Sarah Eskreis-Winkler

Lukas Hirsch, Yu Huang, Hernan A. Makse et al.

Women with an increased life-time risk of breast cancer undergo supplemental annual screening MRI. We propose to predict the risk of developing breast cancer within one year based on the current MRI, with the objective of reducing screening burden and facilitating early detection. An AI algorithm was developed on 53,858 breasts from 12,694 patients who underwent screening or diagnostic MRI and accrued over 12 years, with 2,331 confirmed cancers. A first U-Net was trained to segment lesions and identify regions of concern. A second convolutional network was trained to detect malignant cancer using features extracted by the U-Net. This network was then fine-tuned to estimate the risk of developing cancer within a year in cases that radiologists considered normal or likely benign. Risk predictions from this AI were evaluated with a retrospective analysis of 9,183 breasts from a high-risk screening cohort, which were not used for training. Statistical analysis focused on the tradeoff between number of omitted exams versus negative predictive value, and number of potential early detections versus positive predictive value. The AI algorithm identified regions of concern that coincided with future tumors in 52% of screen-detected cancers. Upon directed review, a radiologist found that 71.3% of cancers had a visible correlate on the MRI prior to diagnosis, 65% of these correlates were identified by the AI model. Reevaluating these regions in 10% of all cases with higher AI-predicted risk could have resulted in up to 33% early detections by a radiologist. Additionally, screening burden could have been reduced in 16% of lower-risk cases by recommending a later follow-up without compromising current interval cancer rate. With increasing datasets and improving image quality we expect this new AI-aided, adaptive screening to meaningfully reduce screening burden and improve early detection.

Lukas Hirsch, Yu Huang, Shaojun Luo et al.

Purpose: To develop a deep network architecture that would achieve fully automated radiologist-level segmentation of cancers at breast MRI. Materials and Methods: In this retrospective study, 38229 examinations (composed of 64063 individual breast scans from 14475 patients) were performed in female patients (age range, 12-94 years; mean age, 52 years +/- 10 [standard deviation]) who presented between 2002 and 2014 at a single clinical site. A total of 2555 breast cancers were selected that had been segmented on two-dimensional (2D) images by radiologists, as well as 60108 benign breasts that served as examples of noncancerous tissue; all these were used for model training. For testing, an additional 250 breast cancers were segmented independently on 2D images by four radiologists. Authors selected among several three-dimensional (3D) deep convolutional neural network architectures, input modalities, and harmonization methods. The outcome measure was the Dice score for 2D segmentation, which was compared between the network and radiologists by using the Wilcoxon signed rank test and the two one-sided test procedure. Results: The highest-performing network on the training set was a 3D U-Net with dynamic contrast-enhanced MRI as input and with intensity normalized for each examination. In the test set, the median Dice score of this network was 0.77 (interquartile range, 0.26). The performance of the network was equivalent to that of the radiologists (two one-sided test procedures with radiologist performance of 0.69-0.84 as equivalence bounds, P <= .001 for both; n = 250). Conclusion: When trained on a sufficiently large dataset, the developed 3D U-Net performed as well as fellowship-trained radiologists in detailed 2D segmentation of breast cancers at routine clinical MRI.