IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 33, NO.

7, JULY 2014 1503

Multi-Dimensional Tumor Detection in Automated
Whole Breast Ultrasound Using Topographic
Watershed
Chung-Ming Lo, Rong-Tai Chen, Yeun-Chung Chang, Ya-Wen Yang, Ming-Jen Hung, Chiun-Sheng Huang*, and
Ruey-Feng Chang*, Senior Member, IEEE
AbstractAutomated whole breast ultrasound (ABUS) is be-
coming a popular screening modality for whole breast examination.
Compared to conventional handheld ultrasound, ABUS achieves
operator-independent and is feasible for mass screening. How-
ever, reviewing hundreds of slices in an ABUS image volume is
time-consuming. Acomputer-aideddetection(CADe) systembased
on watershed transform was proposed in this study to accelerate
the reviewing. The watershed transform was applied to gather
similar tissues around local minima to be homogeneous regions.
The likelihoods of being tumors of the regions were estimated using
the quantitative morphology, intensity, and texture features in the
2-D/3-D false positive reduction (FPR). The collected database
comprised 68 benign and 65 malignant tumors. As a result, the
proposed system achieved sensitivities of 100% (133/133), 90%
(121/133), and 80% (107/133) with FPs/pass of 9.44, 5.42, and 3.33,
respectively. The gure of merit of the combination of three feature
sets is 0.46whichis signicantlybetter thanthat of other feature sets
( ). In summary, the proposed CADe systembased
on the multi-dimensional FPR using the integrated feature set is
promisingindetecting tumors inABUSimages.
Index TermsAutomated whole breast ultrasound, breast
cancer, computer-aided detection, multi-dimensional false positive
reduction, watershed segmentation.
I. INTRODUCTION
B
REAST cancer is the most common cancer and is the
second leading cause of mortality for women in 2013 [1].
Early detection and treatment of breast cancer have been shown
Manuscript received February 17, 2014; revised March 19, 2014; accepted
March 28, 2014. Date of publication April 03, 2014; date of current version
June 27, 2014. This work was supported in part by the National Science Coun-
cilunder Grant NSC 101-2221-E-002-068-MY3, in part by the Ministry of Eco-
nomic Affairs under Grant 102-EC-17-A-19-S1-164, in part by the Department
of Health under Grant DOH102-TD-C-111-001, and in part by the Ministry of
Education (Republic of China) under Grant AE-00-00-06. Asterisk indicates
corresponding author.
C.-M. Lo, R.-T. Chen, and M.-J. Hung are with the Department of Com-
puter Science and Information Engineering, National Taiwan University, Taipei,
Taiwan.
Y.-C. Chang is with the Department of Medical Imaging, National Taiwan
University Hospital and National Taiwan University College of Medicine,
Taipei, Taiwan.
Y.-W. Yang is with the Department of Surgery, National Taiwan University
Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
*C.-S. Huang is with the Department of Surgery, National Taiwan University
Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
(e-mail: huangcs@ntu.edu.tw).
*R.-F. Chang is with Department of Computer Science and Information En-
gineering, the Graduate Institute of Biomedical Electronics and Bioinformatics,
National Taiwan University, Taipei, Taiwan (e-mail: rfchang@csie.ntu.edu.tw).
Color versions of one or more of the gures in this paper are available online
at http://ieeexplore.ieee.org.
Digital Object Identier 10.1109/TMI.2014.2315206
to be useful in reducing mortality rates [2]. Two screening
modalities, mammography [3], [4] and breast ultrasound (US)
[5], [6] are the popular modalities for the detection and diag-
nosis of breast tumor. Conventionally, mammography is the
main imaging tool on clinical examinations. The drawbacks
of mammography are high false positive rate, and not sen-
sitive for women with dense breast tissue [7][9]. US is an
adjunct imaging modality to the mammography for detecting
tumors in dense breasts. Compared to mammography, the US
examination is radiation-free and makes patients feel less pain
[10][12]. The disadvantages of conventional handheld US are
operator dependent and poorly reproducible. For these issues,
automated whole breast US (ABUS) imaging systems have
been developed to automatically scan the whole breast. Using
ABUS in conjunction with mammography resulted in signi-
cantly increased cancer detection rates [7]. The advantages of
ABUS in less operator dependent and greater reproducibility
for follow-up studies has also been shown [7], [13]. How-
ever, reviewing hundreds of slices in 3-D ABUS images to
discover suspicious abnormalities is time-consuming. The
computer-aided detection (CADe) systems of ABUS images
have been proposed to accelerate the reviewing procedure and
reduce oversight errors [14][18].
