Regular mammography screening is essential for early breast cancer detection. Deep learning-based risk prediction methods have sparked interest to adjust screening intervals for high-risk groups. While early methods focused only on current mammograms, recent approaches leverage the temporal aspect of screenings to track breast tissue changes over time, requiring spatial alignment across different time points. Two main strategies for this have emerged: explicit feature alignment through deformable registration and implicit learned alignment using techniques like transformers, with the former providing more control. However, the optimal approach for explicit alignment in mammography remains underexplored. In this study, we provide insights into where explicit alignment should occur (input space vs. representation space) and if alignment and risk prediction should be jointly optimized. We demonstrate that jointly learning explicit alignment in representation space while optimizing risk estimation performance, as done in the current state-of-the-art approach, results in a trade-off between alignment quality and predictive performance and show that image-level alignment is superior to representation-level alignment, leading to better deformation field quality and enhanced risk prediction accuracy. The code is available at https://github.com/sot176/Longitudinal_Mammogram_Alignment.git.
Although digital breast tomosynthesis (DBT) improves diagnostic performance over full-field digital mammography (FFDM), false-positive recalls remain a concern in breast cancer screening. We developed a multi-modal artificial intelligence system integrating FFDM, synthetic mammography, and DBT to provide breast-level predictions and bounding-box localizations of suspicious findings. Our AI system, trained on approximately 500,000 mammography exams, achieved 0.945 AUROC on an internal test set. It demonstrated capacity to reduce recalls by 31.7% and radiologist workload by 43.8% while maintaining 100% sensitivity, underscoring its potential to improve clinical workflows. External validation confirmed strong generalizability, reducing the gap to a perfect AUROC by 35.31%-69.14% relative to strong baselines. In prospective deployment across 18 sites, the system reduced recall rates for low-risk cases. An improved version, trained on over 750,000 exams with additional labels, further reduced the gap by 18.86%-56.62% across large external datasets. Overall, these results underscore the importance of utilizing all available imaging modalities, demonstrate the potential for clinical impact, and indicate feasibility of further reduction of the test error with increased training set when using large-capacity neural networks.
Medical image segmentation is crucial in assisting medical doctors in making diagnoses and enabling accurate automatic diagnosis. While advanced convolutional neural networks (CNNs) excel in segmenting regions of interest with pixel-level precision, they often struggle with long-range dependencies, which is crucial for enhancing model performance. Conversely, transformer architectures leverage attention mechanisms to excel in handling long-range dependencies. However, the computational complexity of transformers grows quadratically, posing resource-intensive challenges, especially with high-resolution medical images. Recent research aims to combine CNN and transformer architectures to mitigate their drawbacks and enhance performance while keeping resource demands low. Nevertheless, existing approaches have not fully leveraged the strengths of both architectures to achieve high accuracy with low computational requirements. To address this gap, we propose a novel architecture for 2D medical image segmentation (QTSeg) that leverages a feature pyramid network (FPN) as the image encoder, a multi-level feature fusion (MLFF) as the adaptive module between encoder and decoder and a multi-query mask decoder (MQM Decoder) as the mask decoder. In the first step, an FPN model extracts pyramid features from the input image. Next, MLFF is incorporated between the encoder and decoder to adapt features from different encoder stages to the decoder. Finally, an MQM Decoder is employed to improve mask generation by integrating query tokens with pyramid features at all stages of the mask decoder. Our experimental results show that QTSeg outperforms state-of-the-art methods across all metrics with lower computational demands than the baseline and the existing methods. Code is available at https://github.com/tpnam0901/QTSeg (v0.1.0)
Improving breast cancer detection and monitoring techniques is a critical objective in healthcare, driving the need for innovative imaging technologies and diagnostic approaches. This study introduces a novel multi-tiered self-contrastive model tailored for microwave radiometry (MWR) in breast cancer detection. Our approach incorporates three distinct models: Local-MWR (L-MWR), Regional-MWR (R-MWR), and Global-MWR (G-MWR), designed to analyze varying sub-regional comparisons within the breasts. These models are integrated through the Joint-MWR (J-MWR) network, which leverages self-contrastive results at each analytical level to improve diagnostic accuracy. Utilizing a dataset of 4,932 female patients, our research demonstrates the efficacy of our proposed models. Notably, the J-MWR model achieves a Matthew's correlation coefficient of 0.74 $\pm$ 0.018, surpassing existing MWR neural networks and contrastive methods. These findings highlight the potential of self-contrastive learning techniques in improving the diagnostic accuracy and generalizability for MWR-based breast cancer detection. This advancement holds considerable promise for future investigations into enabling point-of-care testing. The source code is available at: https://github.com/cgalaz01/self_contrastive_mwr.
