Transformers Improve Breast Cancer Diagnosis from Unregistered Multi-View Mammograms

Deep convolutional neural networks (CNNs) have been widely used in various medical imaging tasks. However, due to the intrinsic locality of convolution operation, CNNs generally cannot model long-range dependencies well, which are important for accurately identifying or mapping corresponding breast lesion features computed from unregistered multiple mammograms. This motivates us to leverage the architecture of Multi-view Vision Transformers to capture long-range relationships of multiple mammograms from the same patient in one examination. For this purpose, we employ local Transformer blocks to separately learn patch relationships within four mammograms acquired from two-view (CC/MLO) of two-side (right/left) breasts. The outputs from different views and sides are concatenated and fed into global Transformer blocks, to jointly learn patch relationships between four images representing two different views of the left and right breasts. To evaluate the proposed model, we retrospectively assembled a dataset involving 949 sets of mammograms, which include 470 malignant cases and 479 normal or benign cases. We trained and evaluated the model using a five-fold cross-validation method. Without any arduous preprocessing steps (e.g., optimal window cropping, chest wall or pectoral muscle removal, two-view image registration, etc.), our four-image (two-view-two-side) Transformer-based model achieves case classification performance with an area under ROC curve (AUC = 0.818), which significantly outperforms AUC = 0.784 achieved by the state-of-the-art multi-view CNNs (p = 0.009). It also outperforms two one-view-two-side models that achieve AUC of 0.724 (CC view) and 0.769 (MLO view), respectively. The study demonstrates the potential of using Transformers to develop high-performing computer-aided diagnosis schemes that combine four mammograms.

Virtual Adversarial Training for Semi-supervised Breast Mass Classification

This study aims to develop a novel computer-aided diagnosis (CAD) scheme for mammographic breast mass classification using semi-supervised learning. Although supervised deep learning has achieved huge success across various medical image analysis tasks, its success relies on large amounts of high-quality annotations, which can be challenging to acquire in practice. To overcome this limitation, we propose employing a semi-supervised method, i.e., virtual adversarial training (VAT), to leverage and learn useful information underlying in unlabeled data for better classification of breast masses. Accordingly, our VAT-based models have two types of losses, namely supervised and virtual adversarial losses. The former loss acts as in supervised classification, while the latter loss aims at enhancing model robustness against virtual adversarial perturbation, thus improving model generalizability. To evaluate the performance of our VAT-based CAD scheme, we retrospectively assembled a total of 1024 breast mass images, with equal number of benign and malignant masses. A large CNN and a small CNN were used in this investigation, and both were trained with and without the adversarial loss. When the labeled ratios were 40% and 80%, VAT-based CNNs delivered the highest classification accuracy of 0.740 and 0.760, respectively. The experimental results suggest that the VAT-based CAD scheme can effectively utilize meaningful knowledge from unlabeled data to better classify mammographic breast mass images.

Recent advances and clinical applications of deep learning in medical image analysis

Deep learning has become the mainstream technology in computer vision, and it has received extensive research interest in developing new medical image processing algorithms to support disease detection and diagnosis. As compared to conventional machine learning technologies, the major advantage of deep learning is that models can automatically identify and recognize representative features through the hierarchal model architecture, while avoiding the laborious development of hand-crafted features. In this paper, we reviewed and summarized more than 200 recently published papers to provide a comprehensive overview of applying deep learning methods in various medical image analysis tasks. Especially, we emphasize the latest progress and contributions of state-of-the-art unsupervised and semi-supervised deep learning in medical images, which are summarized based on different application scenarios, including lesion classification, segmentation, detection, and image registration. Additionally, we also discussed the major technical challenges and suggested the possible solutions in future research efforts.