Lesion detection in contrast enhanced spectral mammography

Background \& purpose: The recent emergence of neural networks models for the analysis of breast images has been a breakthrough in computer aided diagnostic. This approach was not yet developed in Contrast Enhanced Spectral Mammography (CESM) where access to large databases is complex. This work proposes a deep-learning-based Computer Aided Diagnostic development for CESM recombined images able to detect lesions and classify cases. Material \& methods: A large CESM diagnostic dataset with biopsy-proven lesions was collected from various hospitals and different acquisition systems. The annotated data were split on a patient level for the training (55%), validation (15%) and test (30%) of a deep neural network with a state-of-the-art detection architecture. Free Receiver Operating Characteristic (FROC) was used to evaluate the model for the detection of 1) all lesions, 2) biopsied lesions and 3) malignant lesions. ROC curve was used to evaluate breast cancer classification. The metrics were finally compared to clinical results. Results: For the evaluation of the malignant lesion detection, at high sensitivity (Se>0.95), the false positive rate was at 0.61 per image. For the classification of malignant cases, the model reached an Area Under the Curve (AUC) in the range of clinical CESM diagnostic results. Conclusion: This CAD is the first development of a lesion detection and classification model for CESM images. Trained on a large dataset, it has the potential to be used for helping the management of biopsy decision and for helping the radiologist detecting complex lesions that could modify the clinical treatment.