Review

The reliability of Convolution Neural Networks diagnosing

malignancy in mammography

Abstract

Background and objectives Breast cancer is one of the most common cause of
death in women worldwide, and current diagnosis depend solely on radiologists’
decisions which may exist “detection errors” and “interpretation errors”. As artificial
intelligence entering the field of medicine, more and more studies have shown
evidences of the feasibility of AI diagnosis in radiography, among which convolution
neural network (CNN) is one of the most popular method used in diagnosing
mammographic malignancy. Therefore in this paper we are to review the recent
studies in the subject of diagnosing malignancy in mammography using convolution
neural networks and their reliability.

Material and method Database such as Medline and Pubmed were searched
using terms “(deep learning [MeSH Terms]) or convolutional neural network or
artificial intelligence” for the artificial intelligence part and “Breast Neoplasms [MeSH]
or breast cancer or breast carcinoma” for the clinical diseases and “Mammography
[MeSH Terms]” for the diagnostic method. After extracting relevant features, this
review will compare and discuss the result.

Results In this review, we included 21 studies in total, and most of them are
developed for differentiating benign and malignant mass within mammograms. The
total overall mean value of the CNN’s AUC, specificity, sensitivity and total accuracy is
0.838, 0.841, 0.803, 0.889, respectively. The minimum and maximum values of those
parameters are 0.5356-0.996, 0.66-0.97, 0.4353-0.9687 and 0.6646-0.9894,
respectively.

Conclusions The CNN applications in detecting malignancy of mammography is

quite promising, but it needs further standardized investigations before it can become
part of the diagnostic routine of mammography radiologists.

Keywords Artificial Intelligence, diagnosis, Deep learning, Breast cancer, Breast

carcinoma, Breast lesion, Artificial Neural Networks, convolutional neural network,
BIRADS, image reading, mammogram, mammography.

1. Introduction
Breast cancer epidemiology
Breast cancer is one of the leading cause of cancer related deaths around the globe.
In 2017, 134,174 incidences of cancer were estimated to be diagnosed in Australia of
which 17, 586 (13.1%) cases are breast cancer in women and currently the most
frequently diagnosed cancer in women. In terms of mortality rates, the total mortality
counts due to cancer in 2017 was 27,076 of which 3,087 were due to breast cancer,
making it the second most common cause of death from cancers in women(1).

Risk factors

With regards to risk factor the most important one to consider is gender, in Australia a
total of 17,730 estimated new cases, 144 (0.81%) were men. The incidence of breast
cancer rises throughout a women’s lifetime as well, with the peak incidence rate at
around 75-80 and then declining rate thereafter. The risk of breast cancer is also
significantly higher in people who have first-degree relatives, specifically those who
inherited the BRCA1 or BRCA2 gene.

Other risks factors include: age of menarche, age of menopause, age at first live birth,
oestrogen exposure, breast density, radiation exposure, diet, obesity, exercise,
breastfeeding, tobacco, environmental toxins (2).

Current human diagnostics methods and weaknesses

Since breast cancer is such a common cause of death, the early detection of breast
cancer is recommended by Australian government followed by individual’s breast
awareness, clinical examination and mammography. Under the guidance of which, a
regular breast screening program on the basis of every two years is provided for all
women aged 50-69 years(3).

As for the diagnosis of mammograms, the American College of Radiography has

developed the Breast Imaging Reporting and Data system (BIRADS) to standardize
the mammographic report, assess diagnostic findings and recommend following
procedures by categorizing and defining image findings by breast composition,
asymmetry, lymph node dilation, skin lesions, location of lesions, calcification and
masses(4). This system has been adapted worldwide and become a standard for
mammography reporting.

However, mammography has its limitation in detection of breast cancer when using
BIRADS classification. The “detection errors(lesions missed by readers)” and
“interpretation errors(lesions misinterpreted by readers)” may occur(5). The
performance of this modality is also not perfect. The accuracy of mammography
recorded by radiologists is 70.2%(6), which has a potential to be increased.

Current use of AI in clinical setting - Computer Aided detection (CAD)

The computer-aided detection(CAD) system for mammography was first developed in

the 1960s (7) and approved by FDA in 1998 (8). This system, which is neural network
can assist clinician using algorithms to obtain the suspicious features and classify
them into benign or malignant (9, 10). Some research indicates that CAD is highly
dependent on the quality of the training data(7) and cannot increase the accuracy
comparing with a second human reader(11); it can also produce false marks which
consumes more time than without it (10). Thus, our group is going to discuss the more
advanced AI application in mammography diagnosis.

Introduction to advanced AI - CNN and its currents development and uses

Currently, artificial intelligence in healthcare system can be divided into two major
categories: natural language processing (NLP) and machine learning (ML). The first
category NLP is a type of system that can turn clinical notes or clinician’s comments
into organized and analysable data, which can be used for further AI applications.
Since this review is discussing AI applied in image diagnose, we will not have further
discussion on NLP. Then the second category is ML, a robust and promising field of
modern healthcare system, is referred to the system that can process structured data
such as radiographic image and extract a series of features that can make a diagnose
or come to a certain conclusion about the patient. It is used mostly in diagnostic
imaging, genetic analysis and electrophysiological analysis nowadays. Furthermore,
the top 3 research objects of AI are cancers, nerve system and cardiovascular
diseases, which is reasonable because these topics are either well known for causing
deaths or extremely sophisticated (12).

Within the family of machine learning AI, there’s one thriving branch called deep
learning. This is a kind of neural network with multiple layers that can explore complex
and high-volume data, which is exactly what medical image diagnosing need. Most
used deep learning methods are convolution neural network (CNN), deep belief
network and deep neural network, while CNN becomes more and more popular in
recent years.

CNN was first brought up by LeCun et al. (13) for the analysing of high-dimensional
image. To train a CNN, the input data (image) need to have properly normalized pixel
values and features. And after transferring the data through multiple convolution
layers, the CNN comes to a recursive function of the differently weighted pixel values
and features, which is designed to minimise the average error between outcomes in
training stage and predictions in testing stage.

In the following part, our review will discuss in depth about current studies on the
utilization of CNN in diagnosing mammograms.