Objective.Deep learning algorithms have demonstrated impressive performance by leveraging large labeled data. However, acquiring pixel-level annotations for medical image analysis, especially in segmentation tasks, is both costly and time-consuming, posing challenges for supervised learning techniques. Existing semi-supervised methods tend to underutilize representations of unlabeled data and handle labeled and unlabeled data separately, neglecting their interdependencies.Approach.To address this issue, we introduce the Data-Augmented Attention-Decoupled Contrastive model (DADC). This model incorporates an attention decoupling module and utilizes contrastive learning to effectively distinguish foreground and background, significantly improving segmentation accuracy. Our approach integrates an augmentation technique that merges information from both labeled and unlabeled data, notably boosting network performance, especially in scenarios with limited labeled data.Main results.We conducted comprehensive experiments on the automated breast ultrasound (ABUS) dataset and the results demonstrate that DADC outperforms existing segmentation methods in terms of segmentation performance.

Accurate segmentation of tumor regions in automated breast ultrasound (ABUS) images is of paramount importance in computer-aided diagnosis system. However, the inherent diversity of tumors and the imaging interference pose great challenges to ABUS tumor segmentation. In this paper, we propose a global and local feature interaction model combined with graph fusion (GLGM), for 3D ABUS tumor segmentation. In GLGM, we construct a dual branch encoder-decoder, where both local and global features can be extracted. Besides, a global and local feature fusion module is designed, which employs the deepest semantic interaction to facilitate information exchange between local and global features. Additionally, to improve the segmentation performance for small tumors, a graph convolution-based shallow feature fusion module is designed. It exploits the shallow feature to enhance the feature expression of small tumors in both local and global domains. The proposed method is evaluated on a private ABUS dataset and a public ABUS dataset. For the private ABUS dataset, the small tumors (volume smaller than 1 cm3) account for over 50% of the entire dataset. Experimental results show that the proposed GLGM model outperforms several state-of-the-art segmentation models in 3D ABUS tumor segmentation, particularly in segmenting small tumors.

UNASSIGNED: To compare the diagnostic performance of automated breast ultrasound (ABUS) and contrast-enhanced ultrasound (CEUS) in breast cancer.
UNASSIGNED: Published studies were collected by systematically searching the databases PubMed, Embase, Cochrane Library and Web of Science. The sensitivities, specificities, likelihood ratios and diagnostic odds ratio (DOR) were confirmed. The symmetric receiver operator characteristic curve (SROC) was used to assess the threshold of ABUS and CEUS. Fagan\'s nomogram was drawn. Meta-regression and subgroup analyses were applied to search for sources of heterogeneity among the included studies.
UNASSIGNED: A total of 16 studies were included, comprising 4115 participants. The combined sensitivity of ABUS was 0.88 [95% CI (0.73-0.95)], specificity was 0.93 [95% CI (0.82-0.97)], area under the SROC curve (AUC) was 0.96 [95% CI (0.94-0.96)] and DOR was 89. The combined sensitivity of CEUS was 0.88 [95% CI (0.84-0.91)], specificity was 0.76 [95% CI (0.66-0.84)], AUC was 0.89 [95% CI (0.86-0.92)] and DOR was 24. The Deeks\' funnel plot showed no existing publication bias. The prospective design, partial verification bias and blinding contributed to the heterogeneity in specificity, while no sources contributed to the heterogeneity in sensitivity. The post-test probability of ABUS in BC was 75%, and the post-test probability of CEUS in breast cancer was 48%.
UNASSIGNED: Compared with CEUS, ABUS showed higher specificity and DOR for detecting breast cancer. ABUS is expected to further improve the accuracy of BC diagnosis.