Ikedo et al. [16] proposed a fully automatic scheme for
detecting mass. The Canny edge detector was used to detect
edges followed by the classication of near-vertical edges or
near-horizontal edges. The near-vertical edges were regarded
as the positions of tumor candidates. Then, the watershed
transform was adopted to segment the located positions and
generated the tumor candidate regions. Chang et al. [15] devel-
oped a CADe system for detecting breast tumors in multi-pass
automated breast US. After image preprocessing, the gray level
slicing method was adopted to segment the tumor candidates.
Seven quantitative features were then used as the criteria in
distinguishing between tumors and nontumors. Recently, Moon
et al. [17] proposed a CADe system based on multi-scale blob
analysis. After the speckle noise reduction, Hessian analysis
was used to detect the tumor candidates in ABUS images.
Then, three categories features including blobness, internal
echo, and morphology features were extracted to classify tu-
mors and nontumors. Another approach was two-stage CADe
suggested by Tan [18]. Coronal speculation patterns, blobness,
contrast, and depth were extracted from voxels for evaluating
the malignancy of potential abnormalities. The following re-
gion segmentation provided quantitative features for the nal
classication by neural-network classier.
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1504 IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 33, NO. 7, JULY 2014
In this study, a CADe systembased on topographic watershed
segmentation was implemented to extract potential abnormali-
ties in ABUS images. The watershed transform gathered similar
tissues around local minima to become homogeneous regions.
The likelihoods of being tumors of the regions were estimated
using the quantitative morphology, intensity, and texture fea-
tures in 2-D/3-Dfalse positive reduction (FPR). The discrimina-
tion ability of the different feature sets were evaluated using the
free-response operating characteristics (FROC) [19], [20] curve
and the jackknife alternative of FROC-1 (JAFROC-1) gure of
merit (FOM) [21]. At different sensitivity rates, the false posi-
tives (FPs) per pass were estimated for the feasibility on clinical
use.
II. MATERIALS AND METHODS
A. Patients and Data Acquisition
ABUS images collected in this study were acquired using an
ACUSON S2000 Automated Breast Volume Scanner (Siemens
Medical Solutions, Mountain View, CA, USA) between July
and December 2012 in the Breast Center of National Taiwan
University Hospital. The ABUS scanner equipped a 14L5BV
linear array transducer with variable frequencies, ranging from
5 to 15 MHz. In each scanning, the ABUS generated 318 2-D
slices with the thickness of 0.5 mm. To completely scan a breast,
three scannings including anteriorposterior, medial and lateral
passes were performed. A total of six ABUS image volumes
were acquired for a patient. Informed consent and the approval
for this retrospective study were obtained from our institutional
review board.
133 biopsy-proven lesions (size range: 0.37.2 cm, mean:
cm) from104 women (age range: 2180 years, mean
years) including 68 benign and 65 malignant le-
sions were collected. In benign lesions, 36 brocystic changes,
23 broadenomas, and nine papillomas were included. The ma-
lignant lesions included 51 invasive ductal carcinoma (IDC) and
14 ductal carcinoma in situ (DCIS). 34 normal passes with no
pathology-proven tumors were also included in the experiment
for the generalization of the proposed CADe system. The ratio
of abnormal to normal passes was a controlled factor. A total
of 138 passes with 104 abnormal passes and 34 normal passes
composed the image database.
B. Watershed Transform for Tissue Segmentation
The proposed CADe system based on the analysis of regions
composed of various tissues. The toboggan-based watershed
[22] was performed on the transverse planes of 2-D slices in-
stead of using time-consuming 3-D segmentation for tissue seg-
mentation. The acquired ABUS passes were composed of 318
slices. For a better efciency, every ve slices with slight vari-
ation in composition were overlapped in the transverse direc-
tion to reduce the number of slices. The hypoechogenicity of
breast tumor was maintained using the minimum intensity pro-
jection [23] in the overlapping of successive 2-D slices. After
overlapping, the local minimum regions in a slice were consid-
ered to be catchment basins in topography. Conceptually, the
toboggan-based watershed can be regarded as a top-down gra-
dient descent approach. This approach found a gradient descent
Fig. 1. Topographic view of watershed transform.