This study evaluates the effectiveness of deep learning models in classifying histopathological images for early and accurate detection of breast cancer. Eight advanced models, including ResNet-50, DenseNet-121, ResNeXt-50, Vision Transformer (ViT), GoogLeNet (Inception v3), EfficientNet, MobileNet, and SqueezeNet, were compared using a dataset of 277,524 image patches. The Vision Transformer (ViT) model, with its attention-based mechanisms, achieved the highest validation accuracy of 94%, outperforming conventional CNNs. The study demonstrates the potential of advanced machine learning methods to enhance precision and efficiency in breast cancer diagnosis in clinical settings.
It is of great significance to diagnose Invasive Ductal Carcinoma (IDC) in early stage, which is the most common subtype of breast cancer. Although the powerful models in the Computer-Aided Diagnosis (CAD) systems provide promising results, it is still difficult to integrate them into other medical devices or use them without sufficient computation resource. In this paper, we propose BCDNet, which firstly upsamples the input image by the residual block and use smaller convolutional block and a special MLP to learn features. BCDNet is proofed to effectively detect IDC in histopathological RGB images with an average accuracy of 91.6% and reduce training consumption effectively compared to ResNet 50 and ViT-B-16.
Whole Slide Image (WSI) classification with multiple instance learning (MIL) in digital pathology faces significant computational challenges. Current methods mostly rely on extensive self-supervised learning (SSL) for satisfactory performance, requiring long training periods and considerable computational resources. At the same time, no pre-training affects performance due to domain shifts from natural images to WSIs. We introduce Snuffy architecture, a novel MIL-pooling method based on sparse transformers that mitigates performance loss with limited pre-training and enables continual few-shot pre-training as a competitive option. Our sparsity pattern is tailored for pathology and is theoretically proven to be a universal approximator with the tightest probabilistic sharp bound on the number of layers for sparse transformers, to date. We demonstrate Snuffy's effectiveness on CAMELYON16 and TCGA Lung cancer datasets, achieving superior WSI and patch-level accuracies. The code is available on https://github.com/jafarinia/snuffy.
Artificial Intelligence (AI) has emerged as a valuable tool for assisting radiologists in breast cancer detection and diagnosis. However, the success of AI applications in this domain is restricted by the quantity and quality of available data, posing challenges due to limited and costly data annotation procedures that often lead to annotation shifts. This study simulates, analyses and mitigates annotation shifts in cancer classification in the breast mammography domain. First, a high-accuracy cancer risk prediction model is developed, which effectively distinguishes benign from malignant lesions. Next, model performance is used to quantify the impact of annotation shift. We uncover a substantial impact of annotation shift on multiclass classification performance particularly for malignant lesions. We thus propose a training data augmentation approach based on single-image generative models for the affected class, requiring as few as four in-domain annotations to considerably mitigate annotation shift, while also addressing dataset imbalance. Lastly, we further increase performance by proposing and validating an ensemble architecture based on multiple models trained under different data augmentation regimes. Our study offers key insights into annotation shift in deep learning breast cancer classification and explores the potential of single-image generative models to overcome domain shift challenges.
The lack of large and diverse training data on Computer-Aided Diagnosis (CAD) in breast cancer detection has been one of the concerns that impedes the adoption of the system. Recently, pre-training with large-scale image text datasets via Vision-Language models (VLM) (\eg CLIP) partially addresses the issue of robustness and data efficiency in computer vision (CV). This paper proposes Mammo-CLIP, the first VLM pre-trained on a substantial amount of screening mammogram-report pairs, addressing the challenges of dataset diversity and size. Our experiments on two public datasets demonstrate strong performance in classifying and localizing various mammographic attributes crucial for breast cancer detection, showcasing data efficiency and robustness similar to CLIP in CV. We also propose Mammo-FActOR, a novel feature attribution method, to provide spatial interpretation of representation with sentence-level granularity within mammography reports. Code is available publicly: \url{https://github.com/batmanlab/Mammo-CLIP}.