OBJECTIVE: Preoperative evaluation of axillary lymph node (ALN) status is an essential part of deciding the appropriate treatment. According to ACOSOG Z0011 trials, the new goal of the ALN status evaluation is tumor burden (low burden, < 3 positive ALNs; high burden, ≥ 3 positive ALNs), instead of metastasis or non-metastasis. We aimed to develop a radiomics nomogram integrating clinicopathologic features, ABUS imaging features and radiomics features from ABUS for predicting ALN tumor burden in early breast cancer.
METHODS: A total of 310 patients with breast cancer were enrolled. Radiomics score was generated from the ABUS images. Multivariate logistic regression analysis was used to develop the predicting model, we incorporated the radiomics score, ABUS imaging features and clinicopathologic features, and this was presented with a radiomics nomogram. Besides, we separately constructed an ABUS model to analyze the performance of ABUS imaging features in predicting ALN tumor burden. The performance of the models was assessed through discrimination, calibration curve, and decision curve.
RESULTS: The radiomics score, which consisted of 13 selected features, showed moderate discriminative ability (AUC 0.794 and 0.789 in the training and test sets). The ABUS model, comprising diameter, hyperechoic halo, and retraction phenomenon, showed moderate predictive ability (AUC 0.772 and 0.736 in the training and test sets). The ABUS radiomics nomogram, integrating radiomics score with retraction phenomenon and US-reported ALN status, showed an accurate agreement between ALN tumor burden and pathological verification (AUC 0.876 and 0.851 in the training and test sets). The decision curves showed that ABUS radiomics nomogram was clinically useful and more excellent than US-reported ALN status by experienced radiologists.
CONCLUSIONS: The ABUS radiomics nomogram, with non-invasive, individualized and precise assessment, may assist clinicians to determine the optimal treatment strategy and avoid overtreatment.

Breast cancer mortality can be significantly reduced by early detection of its symptoms. The 3-D Automated Breast Ultrasound (ABUS) has been widely used for breast screening due to its high sensitivity and reproducibility. The large number of ABUS slices, and high variation in size and shape of the masses, make the manual evaluation a challenging and time-consuming process. To assist the radiologists, we propose a convolutional BiLSTM network to classify the slices based on the presence of a mass. Because of its patch-based architecture, this model produces the approximate location of masses as a heat map. The prepared dataset consists of 60 volumes belonging to 43 patients. The precision, recall, accuracy, F1-score, and AUC of the proposed model for slice classification were 84%, 84%, 93%, 84%, and 97%, respectively. Based on the FROC analysis, the proposed detector obtained a sensitivity of 82% with two false positives per volume.

OBJECTIVE: Automated breast ultrasound (ABUS) imaging technology has been widely used in clinical diagnosis. Accurate lesion segmentation in ABUS images is essential in computer-aided diagnosis (CAD) systems. Although deep learning-based approaches have been widely employed in medical image analysis, the large variety of lesions and the imaging interference make ABUS lesion segmentation challenging.
METHODS: In this paper, we propose a novel deepest semantically guided multi-scale feature fusion network (DSGMFFN) for lesion segmentation in 2D ABUS slices. In order to cope with the large variety of lesions, a deepest semantically guided decoder (DSGNet) and a multi-scale feature fusion model (MFFM) are designed, where the deepest semantics is fully utilized to guide the decoding and feature fusion. That is, the deepest information is given the highest weight in the feature fusion process, and participates in every decoding stage. Aiming at the challenge of imaging interference, a novel mixed attention mechanism is developed, integrating spatial self-attention and channel self-attention to obtain the correlation among pixels and channels to highlight the lesion region.
RESULTS: The proposed DSGMFFN is evaluated on 3742 slices of 170 ABUS volumes. The experimental result indicates that DSGMFFN achieves 84.54% and 73.24% in Dice similarity coefficient (DSC) and intersection over union (IoU), respectively.
CONCLUSIONS: The proposed method shows better performance than the state-of-the-art methods in ABUS lesion segmentation. Incorrect segmentation caused by lesion variety and imaging interference in ABUS images can be alleviated.

The purpose of the present study was to evaluate the value of full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in the diagnosis of breast cancer compared to FFDM associated with digital breast tomosynthesis (DBT). Methods: This retrospective study included 50 female patients with a denser framework of connective tissue fibers, characteristic of young women who underwent FFDM, DBT, handheld ultrasound (HHUS), and ABUS between January 2017 and October 2018. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of FFDM+ABUS were 81.82% (95% CI [48.22-97.72]), 89.74% (95% CI [75.78-97.13]), 69.23% (95% CI [46.05-85.57]), 94.59% (95% CI [83.26-98.40]), and 88% (95% CI [75.69-95.47]), while for FFDM+DBT, the values were as follows: 91.67% (95% CI [61.52-99.79]), 71.79% (95% CI [55.13-85.00]), 50% (95% CI [37.08-62.92]), 96.55% (95% CI [80.93-99.46]), 76.47% (95% CI [62.51-87.21]). We found an almost perfect agreement between the two readers regarding FFDM associated with ABUS, and substantial agreement regarding FFDM+DBT, with a kappa coefficient of 0.896 and 0.8, respectively; p < 0.001. Conclusions: ABUS and DBT are suitable as additional diagnostic imaging techniques to FFDM in women at an intermediate risk of developing breast cancer through the presence of dense breast tissue. In this study, DBT reduced the number of false negative results, while the use of ABUS resulted in an increase in specificity.