Fig. 2. Watershed transform combined with the watershed depth produced a
hierarchy of catchment basins.
path from each pixel to the local minimum of the topographic
surface. Pixels slid into the same regional minimum were gath-
ered together as a catchment basin. The boundaries between the
catchment basins were known as watershed lines. The number
of segmented regions can be normalized using the watershed
depth [24]. The minimum watershed depth was the difference
in height between a local minimum and the adjacent lowest
boundary points, as shown in Fig. 1. Sequentially combining the
catchment basins whose depths fell below the minimum until
all the catchment basins were of sufcient depth completed the
merging approach. The merging approach was sequential and
generated a hierarchy of regions. ALevel value was set as a frac-
tion of the maximum watershed depth to preserve meaningful
objects and to minimize over-segmentation. As shown in Fig. 2,
the minimum Level is 0 and the maximum Level is 1.
indicates the initial segmentation while was used
in our experiment to achieve the best compromise between con-
tour completeness and the number of regions.
C. Suspicious Abnormality Extraction
Regions with various tissue composition were acquired
after watershed transform. An initial cut-off was automatically
performed to remove unlikely tumor area according to their
echogenicities and anatomical location.
Previous study had reported that benign and malignant
tumors are hypo-echogenic than other normal breast tissues
[25]. To extract the target suspicious abnormalities, regions
with hypo-echogenicity compared to other regions were con-
sidered. Regions in a slice were sorted according to their
average intensity values in ascending order. The criterion for
hypo-echogenicity is dened as
(1)
LO et al.: MULTI-DIMENSIONAL TUMOR DETECTION IN AUTOMATED WHOLE BREAST ULTRASOUND USING TOPOGRAPHIC WATERSHED 1505
Fig. 3. Results of the suspicious abnormality extraction. (a) Original image
with a tumor circled. (b) Illustration of the skin, muscle, and shadows in the
image. (c) Result after applying watershed transformto (a), and (d) the extracted
suspicious abnormalities.
In the experiment, equal to or smaller than
were extracted for further analysis. That is, 50% of brighter
regions were removed according to their hyper-echogenicities
on each slice.
After removing the hyper-echogenic regions, anatomical lo-
cation was the other criterion to determine nontumor regions. A
tumor is an abnormal growth of neoplastic tissues existed in the
breast area surrounded by skin, muscle, and shadows [Fig. 3(b)].
Removing the regions connected to the image border was ex-
pected to be meaningful in decreasing nontumors. As shown in
Fig. 3, the leftest and rightest region in (c) corresponds to the
shadows in (b). So are the top (skin) and bottom (muscle) re-
gions. After removing these border regions, the nal result of
the suspicious abnormality extraction is shown in Fig. 3(d).
D. 2-D/3-D False Positive Reduction
The extracted suspicious abnormalities were the tumor
candidates in the further classication. Quantitative features
were extracted from the tumor candidates and combined
in a classier for the distinguishing between tumors and
nontumors. A 2-D/3-D FPR composed of applying 2-D
FPR followed by 3-D FPR was used in the classication
procedure. In 2-D FPR, the region characteristics were rst
described using the quantitative morphology, intensity, and
texture features. For each region, the quantitative features
were combined to generate a predicted probability being a
tumor in a classier. Nontumor regions with lower probabil-
ities than true tumor regions were ltered out in 2-D FPR.
For 3-D information, the connected component method [26]
TABLE I
QUANTITATIVE FEATURE CATEGORIES USED IN 2-D/3-D
FALSE POSITIVE REDUCTION
was used to merge adjacent 2-D regions with overlapping
between slices to be a 3-D region. Also, 3-D morphology
and intensity features were extracted to remove regions
with lower probabilities than true tumor regions in 3-D
FPR. Based on this approach, the spatial information of 2-D
and 3-D spaces was modeled to lter out the regions with
low likelihoods being tumors. The quantitative features are
described in the following sections and are summarized in
Table I.
1) Morphology Features: Morphology features extracted
from tumor contour can provide useful information for tumor
detection [17]. Four morphology features including region size,
compactness, size to bounding box ratio, and short to long axis
ratio were implemented.
