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Improving localization-based approaches for breast cancer screening exam classification

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 Added by Thibault F\\'evry
 Publication date 2019
and research's language is English




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We trained and evaluated a localization-based deep CNN for breast cancer screening exam classification on over 200,000 exams (over 1,000,000 images). Our model achieves an AUC of 0.919 in predicting malignancy in patients undergoing breast cancer screening, reducing the error rate of the baseline (Wu et al., 2019a) by 23%. In addition, the models generates bounding boxes for benign and malignant findings, providing interpretable predictions.



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Background and Aim: Recently, deep learning using convolutional neural network has been used successfully to classify the images of breast cells accurately. However, the accuracy of manual classification of those histopathological images is comparatively low. This research aims to increase the accuracy of the classification of breast cancer images by utilizing a Patch-Based Classifier (PBC) along with deep learning architecture. Methodology: The proposed system consists of a Deep Convolutional Neural Network (DCNN) that helps in enhancing and increasing the accuracy of the classification process. This is done by the use of the Patch-based Classifier (PBC). CNN has completely different layers where images are first fed through convolutional layers using hyperbolic tangent function together with the max-pooling layer, drop out layers, and SoftMax function for classification. Further, the output obtained is fed to a patch-based classifier that consists of patch-wise classification output followed by majority voting. Results: The results are obtained throughout the classification stage for breast cancer images that are collected from breast-histology datasets. The proposed solution improves the accuracy of classification whether or not the images had normal, benign, in-situ, or invasive carcinoma from 87% to 94% with a decrease in processing time from 0.45 s to 0.2s on average. Conclusion: The proposed solution focused on increasing the accuracy of classifying cancer in the breast by enhancing the image contrast and reducing the vanishing gradient. Finally, this solution for the implementation of the Contrast Limited Adaptive Histogram Equalization (CLAHE) technique and modified tangent function helps in increasing the accuracy.
Data scarcity and class imbalance are two fundamental challenges in many machine learning applications to healthcare. Breast cancer classification in mammography exemplifies these challenges, with a malignancy rate of around 0.5% in a screening population, which is compounded by the relatively small size of lesions (~1% of the image) in malignant cases. Simultaneously, the prevalence of screening mammography creates a potential abundance of non-cancer exams to use for training. Altogether, these characteristics lead to overfitting on cancer cases, while under-utilizing non-cancer data. Here, we present a novel generative adversarial network (GAN) model for data augmentation that can realistically synthesize and remove lesions on mammograms. With self-attention and semi-supervised learning components, the U-net-based architecture can generate high resolution (256x256px) outputs, as necessary for mammography. When augmenting the original training set with the GAN-generated samples, we find a significant improvement in malignancy classification performance on a test set of real mammogram patches. Overall, the empirical results of our algorithm and the relevance to other medical imaging paradigms point to potentially fruitful further applications.
We present a deep convolutional neural network for breast cancer screening exam classification, trained and evaluated on over 200,000 exams (over 1,000,000 images). Our network achieves an AUC of 0.895 in predicting whether there is a cancer in the breast, when tested on the screening population. We attribute the high accuracy of our model to a two-stage training procedure, which allows us to use a very high-capacity patch-level network to learn from pixel-level labels alongside a network learning from macroscopic breast-level labels. To validate our model, we conducted a reader study with 14 readers, each reading 720 screening mammogram exams, and find our model to be as accurate as experienced radiologists when presented with the same data. Finally, we show that a hybrid model, averaging probability of malignancy predicted by a radiologist with a prediction of our neural network, is more accurate than either of the two separately. To better understand our results, we conduct a thorough analysis of our networks performance on different subpopulations of the screening population, model design, training procedure, errors, and properties of its internal representations.
Deep neural networks (DNNs) show promise in breast cancer screening, but their robustness to input perturbations must be better understood before they can be clinically implemented. There exists extensive literature on this subject in the context of natural images that can potentially be built upon. However, it cannot be assumed that conclusions about robustness will transfer from natural images to mammogram images, due to significant differences between the two image modalities. In order to determine whether conclusions will transfer, we measure the sensitivity of a radiologist-level screening mammogram image classifier to four commonly studied input perturbations that natural image classifiers are sensitive to. We find that mammogram image classifiers are also sensitive to these perturbations, which suggests that we can build on the existing literature. We also perform a detailed analysis on the effects of low-pass filtering, and find that it degrades the visibility of clinically meaningful features called microcalcifications. Since low-pass filtering removes semantically meaningful information that is predictive of breast cancer, we argue that it is undesirable for mammogram image classifiers to be invariant to it. This is in contrast to natural images, where we do not want DNNs to be sensitive to low-pass filtering due to its tendency to remove information that is human-incomprehensible.
Gastric cancer is one of the most common cancers, which ranks third among the leading causes of cancer death. Biopsy of gastric mucosa is a standard procedure in gastric cancer screening test. However, manual pathological inspection is labor-intensive and time-consuming. Besides, it is challenging for an automated algorithm to locate the small lesion regions in the gigapixel whole-slide image and make the decision correctly.To tackle these issues, we collected large-scale whole-slide image dataset with detailed lesion region annotation and designed a whole-slide image analyzing framework consisting of 3 networks which could not only determine the screening result but also present the suspicious areas to the pathologist for reference. Experiments demonstrated that our proposed framework achieves sensitivity of 97.05% and specificity of 92.72% in screening task and Dice coefficient of 0.8331 in segmentation task. Furthermore, we tested our best model in real-world scenario on 10,315 whole-slide images collected from 4 medical centers.
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