Palpable Breast Lump Triage by Minimally Trained Operators in Mexico Using Computer-Assisted Diagnosis and Low-Cost Ultrasound.
Palpable Breast Lump Triage by Minimally Trained Operators in Mexico Using Computer-Assisted Diagnosis and Low-Cost Ultrasound.
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DOI：
10.1200/jgo.17.00222
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发表时间：
2018-08
影响因子：
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通讯作者：
Mammone R
中科院分区：
文献类型：
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作者：
Love SM;Berg WA;Podilchuk C;López Aldrete AL;Gaxiola Mascareño AP;Pathicherikollamparambil K;Sankarasubramanian A;Eshraghi L;Mammone R
在低收入和中等收入国家，大多数乳腺癌表现为可触及的肿块；然而，大多数可触及的肿块是良性的。我们已经为现有的低成本便携式超声系统开发了基于人工智能的计算机辅助诊断（CADx），以分类哪些肿块需要进一步评估，哪些肿块明显是良性的。进行这项试点研究是为了证明，在低收入和中等收入国家，受过最低限度培训的卫生保健工作者可以成功地使用这种方法。我们招募并培训了三名非放射科医生的卫生保健工作者，让他们参加在墨西哥哈利斯科州进行的一项机构审查委员会批准的、符合《健康保险可移植性和责任法案》的试点研究，以确定他们是否可以使用便携式超声（GE Vscan双探头）获取足够质量的可触及乳房肿块图像，以便进行准确的计算机分析。32名女性32个乳房肿块的图像然后用分流- cadx系统进行分析，产生良性或可疑的输出（推荐活检）。将Triage-CADx输出与放射科医生的读数进行比较。非放射科医生能够获得足够的图像。CADx软件的分类与放射科专家的评估一样准确，两种癌症中有两种（100%）被认为是可疑的，30种良性病变中有30种（100%）被归类为良性。一种装有CADx软件的便携式超声系统可以成功地被一线医护人员用于可触及的乳房肿块的分类。这些结果为实施实用、经济有效的可触及乳房肿块分诊提供了可能性，确保稀缺的资源可以用于需要进一步检查的可疑病变。
In low- to middle-income countries (LMICs), most breast cancers present as palpable lumps; however, most palpable lumps are benign. We have developed artificial intelligence–based computer-assisted diagnosis (CADx) for an existing low-cost portable ultrasound system to triage which lumps need further evaluation and which are clearly benign. This pilot study was conducted to demonstrate that this approach can be successfully used by minimally trained health care workers in an LMIC country. We recruited and trained three nonradiologist health care workers to participate in an institutional review board–approved, Health Insurance Portability and Accountability Act–compliant pilot study in Jalisco, Mexico, to determine whether they could use portable ultrasound (GE Vscan Dual Probe) to acquire images of palpable breast lumps of adequate quality for accurate computer analysis. Images from 32 women with 32 breast masses were then analyzed with a triage-CADx system, generating an output of benign or suspicious (biopsy recommended). Triage-CADx outputs were compared with radiologist readings. The nonradiologists were able to acquire adequate images. Triage by the CADx software was as accurate as assessment by specialist radiologists, with two (100%) of two cancers considered suspicious and 30 (100%) of 30 benign lesions classified as benign. A portable ultrasound system with CADx software can be successfully used by first-level health care workers to triage palpable breast lumps. These results open up the possibility of implementing practical, cost-effective triage of palpable breast lumps, ensuring that scarce resources can be dedicated to suspicious lesions requiring further workup.