The delineation of region boundary was obtained after the
watershed transform. By calculating the region area [
(2-D)] and region volume [ (3-D)], noises or shadows
with extremely small and large sizes can be distinguished and
be removed. A tumor is formed by an abnormal growth of
neoplastic tissues. In other words, a tumor can be regarded as
a cluster of homogeneous region. The region size to bounding
box ratio was used to describe the aggregation property of
the region. The region volume to 3-D bounding box was also
1506 IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 33, NO. 7, JULY 2014
calculated. The 2-D and 3-D size to bounding box ratio were
dened by the following equations:
(2)
(3)
where and are the width and height of the 2-D
bounding box, respectively. , , and
are the width, height, and length of the 3-D bounding box, re-
spectively.
Fat tissues have at and narrow shapes in ABUS images. Ac-
cording to this property, the short to long axis ratio was
used to remove the nontumor regions with a fat-like shape. The
2-D and 3-D short to long axis ratio are dened as
(4)
(5)
Another useful shape descriptor of a region is compactness
[28]. Compactness, , is used to describe the relation between
the contour and the region area. The compactness value is 1 on
a regular and round region, while the value is within (0, 1] on
an irregular and fragmented object. The compactness formulas
for 2-D and 3-D region are dened by
(6)
(7)
where indicates the length of the 2-D regions perimeter and
represents the surface area of a 3-D region.
2) Intensity Features: The echogenicity of a tumor is lower
than surrounding normal tissues in ABUS images. The intensity
mean, , was then used to remove hyper-echogenicities.
The 2-D and 3-D intensity mean are dened as follows:
(8)
(9)
where and are the intensity value of pixels
(2-D) and voxels (3-D) in a region, respectively.
The intensity distribution inside a tumor was also quantied
for the uniformity property. Whether a region is composed of
identical tissues or is a mixture of various tissues can be ob-
served by the intensity standard deviation (SD). The following
equations dened the intensity SD of 2-D and 3-D region, re-
spectively
(10)
(11)
Fig. 4. Pixel pair of four directions from the centered pixel ( ). Pixel 1 to 4 are
the neighboring pixels in the direction of 0 , 45 , 90 , and 135 with ,
respectively.
The intensity rank mentioned previously was also a quantitative
feature. The intensity value of a region relative to other regions
would reveal the echogenic characteristics.
The contrasts between a region and its adjacent neighbors
were quantied. Two regions are adjacent if they share a
common boundary. The intensity difference of adjacent regions
is dened as
(12)
where is the set of adjacent regions and is the number
of the adjacent regions.
3) Texture Features: Texture is one of the important features
in identifying an object in an image. Texture features can be
classied into two groups according to the statistics: rst-order
features and second-order features. The rst-order features
extracted from intensity histograms shows the entirety proper-
ties. The extended second-order features take the correlations
between pixels and their neighbors into consideration. The
gray level co-occurrence matrix (GLCM) method [29] which
describes the second-order texture features have shown to be
useful in pattern recognition applications [30], [31]. To gen-
erate GLCM features, an original image was quantied into an
image with reduced number of intensity bins, . Afterward,
the co-occurrence matrices were
computed from by scanning each pixel and its neighboring
pixels. Each element is the frequencies of two
neighboring pixels separated by a distance and the direction
is given by the angle , one with gray value and the other
with gray value . and , 45 , 90 , 135 , shown
in Fig. 4 was used in the experiment [32]. That is, the GLCM
features were extracted from four co-occurrence matrices with
different angles.
Eight GLCM texture features are dened as follows:
(13)
(14)
LO et al.: MULTI-DIMENSIONAL TUMOR DETECTION IN AUTOMATED WHOLE BREAST ULTRASOUND USING TOPOGRAPHIC WATERSHED 1507
Fig. 5. Series of the results after applying the 3-D FPR. (a) he original ABUS images with a tumor circled in the middle slice. (b) Result after applying watershed
transform to (a). (c) Remaining tumor candidates after suspicious abnormality extraction. (d) Detected results after applying 2-D FPR. (e) Final detected results
after applying 3-D FPR. Solid circle indicates the tumor area specied in pathology report and the dot circle indicates the false positive area.
(15)
(16)
(17)
(18)
(19)
(20)
where , , , and are mean and standard deviation of
the marginal distributions of .
