The MAMA-MIA Challenge: Advancing Generalizability and Fairness in Breast MRI Tumor Segmentation and Treatment Response Prediction

Breast cancer is the most frequently diagnosed malignancy among women worldwide and a leading cause of cancer-related mortality. Dynamic contrast-enhanced magnetic resonance imaging plays a central role in tumor characterization and treatment monitoring, particularly in patients receiving neoadjuvant chemotherapy. However, existing artificial intelligence models for breast magnetic resonance imaging are often developed using single-center data and evaluated using aggregate performance metrics, limiting their generalizability and obscuring potential performance disparities across demographic subgroups. The MAMA-MIA Challenge was designed to address these limitations by introducing a large-scale benchmark that jointly evaluates primary tumor segmentation and prediction of pathologic complete response using pre-treatment magnetic resonance imaging only. The training cohort comprised 1,506 patients from multiple institutions in the United States, while evaluation was conducted on an external test set of 574 patients from three independent European centers to assess cross-continental and cross-institutional generalization. A unified scoring framework combined predictive performance with subgroup consistency across age, menopausal status, and breast density. Twenty-six international teams participated in the final evaluation phase. Results demonstrate substantial performance variability under external testing and reveal trade-offs between overall accuracy and subgroup fairness. The challenge provides standardized datasets, evaluation protocols, and public resources to promote the development of robust and equitable artificial intelligence systems for breast cancer imaging.

MRI Breast tissue segmentation using nnU-Net for biomechanical modeling

Integrating 2D mammography with 3D magnetic resonance imaging (MRI) is crucial for improving breast cancer diagnosis and treatment planning. However, this integration is challenging due to differences in imaging modalities and the need for precise tissue segmentation and alignment. This paper addresses these challenges by enhancing biomechanical breast models in two main aspects: improving tissue identification using nnU-Net segmentation models and evaluating finite element (FE) biomechanical solvers, specifically comparing NiftySim and FEBio. We performed a detailed six-class segmentation of breast MRI data using the nnU-Net architecture, achieving Dice Coefficients of 0.94 for fat, 0.88 for glandular tissue, and 0.87 for pectoral muscle. The overall foreground segmentation reached a mean Dice Coefficient of 0.83 through an ensemble of 2D and 3D U-Net configurations, providing a solid foundation for 3D reconstruction and biomechanical modeling. The segmented data was then used to generate detailed 3D meshes and develop biomechanical models using NiftySim and FEBio, which simulate breast tissue's physical behaviors under compression. Our results include a comparison between NiftySim and FEBio, providing insights into the accuracy and reliability of these simulations in studying breast tissue responses under compression. The findings of this study have the potential to improve the integration of 2D and 3D imaging modalities, thereby enhancing diagnostic accuracy and treatment planning for breast cancer.

Graph Neural Networks for modelling breast biomechanical compression

Breast compression simulation is essential for accurate image registration from 3D modalities to X-ray procedures like mammography. It accounts for tissue shape and position changes due to compression, ensuring precise alignment and improved analysis. Although Finite Element Analysis (FEA) is reliable for approximating soft tissue deformation, it struggles with balancing accuracy and computational efficiency. Recent studies have used data-driven models trained on FEA results to speed up tissue deformation predictions. We propose to explore Physics-based Graph Neural Networks (PhysGNN) for breast compression simulation. PhysGNN has been used for data-driven modelling in other domains, and this work presents the first investigation of their potential in predicting breast deformation during mammographic compression. Unlike conventional data-driven models, PhysGNN, which incorporates mesh structural information and enables inductive learning on unstructured grids, is well-suited for capturing complex breast tissue geometries. Trained on deformations from incremental FEA simulations, PhysGNN's performance is evaluated by comparing predicted nodal displacements with those from finite element (FE) simulations. This deep learning (DL) framework shows promise for accurate, rapid breast deformation approximations, offering enhanced computational efficiency for real-world scenarios.