Deep neural networks have reached remarkable achievements in medical image processing tasks, specifically in classifying and detecting various diseases. However, when confronted with limited data, these networks face a critical vulnerability, often succumbing to overfitting by excessively memorizing the limited information available. This work addresses the challenge mentioned above by improving the supervised contrastive learning method leveraging both image-level labels and domain-specific augmentations to enhance model robustness. This approach integrates self-supervised pre-training with a two-stage supervised contrastive learning strategy. In the first stage, we employ a modified supervised contrastive loss that not only focuses on reducing false negatives but also introduces an elimination effect to address false positives. In the second stage, a relaxing mechanism is introduced that refines positive and negative pairs based on similarity, ensuring that only relevant image representations are aligned. We evaluate our method on the BreakHis dataset, which consists of breast cancer histopathology images, and demonstrate an increase in classification accuracy by 1.45% in the image level, compared to the state-of-the-art method. This improvement corresponds to 93.63% absolute accuracy, highlighting the effectiveness of our approach in leveraging properties of data to learn more appropriate representation space.
The Deep Learning revolution has enabled groundbreaking achievements in recent years. From breast cancer detection to protein folding, deep learning algorithms have been at the core of very important advancements. However, these modern advancements are becoming more and more data-hungry, especially on labeled data whose availability is scarce: this is even more prevalent in the medical context. In this work, we show how active learning could be very effective in data scarcity situations, where obtaining labeled data (or annotation budget is very limited). We compare several selection criteria (BALD, MeanSTD, and MaxEntropy) on the ISIC 2016 dataset. We also explored the effect of acquired pool size on the model's performance. Our results suggest that uncertainty is useful to the Melanoma detection task, and confirms the hypotheses of the author of the paper of interest, that \textit{bald} performs on average better than other acquisition functions. Our extended analyses however revealed that all acquisition functions perform badly on the positive (cancerous) samples, suggesting exploitation of class unbalance, which could be crucial in real-world settings. We finish by suggesting future work directions that would be useful to improve this current work. The code of our implementation is open-sourced at \url{https://github.com/bonaventuredossou/ece526_course_project}
Undoubtedly breast cancer identifies itself as one of the most widespread and terrifying cancers across the globe. Millions of women are getting affected each year from it. Breast cancer remains the major one for being the reason of largest number of demise of women. In the recent time of research, Medical Image Computing and Processing has been playing a significant role for detecting and classifying breast cancers from ultrasound images and mammograms, along with the celestial touch of deep neural networks. In this research, we focused mostly on our rigorous implementations and iterative result analysis of different cutting-edge modified versions of EfficientNet architectures namely EfficientNet-V1 (b0-b7) and EfficientNet-V2 (b0-b3) with ultrasound image, named as CEIMVEN. We utilized transfer learning approach here for using the pre-trained models of EfficientNet versions. We activated the hyper-parameter tuning procedures, added fully connected layers, discarded the unprecedented outliers and recorded the accuracy results from our custom modified EfficientNet architectures. Our deep learning model training approach was related to both identifying the cancer affected areas with region of interest (ROI) techniques and multiple classifications (benign, malignant and normal). The approximate testing accuracies we got from the modified versions of EfficientNet-V1 (b0- 99.15%, b1- 98.58%, b2- 98.43%, b3- 98.01%, b4- 98.86%, b5- 97.72%, b6- 97.72%, b7- 98.72%) and EfficientNet-V2 (b0- 99.29%, b1- 99.01%, b2- 98.72%, b3- 99.43%) are showing very bright future and strong potentials of deep learning approach for the successful detection and classification of breast cancers from the ultrasound images at a very early stage. The code for this research is available here: https://github.com/ac005sheekar/CEIMVEN-Breast.
