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Bioengineering 2018, 5(3), 62;

Evaluation of a Computer-Aided Diagnosis System in the Classification of Lesions in Breast Strain Elastography Imaging

Department of Electrical and Computer Engineering, University of São Paulo, 400 Trabalhador São-carlense Av., São Carlos 13566-590, Brazil
Brazilian Institute for Cancer Control, 2576 Alcântara Machado Av., São Paulo 03101-005, Brazil
Faculty of Medical Sciences of Santa Casa de São Paulo, 61 Doutor Cesário Motta Júnior St., São Paulo 01221-020, Brazil
Department of Physics, University of São Paulo, 3900 Bandeirantes Av., Ribeirão Preto 14040-901, Brazil
Department of Radiology, University of Pittsburgh, 3362 Fifth Av., Pittsburgh, PA 15123, USA
Author to whom correspondence should be addressed.
Received: 12 June 2018 / Revised: 27 July 2018 / Accepted: 6 August 2018 / Published: 9 August 2018
(This article belongs to the Special Issue Biosignal Processing)
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Purpose: Evaluation of the performance of a computer-aided diagnosis (CAD) system based on the quantified color distribution in strain elastography imaging to evaluate the malignancy of breast tumors. Methods: The database consisted of 31 malignant and 52 benign lesions. A radiologist who was blinded to the diagnosis performed the visual analysis of the lesions. After six months with no eye contact on the breast images, the same radiologist and other two radiologists manually drew the contour of the lesions in B-mode ultrasound, which was masked in the elastography image. In order to measure the amount of hard tissue in a lesion, we developed a CAD system able to identify the amount of hard tissue, represented by red color, and quantify its predominance in a lesion, allowing classification as soft, intermediate, or hard. The data obtained with the CAD system were compared with the visual analysis. We calculated the sensitivity, specificity, and area under the curve (AUC) for the classification using the CAD system from the manual delineation of the contour by each radiologist. Results: The performance of the CAD system for the most experienced radiologist achieved sensitivity of 70.97%, specificity of 88.46%, and AUC of 0.853. The system presented better performance compared with his visual diagnosis, whose sensitivity, specificity, and AUC were 61.29%, 88.46%, and 0.829, respectively. The system obtained sensitivity, specificity, and AUC of 67.70%, 84.60%, and 0.783, respectively, for images segmented by Radiologist 2, and 51.60%, 92.30%, and 0.771, respectively, for those segmented by the Resident. The intra-class correlation coefficient was 0.748. The inter-observer agreement of the CAD system with the different contours was good in all comparisons. Conclusions: The proposed CAD system can improve the radiologist performance for classifying breast masses, with excellent inter-observer agreement. It could be a promising tool for clinical use. View Full-Text
Keywords: breast cancer; elastography imaging; computer-aided diagnosis; color map; inter-observer agreement breast cancer; elastography imaging; computer-aided diagnosis; color map; inter-observer agreement

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Marcomini, K.D.; Fleury, E.F.C.; Oliveira, V.M.; Carneiro, A.A.O.; Schiabel, H.; Nishikawa, R.M. Evaluation of a Computer-Aided Diagnosis System in the Classification of Lesions in Breast Strain Elastography Imaging. Bioengineering 2018, 5, 62.

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