Longitudinal Case-Control Study of Active and Passive Dense Mammographic Breast Tissue.

Mammography is used as secondary prevention for breast cancer. Computer-aided detection and image-based short-term risk estimation were developed to improve the accuracy of mammography. However, most approaches inherently lack the ability to connect observations at the mammography level to observations of cancer onset and progression seen at a smaller scale, which can occur years before imageable cancer and lead to primary prevention. The Hurst exponent (H) can quantify mammographic tissue into regions of dense tissue undergoing active restructuring and regions that remain passive, with amounts of active and passive dense tissue that differ between cancer and controls at diagnosis. A longitudinal retrospective case-control study was conducted to test the hypothesis that differences can be detected before diagnosis and changes could signal developing cancer. Mammograms and reports were collected from 50 patients from Maine Medical Center in 2015 with at least a 5-year screening history. Age-matching patients within 2 years created a primary dataset, and within 5 years, a secondary dataset was created to test for sensitivity. The amount of passive (H≥0.55) and active dense tissue (0.45

WAVELET-BASED AUTOMATIC PECTORAL MUSCLE SEGMENTATION FOR MAMMOGRAMS.

The computational analysis to assist radiologists in the interpretation of mammograms usually requires a pre-processing step where the image is converted into a black and white mask to separate breast tissue from the pectoral muscle and the image background. The manual delineation of the breast tissue from the mammogram image is subjective and time-consuming. The 2D Wavelet Transform Modulus Maxima (WTMM) segmentation method, a powerful and versatile multi-scale edge detection approach, is adapted and presented as a novel automated breast tissue segmentation method. The algorithm computes the local maxima of the modulus of the continuous Gaussian wavelet transform to produce candidate edge detection lines called maxima chains. These maxima chains from multiple wavelet scales are optimally sorted to produce a breast tissue segmentation mask. The mammographic mask is quantitatively compared to a manual delineation using the Dice-Sorenson Coefficient (DSC). The adaptation of the 2D WTMM segmentation method produces a median DSC of 0.9763 on 1042 mediolateral oblique (MLO) 2D Full Field Digital mammographic views from 82 patients obtained from the MaineHealth Biobank (Scarborough, Maine, USA). Our proposed approach is evaluated against OpenBreast , an open-source automated analysis software in MATLAB, through comparing each approach's masks to the manual delineations. OpenBreast produces a lower median DSC of 0.9710. To determine statistical significance, the analysis is restricted to 82 mammograms (one randomly chosen per patient), which yields DSC medians of 0.9756 for the WTMM approach vs. 0.9698 for OpenBreast ( p -value = 0.0067 using a paired Wilcoxon Rank Sum test). Thus, the 2D WTMM segmentation method can reliably delineate the pectoral muscle and produce an accurate segmentation of whole breast tissue in mammograms.

Mammographic evidence of microenvironment changes in tumorous breasts.

PURPOSE: The microenvironment of breast tumors plays a critical role in tumorigenesis. As long as the structural integrity of the microenvironment is upheld, the tumor is suppressed. If tissue structure is lost through disruptions in the normal cell cycle, the microenvironment may act as a tumor promoter. Therefore, the properties that distinguish between healthy and tumorous tissues may not be solely in the tumor characteristics but rather in surrounding non-tumor tissue. The goal of this paper was to show preliminary evidence that tissue disruption and loss of homeostasis in breast tissue microenvironment and breast bilateral asymmetry can be quantitatively and objectively assessed from mammography via a localized, wavelet-based analysis of the whole breast. METHODS: A wavelet-based multifractal formalism called the 2D Wavelet Transform Modulus Maxima (WTMM) method was used to quantitate density fluctuations from mammographic breast tissue via the Hurst exponent (H). Each entire mammogram was cut in hundreds of 360 × 360 pixel subregions in a gridding scheme of overlapping sliding windows, with each window boundary separated by 32 pixels. The 2D WTMM method was applied to each subregion individually. A data mining approach was set up to determine which metrics best discriminated between normal vs. cancer cases. These same metrics were then used, without modification, to discriminate between normal vs. benign and benign vs. cancer cases. RESULTS: The density fluctuations in healthy mammographic breast tissue are either monofractal anti-correlated (H < 1/2) for fatty tissue or monofractal long-range correlated (H>1/2) for dense tissue. However, tissue regions with H~1/2, as well as left vs. right breast asymetries, were found preferably in tumorous (benign or cancer) breasts vs. normal breasts, as quantified via a combination metric yielding a P-value ~ 0.0006. No metric considered showed significant differences between cancer vs. benign breasts. CONCLUSIONS: Since mammographic tissue regions associated with uncorrelated (H~1/2) density fluctuations were predominantly in tumorous breasts, and since the underlying physical processes associated with a H~1/2 signature are those of randomness, lack of spatial correlation, and free diffusion, it is hypothesized that this signature is also associated with tissue disruption and loss of tissue homeostasis.