Breast cancer is a leading cause of cancer-related deaths, but current programs are expensive and prone to false positives, leading to unnecessary follow-up and patient anxiety. This paper proposes a solution to automated breast cancer detection, to improve the efficiency and accuracy of screening programs. Different methodologies were tested against the RSNA dataset of radiographic breast images of roughly 20,000 female patients and yielded an average validation case pF1 score of 0.56 across methods.
Magnetic resonance imaging (MRI) is the most sensitive technique for breast cancer detection among current clinical imaging modalities. Contrast-enhanced MRI (CE-MRI) provides superior differentiation between tumors and invaded healthy tissue, and has become an indispensable technique in the detection and evaluation of cancer. However, the use of gadolinium-based contrast agents (GBCA) to obtain CE-MRI may be associated with nephrogenic systemic fibrosis and may lead to bioaccumulation in the brain, posing a potential risk to human health. Moreover, and likely more important, the use of gadolinium-based contrast agents requires the cannulation of a vein, and the injection of the contrast media which is cumbersome and places a burden on the patient. To reduce the use of contrast agents, diffusion-weighted imaging (DWI) is emerging as a key imaging technique, although currently usually complementing breast CE-MRI. In this study, we develop a multi-sequence fusion network to synthesize CE-MRI based on T1-weighted MRI and DWIs. DWIs with different b-values are fused to efficiently utilize the difference features of DWIs. Rather than proposing a pure data-driven approach, we invent a multi-sequence attention module to obtain refined feature maps, and leverage hierarchical representation information fused at different scales while utilizing the contributions from different sequences from a model-driven approach by introducing the weighted difference module. The results show that the multi-b-value DWI-based fusion model can potentially be used to synthesize CE-MRI, thus theoretically reducing or avoiding the use of GBCA, thereby minimizing the burden to patients. Our code is available at \url{https://github.com/Netherlands-Cancer-Institute/CE-MRI}.
Computer-aided detection systems based on deep learning have shown good performance in breast cancer detection. However, high-density breasts show poorer detection performance since dense tissues can mask or even simulate masses. Therefore, the sensitivity of mammography for breast cancer detection can be reduced by more than 20% in dense breasts. Additionally, extremely dense cases reported an increased risk of cancer compared to low-density breasts. This study aims to improve the mass detection performance in highdensity breasts using synthetic high-density full-field digital mammograms (FFDM) as data augmentation during breast mass detection model training. To this end, a total of five cycle-consistent GAN (CycleGAN) models using three FFDM datasets were trained for low-to-high-density image translation in highresolution mammograms. The training images were split by breast density BIRADS categories, being BI-RADS A almost entirely fatty and BI-RADS D extremely dense breasts. Our results showed that the proposed data augmentation technique improved the sensitivity and precision of mass detection in models trained with small datasets and improved the domain generalization of the models trained with large databases. In addition, the clinical realism of the synthetic images was evaluated in a reader study involving two expert radiologists and one surgical oncologist.
Breast cancer is the most common cancer among women worldwide. Early-stage diagnosis of breast cancer can significantly improve the efficiency of treatment. Computer-aided diagnosis (CAD) systems are widely adopted in this issue due to their reliability, accuracy and affordability. There are different imaging techniques for a breast cancer diagnosis; one of the most accurate ones is histopathology which is used in this paper. Deep feature transfer learning is used as the main idea of the proposed CAD system's feature extractor. Although 16 different pre-trained networks have been tested in this study, our main focus is on the classification phase. The Inception-ResNet-v2 which has both residual and inception networks profits together has shown the best feature extraction capability in the case of breast cancer histopathology images among all tested CNNs. In the classification phase, the ensemble of CatBoost, XGBoost and LightGBM has provided the best average accuracy. The BreakHis dataset was used to evaluate the proposed method. BreakHis contains 7909 histopathology images (2,480 benign and 5,429 malignant) in four magnification factors. The proposed method's accuracy (IRv2-CXL) using 70% of BreakHis dataset as training data in 40x, 100x, 200x and 400x magnification is 96.82%, 95.84%, 97.01% and 96.15%, respectively. Most studies on automated breast cancer detection have focused on feature extraction, which made us attend to the classification phase. IRv2-CXL has shown better or comparable results in all magnifications due to using the soft voting ensemble method which could combine the advantages of CatBoost, XGBoost and LightGBM together.
