A Workflow to Efficiently Generate Dense Tissue Ground Truth Masks for Digital Breast Tomosynthesis

Digital breast tomosynthesis (DBT) is now the standard of care for breast cancer screening in the USA. Accurate segmentation of fibroglandular tissue in DBT images is essential for personalized risk estimation, but algorithm development is limited by scarce human-delineated training data. In this study we introduce a time- and labor-saving framework to generate a human-annotated binary segmentation mask for dense tissue in DBT. Our framework enables a user to outline a rough region of interest (ROI) enclosing dense tissue on the central reconstructed slice of a DBT volume and select a segmentation threshold to generate the dense tissue mask. The algorithm then projects the ROI to the remaining slices and iteratively adjusts slice-specific thresholds to maintain consistent dense tissue delineation across the DBT volume. By requiring annotation only on the central slice, the framework substantially reduces annotation time and labor. We used 44 DBT volumes from the DBTex dataset for evaluation. Inter-reader agreement was assessed by computing patient-wise Dice similarity coefficients between segmentation masks produced by two radiologists, yielding a median of 0.84. Accuracy of the proposed method was evaluated by having a radiologist manually segment the 20th and 80th percentile slices from each volume (CC and MLO views; 176 slices total) and calculate Dice scores between the manual and proposed segmentations, yielding a median of 0.83.