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Differences between human and machine perception in medical diagnosis

Makino, Taro; Jastrzębski, Stanisław; Oleszkiewicz, Witold; Chacko, Celin; Ehrenpreis, Robin; Samreen, Naziya; Chhor, Chloe; Kim, Eric; Lee, Jiyon; Pysarenko, Kristine; Reig, Beatriu; Toth, Hildegard; Awal, Divya; Du, Linda; Kim, Alice; Park, James; Sodickson, Daniel K; Heacock, Laura; Moy, Linda; Cho, Kyunghyun; Geras, Krzysztof J
Deep neural networks (DNNs) show promise in image-based medical diagnosis, but cannot be fully trusted since they can fail for reasons unrelated to underlying pathology. Humans are less likely to make such superficial mistakes, since they use features that are grounded on medical science. It is therefore important to know whether DNNs use different features than humans. Towards this end, we propose a framework for comparing human and machine perception in medical diagnosis. We frame the comparison in terms of perturbation robustness, and mitigate Simpson's paradox by performing a subgroup analysis. The framework is demonstrated with a case study in breast cancer screening, where we separately analyze microcalcifications and soft tissue lesions. While it is inconclusive whether humans and DNNs use different features to detect microcalcifications, we find that for soft tissue lesions, DNNs rely on high frequency components ignored by radiologists. Moreover, these features are located outside of the region of the images found most suspicious by radiologists. This difference between humans and machines was only visible through subgroup analysis, which highlights the importance of incorporating medical domain knowledge into the comparison.
PMID: 35477730
ISSN: 2045-2322
CID: 5205672

Breast Inflammatory Change Is Transient Following COVID-19 Vaccination

Kim, Eric; Reig, Beatriu
PMID: 35289660
ISSN: 1527-1315
CID: 5220702

Axillary Adenopathy after COVID-19 Vaccine: No Reason to Delay Screening Mammogram

Wolfson, Stacey; Kim, Eric; Plaunova, Anastasia; Bukhman, Rita; Sarmiento, Ruth D; Samreen, Naziya; Awal, Divya; Sheth, Monica M; Toth, Hildegard B; Moy, Linda; Reig, Beatriu
PMID: 35133198
ISSN: 1527-1315
CID: 5156732

Artificial intelligence system reduces false-positive findings in the interpretation of breast ultrasound exams

Shen, Yiqiu; Shamout, Farah E; Oliver, Jamie R; Witowski, Jan; Kannan, Kawshik; Park, Jungkyu; Wu, Nan; Huddleston, Connor; Wolfson, Stacey; Millet, Alexandra; Ehrenpreis, Robin; Awal, Divya; Tyma, Cathy; Samreen, Naziya; Gao, Yiming; Chhor, Chloe; Gandhi, Stacey; Lee, Cindy; Kumari-Subaiya, Sheila; Leonard, Cindy; Mohammed, Reyhan; Moczulski, Christopher; Altabet, Jaime; Babb, James; Lewin, Alana; Reig, Beatriu; Moy, Linda; Heacock, Laura; Geras, Krzysztof J
Though consistently shown to detect mammographically occult cancers, breast ultrasound has been noted to have high false-positive rates. In this work, we present an AI system that achieves radiologist-level accuracy in identifying breast cancer in ultrasound images. Developed on 288,767 exams, consisting of 5,442,907 B-mode and Color Doppler images, the AI achieves an area under the receiver operating characteristic curve (AUROC) of 0.976 on a test set consisting of 44,755 exams. In a retrospective reader study, the AI achieves a higher AUROC than the average of ten board-certified breast radiologists (AUROC: 0.962 AI, 0.924 ± 0.02 radiologists). With the help of the AI, radiologists decrease their false positive rates by 37.3% and reduce requested biopsies by 27.8%, while maintaining the same level of sensitivity. This highlights the potential of AI in improving the accuracy, consistency, and efficiency of breast ultrasound diagnosis.
PMID: 34561440
ISSN: 2041-1723
CID: 5039442

Lessons from the first DBTex Challenge

Park, Jungkyu; Shoshan, Yoel; Marti, Robert; Gómez del Campo, Pablo; Ratner, Vadim; Khapun, Daniel; Zlotnick, Aviad; Barkan, Ella; Gilboa-Solomon, Flora; Chłędowski, Jakub; Witowski, Jan; Millet, Alexandra; Kim, Eric; Lewin, Alana; Pysarenko, Kristine; Chen, Sardius; Goldberg, Julia; Patel, Shalin; Plaunova, Anastasia; Wegener, Melanie; Wolfson, Stacey; Lee, Jiyon; Hava, Sana; Murthy, Sindhoora; Du, Linda; Gaddam, Sushma; Parikh, Ujas; Heacock, Laura; Moy, Linda; Reig, Beatriu; Rosen-Zvi, Michal; Geras, Krzysztof J.
ISSN: 2522-5839
CID: 5000532

