al final de la evaluación, se presenta un informe que contiene la fecha y hora de la evaluación, el nombre de usuario y la puntuación obtenida. El informe también proporciona comentarios al usuario y destaca dónde el usuario identificó incorrectamente la anatomía. El software permitió asistir en el proceso de aprendizaje de mamografías multifactoriales para radiólogos. Sin embargo lo és necesaria la mejora del software, incluidas imágenes de alta calidad y estudios de casos.

Diagnostic values of shear wave elastography and strain elastography for breast lesions

ABSTRACT Background: Strain elastography (SE) and shear wave elastography (SWE) have high diagnostic yield for breast lesions, but the optimal parameters remain elusive. Aim: To evaluate the diagnostic yield of SWE and SE for breast lesions by multivariate logistic regression analysis. Material and Methods: A total of 132 patients with 164 breast tumors were enrolled. Breast lesions were classified with the breast imaging reporting and data system (BI-RADS). Maximum (Emax), mean (Emean) and standard deviation (Esd) of elastic modulus, lesion/fat elasticity ratio and elastographic classification were obtained by SWE. Strain ratio (SR) and elastographic score were obtained by SE. A multivariate logistic regression analysis was performed. The diagnostic efficiencies of BI-RADS classification, SWE, SE and their combination were compared plotting ROC curves. Results: There were 110 benign and 54 malignant lesions which had significantly different SWE and SE parameters. The parameters included in the logistic regression were Esd and elastographic classification obtained by SWE and the elastographic score obtained by SE. When combining SWE with SE, Esd, SR and SWE classification were included in the equation. The areas under ROC curves for BI-RADS classification, SWE, SE and their combination were 0.75, 0.88, 0.79 and 0.89, respectively. Conclusions: The diagnostic value of SWE in combination with SE for breast lesions exceeded that of SE or SWE alone. Esd showed a good diagnostic yield when SWE was used alone or combined with SE.

Antecedentes: La elastografía de deformación (SE) y de onda cortante (SWE) son útiles para el diagnóstico de lesiones mamarias, pero falta definir los parámetros óptimos. Objetivo: Evaluar el valor diagnóstico de SE y SWE en lesiones mamarias usando una regresión logística multivariable. Material y Métodos: Ciento treinta y dos pacientes con 164 tumores mamarios fueron evaluados, los que se clasificaron usando el sistema BI-RADS (breast imaging reporting and data system). El módulo elástico máximo, promedio y su desviación estándar (Esd), la razón entre la elasticidad de la lesión y de la grasa y la clasificación elastográfica se obtuvieron con SWE. La razón de deformación (SR) y el puntaje elastográfico se obtuvieron con SE. Se efectuó una regresión logística y las eficiencias diagnósticas de la clasificación BI-RADS, SWE and SE y su combinación se compararon usando curvas ROC (receiver operating characteristic curves). Resultados: Ciento diez lesiones fueron benignas y 54 malignas. Estas tenían parámetros SWE y SE significativamente diferentes. En la ecuación de regresión logística, se incluyeron la clasificación elastográfica y el Esd obtenidos por SWE y el puntaje elastográfico obtenido por SE. Cuando se combinó SWE y SE, se incluyeron en la ecuación el Esd, SR y la clasificación por SWE. Las áreas bajo la curva ROC para la clasificación BI-RADS, SWE y SE y la combinación de ambas fueron 0.75, 0.88, 079 y 0.89 respectivamente. Conclusiones: La combinación de SWE y SE tuvo un mejor rendimiento diagnóstico para lesiones mamarias que cada parámetro por separado. Esd tuvo un buen rendimiento diagnóstico cuando se utilizó SWE sola o combinada con SE.

Prevalência de tejido mamario denso en una población de Bucaramanga, Colombia / Prevalence of breast dense in a population in Bucaramanga, Colombia

Resumen Objetivo: Establecer la prevalencia de mujeres mayores de 50 años con mamas densas estudiadas por mamografía en el área de Bucaramanga. Métodos: Se realizó un estudio descriptivo retrospectivo durante el periodo comprendido entre enero de 2014 y agosto de 2015, en el que se revisaron 10.110 mamografías de pacientes mayores de 50 años. Posteriormente, se hizo una revisión de la literatura en las principales bases de datos. Resultados: De las 10.110 mamografías realizadas, 4.448 fueron encontradas como positivas para mama densa. De estas, el 39,69% correspondió a tejido mamario heterogéneamente denso y el 4,29%, a tejido mamario extremadamente denso, para un total de 43,9% de los casos estudiados. Conclusión: La densidad mamaria es un factor de riesgo independiente de cáncer de mama, considerado de mediana importancia frente a otros factores. A medida que incrementa la densidad mamaria, se genera la superposición del tejido mamario radio-opaco que puede ocultar y llegar a retardar el diagnóstico de un cáncer subyacente. Dada la alta prevalencia de tejido mamario denso encontrado en la población estudiada, se sugiere complementar el tamizaje con otros métodos de imágenes.

Abstract Objective: To establish the prevalence of dense breast tissue in a group of women aged over 50 years, who were studied with mammography in the city of Bucaramanga (Colombia). Methods: A retrospective descriptive study was conducted from January 2014 to August 2015; 10.110 mammograms of patients aged over 50 years were reviewed. Subsequently, a review of the literature in the main databases was made. Results: From 10.110 mammograms that were performed, 4.448 were found to be positive for dense breast tissue. 39,69% had heterogeneously dense breast tissue, and 4,29% extremely dense breast tissue, for a total result of 43,9% patients with positive dense breast tissue. Conclusion: Breast density is an independent risk factor for breast cancer, being of medium importance compared with other factors. As the breast density increases, the overlap of the radiopaque breast tissue that can hide and delay the diagnosis of an underlying cancer is generated. The high prevalence of dense breast tissue that we found in this population suggests the need of complementing screening with other imaging methods.

