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Breast Mass Lesions: Computer-aided Diagnosis Models with Mammographic and Sonographic Descriptors¹

¹ From the Department of Biomedical Engineering (J.L.J., J.Y.L.) and Duke Advanced Imaging Labs, Department of Radiology (J.L.J., J.Y.L., J.A.B.), Duke University Medical Center, 2424 Erwin Rd, Suite 302, Durham, NC 27705. Received April 23, 2006; revision requested June 23; revision received July 24; accepted August 29; final version accepted November 15. Supported by U.S. Army Breast Cancer Research Program W81XWH-05-1-0292 and DAMD17-02-1-0373, and NIH/NCI R01 CA95061 and R21 CA93461. Address correspondence to J.L.J. (e-mail: jonathan.jesneck{at}duke.edu).

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: (a) Full ROC curves for classifier performance: validate set versus retest set. (b) Partial ROC curves for classifier performance: cross validation versus retest set. Results of LDA and ANN generalized well on retest data set, as shown by their overlapping ROC curves. Validation ROC curves (solid curves) lie close to retest ROC curves (dashed curves). LDA and ANN had virtually indistinguishable classification performances. FPF = false-positive fraction, TPF = true-positive fraction.

View larger version (20K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: (a) Full ROC curves for classifier performance: validate set versus retest set. (b) Partial ROC curves for classifier performance: cross validation versus retest set. Results of LDA and ANN generalized well on retest data set, as shown by their overlapping ROC curves. Validation ROC curves (solid curves) lie close to retest ROC curves (dashed curves). LDA and ANN had virtually indistinguishable classification performances. FPF = false-positive fraction, TPF = true-positive fraction.

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: (a) Full ROC curves: LDA versus radiologist on retest set. (b) Partial ROC curves: LDA versus radiologist on retest set. ROC curves for LDA with all features, for LDA with stepwise-selected features, and for radiologist assessment of malignancy. In retesting, LDA, both with all features and with only stepwise-selected features, performed similarly to radiologists. There were no significant differences in any performance metric results among the three ROC curves (P > .2). Although the radiologist curve crossed LDA curves several times, even at points of greater divergence, differences were not significant (P > .2). FPF = false-positive fraction, TPF = true-positive fraction.

View larger version (21K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: (a) Full ROC curves: LDA versus radiologist on retest set. (b) Partial ROC curves: LDA versus radiologist on retest set. ROC curves for LDA with all features, for LDA with stepwise-selected features, and for radiologist assessment of malignancy. In retesting, LDA, both with all features and with only stepwise-selected features, performed similarly to radiologists. There were no significant differences in any performance metric results among the three ROC curves (P > .2). Although the radiologist curve crossed LDA curves several times, even at points of greater divergence, differences were not significant (P > .2). FPF = false-positive fraction, TPF = true-positive fraction.

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: (a) Mediolateral oblique mammogram in 26-year-old patient demonstrates ill-defined, oval-shaped, equal-density mass (arrow) in posterior left breast. Radiopaque marker immediately anterior to mass indicates that this mass was palpable. (b) Sonogram in same patient demonstrates oval, circumscribed mass (arrow) with parallel orientation and no posterior acoustic features. Histopathologic diagnosis indicated that this lesion was necrotic breast tissue. Follow-up examination findings confirmed no interval change 2 years after biopsy. LDA considered this lesion relatively benign, with a score of 0.33 of 1.00, whereas radiologist considered it more indicative of malignancy, with a score of 85 of 100.

View larger version (141K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: (a) Mediolateral oblique mammogram in 26-year-old patient demonstrates ill-defined, oval-shaped, equal-density mass (arrow) in posterior left breast. Radiopaque marker immediately anterior to mass indicates that this mass was palpable. (b) Sonogram in same patient demonstrates oval, circumscribed mass (arrow) with parallel orientation and no posterior acoustic features. Histopathologic diagnosis indicated that this lesion was necrotic breast tissue. Follow-up examination findings confirmed no interval change 2 years after biopsy. LDA considered this lesion relatively benign, with a score of 0.33 of 1.00, whereas radiologist considered it more indicative of malignancy, with a score of 85 of 100.

View larger version (17K): [in this window] [in a new window] [Download PPT slide]   Figure 4a: Histograms of (a) LDA output values and (b) radiologist assessment. Histogram counts for truly benign lesions are shown in gray, and those for truly malignant lesions are shown in black. For classification, a threshold would be applied to LDA output, so that output values below the threshold would be designated benign and those above it would be designated malignant.

View larger version (16K): [in this window] [in a new window] [Download PPT slide]   Figure 4b: Histograms of (a) LDA output values and (b) radiologist assessment. Histogram counts for truly benign lesions are shown in gray, and those for truly malignant lesions are shown in black. For classification, a threshold would be applied to LDA output, so that output values below the threshold would be designated benign and those above it would be designated malignant.

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 5a: (a) Mediolateral oblique mammogram in 52-year-old patient demonstrates oval, well-circumscribed, equal-density mass (arrow) in superior left breast. (b) Sonogram in same patient demonstrates oval, hypoechoic solid mass (arrow) with circumscribed margins, parallel orientation, and posterior acoustic shadowing. Histopathologic results indicated benign fibroadenoma. Both LDA and radiologist correctly considered this lesion very benign, with scores of 0.02 of 1.00 and 0 of 100, respectively.

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 5b: (a) Mediolateral oblique mammogram in 52-year-old patient demonstrates oval, well-circumscribed, equal-density mass (arrow) in superior left breast. (b) Sonogram in same patient demonstrates oval, hypoechoic solid mass (arrow) with circumscribed margins, parallel orientation, and posterior acoustic shadowing. Histopathologic results indicated benign fibroadenoma. Both LDA and radiologist correctly considered this lesion very benign, with scores of 0.02 of 1.00 and 0 of 100, respectively.

View larger version (72K): [in this window] [in a new window] [Download PPT slide]   Figure 6a: (a) Mediolateral oblique mammogram in 57-year-old patient demonstrates ill-defined, irregularly shaped, equal-density mass (arrow) in superior right breast. (b) Sonogram in same patient demonstrates ill-defined, irregularly shaped mass (arrow) with posterior acoustic shadowing and without parallel orientation. Histopathologic diagnosis indicated that this malignant lesion was invasive ductal carcinoma. Both LDA and radiologist correctly considered this lesion very malignant, with scores of 0.99 of 1.00 and 95 of 100, respectively.

View larger version (170K): [in this window] [in a new window] [Download PPT slide]   Figure 6b: (a) Mediolateral oblique mammogram in 57-year-old patient demonstrates ill-defined, irregularly shaped, equal-density mass (arrow) in superior right breast. (b) Sonogram in same patient demonstrates ill-defined, irregularly shaped mass (arrow) with posterior acoustic shadowing and without parallel orientation. Histopathologic diagnosis indicated that this malignant lesion was invasive ductal carcinoma. Both LDA and radiologist correctly considered this lesion very malignant, with scores of 0.99 of 1.00 and 95 of 100, respectively.