(21)
(22)
The classication results of 2-D FPR and 3-D FPR are shown
in Fig. 5. The suspicious abnormalities in the individual slice
of Fig. 5(c) are removed by 2-D FPR to get Fig. 5(d). The nal
classication result presented in Fig. 5(e) is after applying the
3-D FPR to the three slices in Fig. 5(d).
4) Statistical Analysis: The proposed features were tested if
they were signicant in distinguishing tumors and nontumors in
2-D and 3-D FPR. The KolmogorovSmirnov test [33] was rst
applied to determine whether the feature is a normal distribution
or not. If the distribution of a feature was normal, the mean
and SD values of the features were calculated to estimate the
difference between the tumors and nontumors with Students
1508 IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 33, NO. 7, JULY 2014
TABLE II
SENSITIVITIES OF THE CADE SYSTEM AND THE CORRESPONDING FPS/PASS USING DIFFERENT FEATURE SETS
test [33]. If a feature was nonnormal distribution, the median
value was computed and the MannWhitney U test [33] was
used. A -value less than 0.05 was considered to be statistical
signicance.
The quantitative features were used to train the binary lo-
gistic regression classier[34] for region classication. The
performance was evaluated with ten-fold cross-validation. For
each region, the predicted probability as the classication result
was between 0 and 1. A region with probability greater than a
threshold was regarded as a tumor. Otherwise, it was classied
as a nontumor. The ground truth of breast mass was drawn
by an expert breast radiologist. The tumor area was checked
according to the original US examination report. If the distance
between the center of a candidate region and a true tumor is
shorter than 2 cm, the candidate region was determined to
be a true positive. After manually marking the ground truth
of masses, the proposed CADe system can construct a tumor
likelihood model automatically. All steps in the CADe system
were automatic. The trade-offs between the sensitivity of tumor
detection and number of FPs/pass were obtained by different
thresholds and were illustrated using FROC curve [19], [20].
The performance of the CADe system was also evaluated using
JAFROC-1FOM [21]. The FOM describes an average value
that whether the probabilities of tumors were higher than the
highest FP probability in a pass. A CADe system with a higher
FOM indicates a more reliable suggestion about the likelihood
of being a tumor. The FOM is dened as follows:
(23)
(24)
where is the number of passes, is the number of tumors
in all passes, is the number of tumors in th pass,
is the number of nontumors in th pass, and the function rep-
resents the predicted probability of a tumor or a nontumor .
In the function , and are the predicted probabilities of a
tumor and a nontumor, respectively. If the predicted probability
of a tumor is greater than that of a nontumor, the function out-
puts a value of 1. JAFROC-1 FOM was used in analyzing the
performances of the CADe systems using different feature sets.
The evaluated feature sets were composed of one or more fea-
ture sets. In the multiple comparisons between feature sets, the
BonferroniHolm correction method [35] was used to generate
more reliable type I error (FP) rate and -values.
III. RESULTS
The proposed CADe system was evaluated with an ABUS
database including 104 abnormal passes and 34 normal passes.
The pathology-proven tumors in abnormal passes were com-
posed of 68 benign and 65 malignant tumors. In the result of
suspicious abnormality extraction, the maximum, minimum,
average and standard deviation of the suspicious abnormality
number per pass were 470, 53, 291.61, and 92.90, respectively.
Upon the three feature sets, the average number of FPs/pass
at the sensitivity of 100% was reduced from 291.61 to 18.19
via the 2-D FPR and further reduced to 9.44 in the following
3-D FPR. For detecting the malignant tumors only, the pro-
posed CADe system achieved a sensitivity of 100% with 9.10
FPs/pass. The discrimination abilities of the three feature sets
in FPR were shown in Table II. In the statistical analysis, The
JAFROC-1 FOMs of different feature sets are listed and are
compared in Table III. The FOMs of the morphology, intensity,
and texture feature set are 0.14, 0.18, and 0.17, respectively.
Upon the complementary advantage, the best performance
( ) was achieved by the combined feature set
including morphology, intensity, and texture features. The
adjusted -values for FOMs between different combinations of
feature sets are also listed. The combination of different feature
sets can signicantly improve the FOM in tumor detection. The
details of different trade-offs between sensitivity and FPs/pass
for different feature sets are illustrated using FROC curves in
Fig. 6.
