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Case-Based Reasoning Computer Algorithm that Uses Mammographic Findings for Breast Biopsy Decisions

Carey E. Floyd, Jr.1,2, Joseph Y. Lo1,2 and Georgia D. Tourassi1

1 Department of Radiology, Duke University Medical Center, Box 2623, Durham, NC 27710.
2 Department of Biomedical Engineering, Duke University Medical Center, Durham, NC 27710.



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  		Fig. 1. —Histogram shows benign and malignant cases binned by malignancy fraction output of case-based reasoning system. Note that although benign and malignant cases overlap considerably, 81 cases with malignancy fraction of less than 0.1 are all benign. These patients could be spared surgery without missing any malignancies. Dark shading indicates malignant; light shading indicates benign.

 


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  		Fig. 2. —Histogram of benign and malignant cases binned by malignancy fraction expanded around high-sensitivity region binned by malignancy fraction. Note that if threshold were set at 0.15, additional 40 benign cases would not have been biopsied, and one malignancy would have been missed. Dark shading indicates malignant; light shading indicates benign.

 


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  		Fig. 3. —Mammogram of 73-year-old woman with cluster of microcalcifications (>10) described as fine-branching. Cluster is at tip of white arrowhead. Both mammographer and case-based reasoning would correctly recommend biopsy of this malignant lesion.

 


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  		Fig. 4. —Mammogram of 43-year-old woman with isodense lobulated 18-mm mass with well-circumscribed margin. Mass is at tip of white arrowhead. Both mammographer and case-based reasoning would correctly recommend no biopsy of this benign lesion.

 


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  		Fig. 5. —Mammogram of 45-year-old woman with isodense irregular 25-mm mass with obscured margin. Mass is at tip of white arrowhead. Mammographer correctly recommended biopsy of this malignant lesion. Case-based reasoning would miss this malignancy if threshold were increased to avoid 40 more biopsies.

 

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