Since data scarcity and data heterogeneity are prevailing for medical images, well-trained Convolutional Neural Networks (CNNs) using previous normalization methods may perform poorly when deployed to a new site. However, a reliable model for real-world clinical applications should be able to generalize well both on in-distribution (IND) and out-of-distribution (OOD) data (e.g., the new site data). In this study, we present a novel normalization technique called window normalization (WIN) to improve the model generalization on heterogeneous medical images, which is a simple yet effective alternative to existing normalization methods. Specifically, WIN perturbs the normalizing statistics with the local statistics computed on the window of features. This feature-level augmentation technique regularizes the models well and improves their OOD generalization significantly. Taking its advantage, we propose a novel self-distillation method called WIN-WIN for classification tasks. WIN-WIN is easily implemented with twice forward passes and a consistency constraint, which can be a simple extension for existing methods. Extensive experimental results on various tasks (6 tasks) and datasets (24 datasets) demonstrate the generality and effectiveness of our methods.
The evaluation of human epidermal growth factor receptor 2 (HER2) expression is essential to formulate a precise treatment for breast cancer. The routine evaluation of HER2 is conducted with immunohistochemical techniques (IHC), which is very expensive. Therefore, for the first time, we propose a breast cancer immunohistochemical (BCI) benchmark attempting to synthesize IHC data directly with the paired hematoxylin and eosin (HE) stained images. The dataset contains 4870 registered image pairs, covering a variety of HER2 expression levels. Based on BCI, as a minor contribution, we further build a pyramid pix2pix image generation method, which achieves better HE to IHC translation results than the other current popular algorithms. Extensive experiments demonstrate that BCI poses new challenges to the existing image translation research. Besides, BCI also opens the door for future pathology studies in HER2 expression evaluation based on the synthesized IHC images. BCI dataset can be downloaded from https://bupt-ai-cz.github.io/BCI.
Artificial intelligence (AI) is showing promise in improving clinical diagnosis. In breast cancer screening, recent studies show that AI has the potential to improve early cancer diagnosis and reduce unnecessary workup. As the number of proposed models and their complexity grows, it is becoming increasingly difficult to re-implement them. To enable reproducibility of research and to enable comparison between different methods, we release a meta-repository containing models for classification of screening mammograms. This meta-repository creates a framework that enables the evaluation of AI models on any screening mammography data set. At its inception, our meta-repository contains five state-of-the-art models with open-source implementations and cross-platform compatibility. We compare their performance on seven international data sets. Our framework has a flexible design that can be generalized to other medical image analysis tasks. The meta-repository is available at https://www.github.com/nyukat/mammography_metarepository.
For early breast cancer detection, regular screening with mammography imaging is recommended. Routinary examinations result in datasets with a predominant amount of negative samples. A potential solution to such class-imbalance is joining forces across multiple institutions. Developing a collaborative computer-aided diagnosis system is challenging in different ways. Patient privacy and regulations need to be carefully respected. Data across institutions may be acquired from different devices or imaging protocols, leading to heterogeneous non-IID data. Also, for learning-based methods, new optimization strategies working on distributed data are required. Recently, federated learning has emerged as an effective tool for collaborative learning. In this setting, local models perform computation on their private data to update the global model. The order and the frequency of local updates influence the final global model. Hence, the order in which samples are locally presented to the optimizers plays an important role. In this work, we define a memory-aware curriculum learning method for the federated setting. Our curriculum controls the order of the training samples paying special attention to those that are forgotten after the deployment of the global model. Our approach is combined with unsupervised domain adaptation to deal with domain shift while preserving data privacy. We evaluate our method with three clinical datasets from different vendors. Our results verify the effectiveness of federated adversarial learning for the multi-site breast cancer classification. Moreover, we show that our proposed memory-aware curriculum method is beneficial to further improve classification performance. Our code is publicly available at: https://github.com/ameliajimenez/curriculum-federated-learning.