Radiomics and deep learning methods in expanding the use of screening breast MRI [Editorial]

Reig, Beatriu
KEY POINTS/CONCLUSIONS:• The use of screening breast MRI is expanding beyond high-risk women to include intermediate- and average-risk women.• The study by Pötsch et al uses a radiomics-based method to decrease the number of benign biopsies while maintaining high sensitivity.• Future studies will likely increasingly focus on deep learning methods and abbreviated MRI data.
PMID: 34014381
ISSN: 1432-1084
CID: 4877452

Breast MRI for Evaluation of Response to Neoadjuvant Therapy

Reig, Beatriu; Lewin, Alana A; Du, Linda; Heacock, Laura; Toth, Hildegard K; Heller, Samantha L; Gao, Yiming; Moy, Linda
Neoadjuvant therapy is increasingly being used to treat early-stage triple-negative and human epidermal growth factor 2-overexpressing breast cancers, as well as locally advanced and inflammatory breast cancers. The rationales for neoadjuvant therapy are to shrink tumor size and potentially decrease the extent of surgery, to serve as an in vivo test of response to therapy, and to reveal prognostic information for the patient. MRI is the most accurate modality to demonstrate response to therapy and to help ensure accurate presurgical planning. Changes in lesion diameter, volume, and enhancement are used to predict complete response, partial response, or nonresponse to therapy. However, residual disease may be overestimated or underestimated at MRI. Fibrosis, necrotic tumors, and residual benign masses may be causes of overestimation of residual disease. Nonmass lesions, invasive lobular carcinoma, hormone receptor-positive tumors, nonconcentric shrinkage patterns, the use of antiangiogenic therapy, and late-enhancing foci may be causes of underestimation of residual disease. In patients with known axillary lymph node metastasis, neoadjuvant therapy may be followed by targeted axillary dissection to avoid the potential morbidity associated with an axillary lymph node dissection. Diffusion-weighted imaging, radiomics, machine learning, and deep learning methods are under investigation to improve MRI accuracy in predicting treatment response.©RSNA, 2021.
PMID: 33939542
ISSN: 1527-1323
CID: 4858892

Magnetic Resonance Imaging in Screening of Breast Cancer

Gao, Yiming; Reig, Beatriu; Heacock, Laura; Bennett, Debbie L; Heller, Samantha L; Moy, Linda
Magnetic Resonance (MR) imaging is the most sensitive modality for breast cancer detection but is currently limited to screening women at high risk due to limited specificity and test accessibility. However, specificity of MR imaging improves with successive rounds of screening, and abbreviated approaches have the potential to increase access and decrease cost. There is growing evidence to support supplemental MR imaging in moderate-risk women, and current guidelines continue to evolve. Functional imaging has the potential to maximize survival benefit of screening. Leveraging MR imaging as a possible primary screening tool is therefore also being investigated in average-risk women.
PMID: 33223002
ISSN: 1557-8275
CID: 4676352

Abbreviated MR Imaging for Breast Cancer

Heacock, Laura; Lewin, Alana A; Toth, Hildegard K; Moy, Linda; Reig, Beatriu
Breast MR imaging is the most sensitive imaging method for the detection of breast cancer and detects more aggressive malignancies than mammography and ultrasound examination. Despite these advantages, breast MR imaging has low use rates for breast cancer screening. Abbreviated breast MR imaging, in which a limited number of breast imaging sequences are obtained, has been proposed as a way to solve cost and patient tolerance issues while preserving the high cancer detection rate of breast MR imaging. This review discusses abbreviated breast MR imaging, including protocols, multicenter clinical trial results, clinical workflow implementation challenges, and future directions.
PMID: 33223003
ISSN: 1557-8275
CID: 4680132

Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer

Reig, Beatriu; Heacock, Laura; Lewin, Alana; Cho, Nariya; Moy, Linda
The goals of imaging after neoadjuvant therapy for breast cancer are to monitor the response to therapy and facilitate surgical planning. MRI has been found to be more accurate than mammography, ultrasound, or clinical exam in evaluating treatment response. However, MRI may both overestimate and underestimate residual disease. The accuracy of MRI is dependent on tumor morphology, histology, shrinkage pattern, and molecular subtype. Emerging MRI techniques that combine functional information such as diffusion, metabolism, and hypoxia may improve MR accuracy. In addition, machine-learning techniques including radiomics and radiogenomics are being studied with the goal of predicting response on pretreatment imaging. This article comprehensively reviews response assessment on breast MRI and highlights areas of ongoing research. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 3.
PMID: 32227407
ISSN: 1522-2586
CID: 4370022