Clinical assessment of the microwave imaging system forbreast cancer screening and early detection

Abstract

Female breast cancer has surpased lung cancer, as the most diagnosed cancer in women population, with around 2.3 million cases arising each year. If diagnosed in late stages, it can be highly lethal, with the survival rate of only 25%. Thus, detecting the cancer in an early stage can have a major impact on decreasing the death rate of the patients. Nowadays, mammography is considered as a gold standard for breast cancer screening and diagnostics. Beside mammography, ultrasound, and magnetic resonance imaging can be used to detect the cancer. However, there are several risk factors that are limiting mentioned imaging modalities, such as: ionizing radiation exposure, pain induced by breast compression, overdiagnosis, false-positive examinations, falsenegativity in dense breasts, operator dependancy, prolonged procedures, high hospital costs, and special facility requirements. Microwave breast imaging emerged as a promising novel imaging technology that can, potentially, contribute to the field of breast cancer early screening and diagnostics, mostly because of its non-ionizing and non-invasive nature. Harmless radiation offers the opportunity of frequent scanning, even for the women of an early age, such as 18. Early-age and routine tests are crucial, especially for women with hereditary genetic mutations, where there is a considerable risk of breast cancer appearance. Beside its non-ionizing, and non-invasive nature, microwave imaging offers fast and painless scans, which can significantly increase the number of breast check-up tests, consequently increasing the number of detected early-stage cancers. Consequently, microwave breast imaging can have can substantially impact on the long-term breast cancer survival rate. The technology itself utilizes the difference in electromagnetic properties of healthy and cancerous tissue, as well as the dielectric difference between different type of cancerous tissues (benign or malignant), to detect the presence of anomalies inside the patient's breast and provide their pathology. In the first part of the thesis, we integrated inverse scattering algorithm to acquire the microwave images, and provide information about breast cancer location (detect the breast cancer), from the data collected with the microwave breast imaging device, namely SAFE, developed by the joint work of Mitos Medikal Technologies A.S. and the Medical Device Research, Development, and Application Laboratory of Istanbul Technical University. Dataset used in the study (scans from 115 patients), was acquired through the clinical trials performed by the Marmara University School of Medicine. In addition to the breast lesion detection, we analyzed the effect of the factors of interest, such as: breast density and size, tumor size, as well as patient's age, on the SAFE clinical capabilities. Results show, that we were able to detect 63% of breast lesions, where the breast size had a high impact on the overall score. Significantly lower number of lesions were detected in smaller breasts (51%), compared to the large ones (74%). Density also influenced our inverse scattering approach, as the overal rate of 76%, we achieved in fatty breasts, decreased to 56% in dense breasts. Second part of the thesis is reserved for the machine learning approach, namely adaptive boosting, we implemented on the SAFE dataset, to classify breast lesions, based on their pathology. We used the same dataset as in the first part of the thesis. As in the previous study, we analyze the effect of breast density and size, tumor size, and patient's age, on the used data. In addition, we perform statistical analysis (two-sample t-test) to determine if the difference between the benign and malignant dataset exists. In the existing dataset, 70 benign, and 43 malignant lesions were present. We exclude two cases, due to the unknown pathology. Our machine learning approach achieved the accuracy of 78%, sensitivity of 79% and specificity of 77%. The results indicate that we were able to classify both, benign and malignant lesions, at similar rate. Participant's age was the only factor that highly affected our approach outcome, where the overall rate (accuracy) of the device in young patient group was 84%, compared to the 76% achieved in older patient group. In the third part of the thesis, we implement another machine learning approach, namely Gradient Boosting, to distinguish benign from malignant lesions, considering new dataset, acquired from latest SAFE clinical trials. Additionally, compared to the previous studies, we changed the measurement unit component of the device. Fiftyfour patients were analyzed, where 29 of them had benign, and 25 malignat findings. As in the previous study, we apply statistical analysis (two-sample t-test), to determine if the difference between the benign and malignant dataset exists. Sensitivity, specificity and accuracy we achieved were 80%, 83% and 81%, showing that, in this study as well, we were able to classify both benign and malignant lesions at similar rate, despite of the hardware and software changes implemented. Contrary to the previous studies, multiple factors (breast size, density and age) affected our approach outcome. We achieved significantly higher accuracy in larger breasts (86%), compared to the smaller ones (78%). Additionally, accuracy acquired in dense breast (67%) was significantly lower than in fatty ones (93%). At the end, our method accuracy was 88% in older patient group, compared to the 71% in younger group.