Purpose: We present a new approach for computer-aided detection and diagnosis in mammography based on Cognition Network Technology (CNT). Originally designed for image processing, CNT has been extended to also perform context- and knowledge-driven analysis of tabular data. For the first time using this technology, an application was created and evaluated for fully automatic searching of patient cases from a reference database of verified findings. The application aims to support radiologists in providing cases of similarity and relevance to a given query case. It adopts an extensible and knowledge-driven concept as a similarity measure.
Methods: As a preprocessing step, all input images from more than 400 patients were fully automatically segmented and the resulting objects classified--this includes the complete breast shape, the position of the mammilla, the pectoral muscle, and various potential candidate objects for suspicious mass lesions. For the similarity search, collections of object properties and metadata from many patients were combined into a single table analysis project. Extended CNT allows for a convenient implementation of knowledge-based structures, for example, by meaningfully linking detected objects in different breast views that might represent identical lesions. Objects from alternative segmentation methods are also be considered, so as to collectively become a sufficient set of base-objects for identifying suspicious mass lesions.
Results: For 80% of 112 patient cases with suspicious lesions, the system correctly identified at least one corresponding mass lesion as an object of interest. In this database, consisting of 1,024 images from a total of 303 patients, an average of 0.66 false-positive objects per image were detected. An additional testing database contained 480 images from 120 patients, 15 of whom were annotated with suspicious mass lesions. Here, 47% (7 out of 15) of these were detected automatically with 1.13 false-positive objects per image. A diagnosis is predicted for each patient case by applying a majority vote from the reference findings of the ten most similar cases. Two separate evaluation scenarios suggest a fraction of correct predictions of respectively 79 and 76%.
Conclusion: Cognition Network Technology was extended to process table data, making it possible to access and relate records from different images and non-image sources, such as demographic patient data or parameters from clinical examinations. A prototypal application enables efficient searching of a patient and image database for similar patient cases. Using concepts of knowledge-driven configuration and flexible extension, the application illustrates a path to a new generation of future CAD systems.