Table IV shows the distribution of missed tumors at sensi-
tivity from 50% to 90%. The numbers of missed malignant and
benign tumors were very close above the sensitivity of 70%. No
matter what size a tumor was, the number of missed tumors de-
creased with the higher sensitivity.
To investigate the generalization of the proposed CADe
system, the average FP numbers of the abnormal pass and
normal pass at different sensitivities are listed in Table V. The
FP number of normal passes was slightly more than that of
abnormal passes at all sensitivity rates.
All tumors specied in the pathology report were detected by
the proposed CADe system. Fig. 7 shows a true positive case
of 1.51 cm broadenomas. The case in Fig. 8 illustrates a true
positive case of 4.46 cm ductal carcinoma in situ and a FP. In
Fig. 9, a rib is shown to be a detected FP. The experiment was
accomplished on an Intel Core i7-2600 3.4 GHz processor with
LO et al.: MULTI-DIMENSIONAL TUMOR DETECTION IN AUTOMATED WHOLE BREAST ULTRASOUND USING TOPOGRAPHIC WATERSHED 1509
TABLE III
ADJUSTED -VALUES OF FOMS BETWEEN DIFFERENT COMBINATIONS
OF FEATURE SETS
Fig. 6. FROC curve and the corresponding JAFROC-1 FOM for each feature
sets.
4 GB RAM. The average running time of the proposed CADe
system was 74.3 s/pass.
IV. DISCUSSION
The motivation of this study was developing a quantitative
tumor detection method to assist radiologists in reviewing
ABUS images. Based on the target, the sensitivity of 100%
should be the performance index for the detection ability. In
our result, the performance of combining morphology, inten-
sity, and texture feature sets in region classication achieved
the sensitivity of 100% (133/133) with 9.44 FPs/pass. The
range of FP marks in the collected cases is from 0 to 29. All
malignant and benign tumors specied in the pathology report
were detected. The acquired ABUS pass was composed of
318 slices. The time-consuming task of reviewing 318 slices
may be reduced to observe 9.44 FPs plus 0.96 (133/138) true
positives with the assistance of the proposed CADe system.
The suggested quantitative features used in FPR were designed
for the characteristics owned by both malignant and benign
tumors since circumscribed malignant lesions with round shape
are often high-grade tumors [36]. A very high percentage of
malignant lesions are taller-than-wide. They are less than 7 or
8 mm in greatest diameter. Most invasive cancers larger than
1 cm are round or wider-than-tall. Detecting and providing all
tumors in the ABUS images for radiologists to do malignancy
evaluation would be better than only the potential malignant
tumors suggested by CADe systems. Tan et al. [18] developed
a two-stage malignancy detection system for ABUS images.
Coronal speculation patterns, blobness, contrast, and depth
were extracted from voxels for evaluating the malignancy of
potential abnormalities. The following region segmentation
provided quantitative features for the nal classication by
neural-network classier. The performance achieved the sensi-
tivity of 64% with 1 FP/pass which is slightly better than the
proposed CADe system (60%, 1.58 FPs). However, 12% of
the malignant tumors is missed in the initial stage. The missed
malignant tumors may have benign-like shape. In this study, the
proposed CADe system achieved the sensitivity of 100% with
quantitative morphology, intensity, and texture feature sets.
The corresponding 9.44 FPs/pass can be further decreased after
adding the landmarks suggested by Tan et al. in the future. The
nding of imperfect instances of landmarks within a certain
class of shapes may be time-consuming. Moon et al. [17] pro-
posed a CADe system based on multi-scale Hessian analysis.
The detection rates of ABUS tumors were 100%, 90%, and
70% with 17.4, 8.8, and 2.7 FPs/pass, respectively. The blob
detection based on Hessian analysis was used in detecting
tumors with low contrast edges or tumors closed to shadows.
We also applied the multi-scale Hessian analysis to the same
dataset used in this study to provide a performance comparison.
The tumor detection rates were 100%, 90%, and 70% with
18.0, 9.1, and 4.3 FPs/pass, respectively. The performance is
close to the result in the article but worse than the sensitivity
of 100% with 9.44 FPs/pass in the proposed CADe algorithm.