OBJECTIVE: Breast cancer is the most common cancer and the leading cause of cancer-related deaths for women all over the world. Recently, automated breast ultrasound (ABUS) has become a new and promising screening modality for whole breast examination. However, reviewing volumetric ABUS is time-consuming and lesions could be missed during the examination. Therefore, computer-aided cancer detection in ABUS volume is extremely expected to help clinician for the breast cancer screening.
METHODS: We develop a novel end-to-end 3D convolutional network for automated cancer detection in ABUS volume, in order to accelerate reviewing and meanwhile to provide high detection sensitivity with low false positives (FPs). Specifically, an efficient 3D Inception Unet-style architecture with fusion deep supervision mechanism is proposed to attain decent detection performance. In addition, a novel asymmetric loss is designed to help the network balancing false positive and false negative regions, thus improving detection sensitivity for small cancerous lesions.
RESULTS: The efficacy of our network was extensively validated on a dataset including 196 patients with 661 cancer regions. Our network obtained a detection sensitivity of 95.1% with 3.0 FPs per ABUS volume. Furthermore, the average inference time of the network was 0.1 second per volume, which largely shortens the conventional reviewing time.
CONCLUSIONS: The proposed network provides efficient and accurate cancer detection scheme using ABUS volume, and may assist clinicians for more efficient breast cancer screening.

Accurate breast mass segmentation of automated breast ultrasound (ABUS) is a great help to breast cancer diagnosis and treatment. However, the lack of clear boundary and significant variation in mass shapes make the automatic segmentation very challenging. In this paper, a novel automatic tumor segmentation method SC-FCN-BLSTM is proposed by incorporating bi-directional long short-term memory (BLSTM) and spatial-channel attention (SC-attention) module into fully convolutional network (FCN). In order to decrease performance degradation caused by ambiguous boundaries and varying tumor sizes, an SC-attention module is designed to integrate both finer-grained spatial information and rich semantic information. Since ABUS is three-dimensional data, utilizing inter-slice context can improve segmentation performance. A BLSTM module with SC-attention is constructed to model the correlation between slices, which employs inter-slice context to assist segmentation for false positive elimination. The proposed method is verified on our private ABUS dataset of 124 patients with 170 volumes, including 3636 2D labeled slices. The Dice similarity coefficient (DSC), Recall, Precision and Hausdorff distance (HD) of the proposed method are 0.8178, 0.8067, 0.8292 and 11.1367. Experimental results demonstrate that the proposed method offered improved segmentation results compared with existing deep learning-based methods.

UNASSIGNED: Conventional ultrasound manual scanning and artificial diagnosis approaches in breast are considered to be operator-dependence, slight slow and error-prone. In this study, we used Automated Breast Ultrasound (ABUS) machine for the scanning, and deep convolutional neural network (CNN) technology, a kind of Deep Learning (DL) algorithm, for the detection and classification of breast nodules, aiming to achieve the automatic and accurate diagnosis of breast nodules.
UNASSIGNED: Two hundred and ninety-three lesions from 194 patients with definite pathological diagnosis results (117 benign and 176 malignancy) were recruited as case group. Another 70 patients without breast diseases were enrolled as control group. All the breast scans were carried out by an ABUS machine and then randomly divided into training set, verification set and test set, with a proportion of 7:1:2. In the training set, we constructed a detection model by a three-dimensionally U-shaped convolutional neural network (3D U-Net) architecture for the purpose of segment the nodules from background breast images. Processes such as residual block, attention connections, and hard mining were used to optimize the model while strategies of random cropping, flipping and rotation for data augmentation. In the test phase, the current model was compared with those in previously reported studies. In the verification set, the detection effectiveness of detection model was evaluated. In the classification phase, multiple convolutional layers and fully-connected layers were applied to set up a classification model, aiming to identify whether the nodule was malignancy.
UNASSIGNED: Our detection model yielded a sensitivity of 91% and 1.92 false positive subjects per automatically scanned imaging. The classification model achieved a sensitivity of 87.0%, a specificity of 88.0% and an accuracy of 87.5%.
UNASSIGNED: Deep CNN combined with ABUS maybe a promising tool for easy detection and accurate diagnosis of breast nodule.