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تسجيل مستخدم جديدAdaptation of a deep learning malignancy model from full-field digital mammography to digital breast tomosynthesis
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Mammography-based screening has helped reduce the breast cancer mortality rate, but has also been associated with potential harms due to low specificity, leading to unnecessary exams or procedures, and low sensitivity. Digital breast tomosynthesis (DBT) improves on conventional mammography by increasing both sensitivity and specificity and is becoming common in clinical settings. However, deep learning (DL) models have been developed mainly on conventional 2D full-field digital mammography (FFDM) or scanned film images. Due to a lack of large annotated DBT datasets, it is difficult to train a model on DBT from scratch. In this work, we present methods to generalize a model trained on FFDM images to DBT images. In particular, we use average histogram matching (HM) and DL fine-tuning methods to generalize a FFDM model to the 2D maximum intensity projection (MIP) of DBT images. In the proposed approach, the differences between the FFDM and DBT domains are reduced via HM and then the base model, which was trained on abundant FFDM images, is fine-tuned. When evaluating on image patches extracted around identified findings, we are able to achieve similar areas under the receiver operating characteristic curve (ROC AUC) of $sim 0.9$ for FFDM and $sim 0.85$ for MIP images, as compared to a ROC AUC of $sim 0.75$ when tested directly on MIP images.
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Breast cancer remains a global challenge, causing over 1 million deaths globally in 2018. To achieve earlier breast cancer detection, screening x-ray mammography is recommended by health organizations worldwide and has been estimated to decrease brea
st cancer mortality by 20-40%. Nevertheless, significant false positive and false negative rates, as well as high interpretation costs, leave opportunities for improving quality and access. To address these limitations, there has been much recent interest in applying deep learning to mammography; however, obtaining large amounts of annotated data poses a challenge for training deep learning models for this purpose, as does ensuring generalization beyond the populations represented in the training dataset. Here, we present an annotation-efficient deep learning approach that 1) achieves state-of-the-art performance in mammogram classification, 2) successfully extends to digital breast tomosynthesis (DBT; 3D mammography), 3) detects cancers in clinically-negative prior mammograms of cancer patients, 4) generalizes well to a population with low screening rates, and 5) outperforms five-out-of-five full-time breast imaging specialists by improving absolute sensitivity by an average of 14%. Our results demonstrate promise towards software that can improve the accuracy of and access to screening mammography worldwide.
Purpose: To develop a Breast Imaging Reporting and Data System (BI-RADS) breast density deep learning (DL) model in a multi-site setting for synthetic two-dimensional mammography (SM) images derived from digital breast tomosynthesis exams using full-
field digital mammography (FFDM) images and limited SM data. Materials and Methods: A DL model was trained to predict BI-RADS breast density using FFDM images acquired from 2008 to 2017 (Site 1: 57492 patients, 187627 exams, 750752 images) for this retrospective study. The FFDM model was evaluated using SM datasets from two institutions (Site 1: 3842 patients, 3866 exams, 14472 images, acquired from 2016 to 2017; Site 2: 7557 patients, 16283 exams, 63973 images, 2015 to 2019). Each of the three datasets were then split into training, validation, and test datasets. Adaptation methods were investigated to improve performance on the SM datasets and the effect of dataset size on each adaptation method is considered. Statistical significance was assessed using confidence intervals (CI), estimated by bootstrapping. Results: Without adaptation, the model demonstrated substantial agreement with the original reporting radiologists for all three datasets (Site 1 FFDM: linearly-weighted $kappa_w$ = 0.75 [95% CI: 0.74, 0.76]; Site 1 SM: $kappa_w$ = 0.71 [95% CI: 0.64, 0.78]; Site 2 SM: $kappa_w$ = 0.72 [95% CI: 0.70, 0.75]). With adaptation, performance improved for Site 2 (Site 1: $kappa_w$ = 0.72 [95% CI: 0.66, 0.79], 0.71 vs 0.72, P = .80; Site 2: $kappa_w$ = 0.79 [95% CI: 0.76, 0.81], 0.72 vs 0.79, P $<$ .001) using only 500 SM images from that site. Conclusion: A BI-RADS breast density DL model demonstrated strong performance on FFDM and SM images from two institutions without training on SM images and improved using few SM images.
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