Mammographic breast density classification is essential for cancer risk assessment but remains challenging due to subjective interpretation and inter-observer variability. This study compares multimodal and CNN-based methods for automated classification using the BI-RADS system, evaluating BioMedCLIP and ConvNeXt across three learning scenarios: zero-shot classification, linear probing with textual descriptions, and fine-tuning with numerical labels. Results show that zero-shot classification achieved modest performance, while the fine-tuned ConvNeXt model outperformed the BioMedCLIP linear probe. Although linear probing demonstrated potential with pretrained embeddings, it was less effective than full fine-tuning. These findings suggest that despite the promise of multimodal learning, CNN-based models with end-to-end fine-tuning provide stronger performance for specialized medical imaging. The study underscores the need for more detailed textual representations and domain-specific adaptations in future radiology applications.
The correct interpretation of breast density is important in the assessment of breast cancer risk. AI has been shown capable of accurately predicting breast density, however, due to the differences in imaging characteristics across mammography systems, models built using data from one system do not generalize well to other systems. Though federated learning (FL) has emerged as a way to improve the generalizability of AI without the need to share data, the best way to preserve features from all training data during FL is an active area of research. To explore FL methodology, the breast density classification FL challenge was hosted in partnership with the American College of Radiology, Harvard Medical School's Mass General Brigham, University of Colorado, NVIDIA, and the National Institutes of Health National Cancer Institute. Challenge participants were able to submit docker containers capable of implementing FL on three simulated medical facilities, each containing a unique large mammography dataset. The breast density FL challenge ran from June 15 to September 5, 2022, attracting seven finalists from around the world. The winning FL submission reached a linear kappa score of 0.653 on the challenge test data and 0.413 on an external testing dataset, scoring comparably to a model trained on the same data in a central location.
The assessment of breast density is crucial in the context of breast cancer screening, especially in populations with a higher percentage of dense breast tissues. This study introduces a novel data augmentation technique termed Attention-Guided Erasing (AGE), devised to enhance the downstream classification of four distinct breast density categories in mammography following the BI-RADS recommendation in the Vietnamese cohort. The proposed method integrates supplementary information during transfer learning, utilizing visual attention maps derived from a vision transformer backbone trained using the self-supervised DINO method. These maps are utilized to erase background regions in the mammogram images, unveiling only the potential areas of dense breast tissues to the network. Through the incorporation of AGE during transfer learning with varying random probabilities, we consistently surpass classification performance compared to scenarios without AGE and the traditional random erasing transformation. We validate our methodology using the publicly available VinDr-Mammo dataset. Specifically, we attain a mean F1-score of 0.5910, outperforming values of 0.5594 and 0.5691 corresponding to scenarios without AGE and with random erasing (RE), respectively. This superiority is further substantiated by t-tests, revealing a p-value of p<0.0001, underscoring the statistical significance of our approach.
The deep learning technique has been shown to be effectively addressed several image analysis tasks in the computer-aided diagnosis scheme for mammography. The training of an efficacious deep learning model requires large data with diverse styles and qualities. The diversity of data often comes from the use of various scanners of vendors. But, in practice, it is impractical to collect a sufficient amount of diverse data for training. To this end, a novel contrastive learning is developed to equip the deep learning models with better style generalization capability. Specifically, the multi-style and multi-view unsupervised self-learning scheme is carried out to seek robust feature embedding against style diversity as a pretrained model. Afterward, the pretrained network is further fine-tuned to the downstream tasks, e.g., mass detection, matching, BI-RADS rating, and breast density classification. The proposed method has been evaluated extensively and rigorously with mammograms from various vendor style domains and several public datasets. The experimental results suggest that the proposed domain generalization method can effectively improve performance of four mammographic image tasks on the data from both seen and unseen domains, and outperform many state-of-the-art (SOTA) generalization methods.
Breast density estimation is one of the key tasks in recognizing individuals predisposed to breast cancer. It is often challenging because of low contrast and fluctuations in mammograms' fatty tissue background. Most of the time, the breast density is estimated manually where a radiologist assigns one of the four density categories decided by the Breast Imaging and Reporting Data Systems (BI-RADS). There have been efforts in the direction of automating a breast density classification pipeline. Breast density estimation is one of the key tasks performed during a screening exam. Dense breasts are more susceptible to breast cancer. The density estimation is challenging because of low contrast and fluctuations in mammograms' fatty tissue background. Traditional mammograms are being replaced by tomosynthesis and its other low radiation dose variants (for example Hologic' Intelligent 2D and C-View). Because of the low-dose requirement, increasingly more screening centers are favoring the Intelligent 2D view and C-View. Deep-learning studies for breast density estimation use only a single modality for training a neural network. However, doing so restricts the number of images in the dataset. In this paper, we show that a neural network trained on all the modalities at once performs better than a neural network trained on any single modality. We discuss these results using the area under the receiver operator characteristics curves.
Building robust deep learning-based models requires large quantities of diverse training data. In this study, we investigate the use of federated learning (FL) to build medical imaging classification models in a real-world collaborative setting. Seven clinical institutions from across the world joined this FL effort to train a model for breast density classification based on Breast Imaging, Reporting & Data System (BI-RADS). We show that despite substantial differences among the datasets from all sites (mammography system, class distribution, and data set size) and without centralizing data, we can successfully train AI models in federation. The results show that models trained using FL perform 6.3% on average better than their counterparts trained on an institute's local data alone. Furthermore, we show a 45.8% relative improvement in the models' generalizability when evaluated on the other participating sites' testing data.
Breast density classification is an essential part of breast cancer screening. Although a lot of prior work considered this problem as a task for learning algorithms, to our knowledge, all of them used small and not clinically realistic data both for training and evaluation of their models. In this work, we explore the limits of this task with a data set coming from over 200,000 breast cancer screening exams. We use this data to train and evaluate a strong convolutional neural network classifier. In a reader study, we find that our model can perform this task comparably to a human expert.