In the result observation, many shadows distributed in the
image border had blob-like structures and were classied to be
FPs. In this study, many shadows were removed in suspicious
abnormality extraction as shown in Fig. 3. Additionally, the
average running time of multi-scale Hessian analysis was about
13 minutes per pass, the computational processing may be
not practical in clinical use. The average running time of the
proposed CADe system was 74.3 s/pass. For the possible appli-
cation in screening, normal passes with no pathology-proven
tumors were also included in the experiment to evaluate the
proposed CADe system. The number of FPs/pass is 10.93 for
normal passes.
The CADe system detected potential carcinomas with hypo-
echoic properties which is the most common presentation of in-
vasive carcinomas. However, the limitation is that it may not
perform well for all kinds of breast carcinomas. Tumors such as
lobular carcinoma presenting with little or no mass may not be
segmented well. Some mucinous/colloid carcinomas are hyper-
echoic or isoechoic which is also a challenge to the detection al-
gorithm. Microcalcications along ducts with ductal thickening
in rare invasive ductal carcinomas are not considered. To eval-
uate the generalization ability, the CADe system will be used in
the screening database with hundreds of normal women since
1510 IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 33, NO. 7, JULY 2014
TABLE IV
MISSED TUMOR NUMBERS FOR DIFFERENT SIZES OF BENIGN AND MALIGNANT TUMORS AT DIFFERENT SENSIVITITY
TABLE V
SENSITIVITY OF THE CADE SYSTEM AND THE CORRESPONDING FPS/PASS
WITH ABNORMAL PASSES, NORMAL PASSES, AND ALL PASSES
Fig. 7. True positive case of 1.51 cmbroadenomas. (a) Original ABUS image.
(b) Potential tumor regions delineated by watershed segmentation. (c) Detected
tumor with the predicted likelihood of 0.53 after 2-D/3-D false positive reduc-
tion. Solid circle indicates the tumor area specied in pathology report.
invasive cancers occur about 37 per thousand women. Another
limitation of this study is that the acquired ABUS image data-
base was collected from a single medical center. To evaluate
the generalization of the CADe system, ABUS databases from
multicenter and different manufactories should be included in
the future study. More quantitative features may need to be cal-
culated for various databases. For example, combining GLCM
features generated by different distance parameters for multi-
resolution analysis would be useful to process datasets fromvar-
ious ABUS systems.
Using more anatomical information existed in the 3-D
breast structure would be also useful in estimating likelihoods
of being tumors. The FPs of fat tissues, ribs, and shadows
could be reduced further. For a better segmentation, intensity
inhomogeneity correction [37] can be used in US images to
suppress the shadows and avoid boundary leakage. Removing
Fig. 8. True positive case of 4.46 cm ductal carcinoma in situ. (a) Original
ABUS image. (b) Potential tumor regions delineated by watershed segmenta-
tion. (c) Detected tumor with the predicted likelihood of 0.53 after 2-D/3-Dfalse
positive reduction. Solid circle indicates the tumor area specied in pathology
report. Dot circle indicates the false positive and the predicted likelihood was
0.76.
Fig. 9. False positive case. (a) Original ABUS image. (b) Potential tumor re-
gions delineated by watershed segmentation. (c) Detected rib region with the
predicted likelihood of 0.61 after 2-D/3-D false positive reduction. Dot circle
indicates the false positive area.
speckle noise in the ABUS images would be also useful for
segmentation. Anisotropic diffusion [38] is widely used to
reduce speckle noises and preserve edges simultaneously. With
LO et al.: MULTI-DIMENSIONAL TUMOR DETECTION IN AUTOMATED WHOLE BREAST ULTRASOUND USING TOPOGRAPHIC WATERSHED 1511
the use of lattice Boltzmann model [39], the additional overload
of diffusion partial differential equation can be solved via GPU.
The potential benet of GPU would be considered to improve
the efciency in the future study. The less time the system
spends, the more useful the system is on clinical examination.
The quantitative model established in the proposed CADe
system was based on the biopsy-proven pathology and US ex-
amination report. For the prospective study, whether radiolo-
gists can benet from the detection algorithm in the sensitivity
of tumor detection is relevant in clinical use. An ABUS image
explorer and marking system is going to be constructed for radi-
ologists to mark tumors and review the abnormalities suggested
by the proposed CADe algorithm. With the quantitative system,
recording tumor locations and generating examination report for
ABUS database would be more efcient.
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