Avaliação das punções aspirativas com agulha fina e das biópsia percutâneas pistola assistida no ano de 2017 em um hospital de ensino em mastologia do serviço publico de saúde no município de São Paulo / Evaluation of fine needle aspiration punctures and percutaneouss pistol biopsies assisted in the year 2017 in a hospital for the teaching of mastology of the public service of health in the municipality of São Paulo

INTRODUÇÃO: Excluindo o câncer de pele não melanoma, o câncer de mama é a neoplasia maligna mais incidente no mundo. Para o ano de 2020, estimam-se aproximadamente 66 mil casos novos de câncer da mama no Brasil. Objetivando o diagnóstico precoce do câncer de mama, o rastreamento com exame de mamografia anual é recomendado em mulheres com risco habitual, na faixa etária de 40 a 74 anos, de acordo com a Sociedade Brasileira de Mastologia (SBM), o Colégio Brasileiro de Radiologia (CBR) e a Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). Resultando assim em propedêuticas invasivas para elucidação diagnóstica, sendo a punção aspirativa por agulha fina (PAAF) e a biópsia por agulha grossa (BAG) os mais usados. OBJETIVO: Correlacionar os resultados da citologia da PAAF com a histologia da BAG e, também, a histologia da BAG com os resultados do anatomopatológico da peça cirúrgica (APPC) no período de janeiro a dezembro de 2017. MÉTODO: Estudo retrospectivo, observacional e descritivo da análise dos resultados de todas as PAAF e BAG guiadas por ultrassonografia mamária (US) realizadas consecutivamente. Os resultados da PAAF foram comparados com as BAG e os da BAG com o APPC. Foram avaliados: valor preditivo positivo (VPP), valor preditivo negativo (VPN), sensibilidade (S), especificidade (E) e acurácia (A) das PAAF e BAG, bem como as taxas de subdiagnósticos e sobrediagnósticos da BAG em relação ao APPC. Para todos os testes estatísticos foram utilizados um nível de significância de 5%. As análises estatísticas foram realizadas com o uso do software estatístico SPSS 20.0 e STATA 12. RESULTADOS: PAAF apresentou baixa acurácia global (28,1%), porém elevadas taxas de especificidades 78,6% e 88% nas categorias 2 e 5, respectivamente. Assim como, elevadas taxas de VPN na categoria 3/4 e na categoria 5 80% e 75,9%, respectivamente. As categorias BAG evidenciaram acurácias diferentes variando de 52,9% a 80,4% e elevadas taxas de especificidade (67,6% a 91,1%). CONCLUSÃO: A PAAF é um ótimo exame nas lesões de benignas e nas de altíssimo risco para malignidade. A BAG é considerada ferramenta de escolha no diagnóstico de câncer de mama por apresentar elevadas taxas de S e E contudo, permanece a recomendação de ressecção cirúrgica para confirmação diagnóstica evitando assim os subdiagnósticos. Palavras-chave: câncer de mama, ultrassonografia mamária, punção aspirativa com agulha fina e biópsia por agulha grossa.

JPEG and raw image files compared to direct measurement of the breast region

Abstract Purpose: To compare JPEG and RAW image file extensions to direct measurement of the breast region. Methods: Points were marked on the breasts and arms of 40 female volunteers. The joining of these points in each hemibody formed seven linear segments, one angular segment and one median segment common to both hemibodies. Volunteers were photographed in a standardized fashion and evaluated by three raters using the software Adobe Photoshop CS6® and three image file extensions (RAW, high resolution JPEG and low resolution JPEG); values were compared to direct anthropometry. Results: All variables had interclass correlation coefficient higher than 0.8 (ICC>0.8). On average, all variables in all methods showed differences (p<0.05) when compared to direct measurement. A formula was created for each segment and each image file extension in comparison with the direct measurement. Conclusion: Measurements were similar among the correlated JPEG and RAW image file extensions but differed from the actual breast measurement obtained with a caliper.

Evaluation of the accuracy of mammography, ultrasound and magnetic resonance imaging in suspect breast lesions

OBJECTIVES: In breast cancer diagnosis, mammography (MMG), ultrasonography (USG) and magnetic resonance imaging (MRI) are the imaging methods most used. There is a scarcity of comparative studies that evaluate the accuracy of these methods in the diagnosis of breast cancer. METHODS: A cross-sectional study was carried out through the review of electronic medical records of 32 female patients who underwent breast imaging examinations at a imaging diagnostic center in Teresina, State of Piauí, Brazil. Patients who had these three imaging methods at the time of the evaluation of the same nodule were included. The nodule must have been classified as suspect by the BI-RADS® system in at least one of the methods. Data from each method were compared with the histopathological examination. Statistical analysis used the calculation of proportions in Excel 2010. RESULTS: MMG showed 56.2%, 87.5%, 81.8%, 66.7% and 71.8% of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, respectively. USG had 75%, 18.8%, 48%, 42.8% and 46.9% of sensitivity, specificity, PPV, NPV and accuracy, respectively. In turn, MRI had 100%, 50%, 66.7%, 100% and 75% of sensitivity, specificity, PPV, NPV and accuracy, respectively. CONCLUSION: Thus, MRI and MMG were more accurate in evaluating suspicious breast lumps. MRI had a low specificity, mainly to high breast density, while MMG had also sensitivity limited due to high breast density and USG has been proven to be useful in these patients.