Explainability features are intended to provide insight into the internal mechanisms of an AI device, but there is a lack of evaluation techniques for assessing the quality of provided explanations. We propose a framework to assess and report explainable AI features. Our evaluation framework for AI explainability is based on four criteria: 1) Consistency quantifies the variability of explanations to similar inputs, 2) Plausibility estimates how close the explanation is to the ground truth, 3) Fidelity assesses the alignment between the explanation and the model internal mechanisms, and 4) Usefulness evaluates the impact on task performance of the explanation. Finally, we developed a scorecard for AI explainability methods that serves as a complete description and evaluation to accompany this type of algorithm. We describe these four criteria and give examples on how they can be evaluated. As a case study, we use Ablation CAM and Eigen CAM to illustrate the evaluation of explanation heatmaps on the detection of breast lesions on synthetic mammographies. The first three criteria are evaluated for clinically-relevant scenarios. Our proposed framework establishes criteria through which the quality of explanations provided by AI models can be evaluated. We intend for our framework to spark a dialogue regarding the value provided by explainability features and help improve the development and evaluation of AI-based medical devices.

We evaluated the accuracy of ChatGPT-3.5's responses to common questions regarding acute breast symptoms and explored whether using lay language, as opposed to medical language, affected the accuracy of the responses. Questions were formulated addressing acute breast conditions, informed by the American College of Radiology (ACR) Appropriateness Criteria (AC) and our clinical experience at a tertiary referral breast center. Of these, seven addressed the most common acute breast symptoms, nine addressed pregnancy-associated breast symptoms, and four addressed specific management and imaging recommendations for a palpable breast abnormality. Questions were submitted three times to ChatGPT-3.5 and all responses were assessed by five fellowship-trained breast radiologists. Evaluation criteria included clinical judgment and adherence to the ACR guidelines, with responses scored as: 1) "appropriate," 2) "inappropriate" if any response contained inappropriate information, or 3) "unreliable" if responses were inconsistent. A majority vote determined the appropriateness for each question. ChatGPT-3.5 generated responses were appropriate for 7/7 (100 %) questions regarding common acute breast symptoms when phrased both colloquially and using standard medical terminology. In contrast, ChatGPT-3.5 generated responses were appropriate for 3/9 (33 %) questions about pregnancy-associated breast symptoms and 3/4 (75 %) questions about management and imaging recommendations for a palpable breast abnormality. ChatGPT-3.5 can automate healthcare information related to appropriate management of acute breast symptoms when prompted with both standard medical terminology or lay phrasing of the questions. However, physician oversight remains critical given the presence of inappropriate recommendations for pregnancy associated breast symptoms and management of palpable abnormalities.

With the advancement of computer technology and imaging equipment, ultrasound has emerged as a crucial tool in breast cancer diagnosis. To gain deeper insights into the research landscape of ultrasound in breast cancer diagnosis, this study employed bibliometric methods for a comprehensive analysis spanning from 2004 to 2024, analyzing 3523 articles from 2176 institutions in 82 countries/regions. Over this period, publications on ultrasound diagnosis of breast cancer showed a fluctuating growth trend from 2004 to 2024. Notably, China, Seoul National University and Kim EK emerged as leading contributors in ultrasound for breast cancer detection, with the most published and cited journals being Ultrasound Med Biol and Radiology. The research spots in this area included "breast lesion", "dense breast" and "breast-conserving surgery", while "machine learning", "ultrasonic imaging", "convolutional neural network", "case report", "pathological complete response", "deep learning", "artificial intelligence" and "classification" are anticipated to become future research frontiers. This groundbreaking bibliometric analysis and visualization of ultrasonic breast cancer diagnosis publications offer clinical medical professionals a reliable research focus and direction.

The clinical application of artificial intelligence (AI) models based on breast ultrasound static images has been hindered in real-world workflows due to operator-dependence of standardized image acquisition and incomplete view of breast lesions on static images. To better exploit the real-time advantages of ultrasound and more conducive to clinical application, we proposed a whole-lesion-aware network based on freehand ultrasound video (WAUVE) scanning in an arbitrary direction for predicting overall breast cancer risk score. The WAUVE was developed using 2912 videos (2912 lesions) of 2771 patients retrospectively collected from May 2020 to August 2022 in two hospitals. We compared the diagnostic performance of WAUVE with static 2D-ResNet50 and dynamic TimeSformer models in the internal validation set. Subsequently, a dataset comprising 190 videos (190 lesions) from 175 patients prospectively collected from December 2022 to April 2023 in two other hospitals, was used as an independent external validation set. A reader study was conducted by four experienced radiologists on the external validation set. We compared the diagnostic performance of WAUVE with the four experienced radiologists and evaluated the auxiliary value of model for radiologists. The WAUVE demonstrated superior performance compared to the 2D-ResNet50 model, while similar to the TimeSformer model. In the external validation set, WAUVE achieved an area under the receiver operating characteristic curve (AUC) of 0.8998 (95% CI = 0.8529-0.9439), and showed a comparable diagnostic performance to that of four experienced radiologists in terms of sensitivity (97.39% vs. 98.48%, p = 0.36), specificity (49.33% vs. 50.00%, p = 0.92), and accuracy (78.42% vs.79.34%, p = 0.60). With the WAUVE model assistance, the average specificity of four experienced radiologists was improved by 6.67%, and higher consistency was achieved (from 0.807 to 0.838). The WAUVE based on non-standardized ultrasound scanning demonstrated excellent performance in breast cancer assessment which yielded outcomes similar to those of experienced radiologists, indicating the clinical application of the WAUVE model promising.

Convolutional Neural Networks (CNNs) have achieved remarkable success in breast ultrasound image segmentation, but they still face several challenges when dealing with breast lesions. Due to the limitations of CNNs in modeling long-range dependencies, they often perform poorly in handling issues such as similar intensity distributions, irregular lesion shapes, and blurry boundaries, leading to low segmentation accuracy. To address these issues, we propose the ThreeF-Net, a fine-grained feature fusion network. This network combines the advantages of CNNs and Transformers, aiming to simultaneously capture local features and model long-range dependencies, thereby improving the accuracy and stability of segmentation tasks. Specifically, we designed a Transformer-assisted Dual Encoder Architecture (TDE), which integrates convolutional modules and self-attention modules to achieve collaborative learning of local and global features. Additionally, we designed a Global Group Feature Extraction (GGFE) module, which effectively fuses the features learned by CNNs and Transformers, enhancing feature representation ability. To further improve model performance, we also introduced a Dynamic Fine-grained Convolution (DFC) module, which significantly improves lesion boundary segmentation accuracy by dynamically adjusting convolution kernels and capturing multi-scale features. Comparative experiments with state-of-the-art segmentation methods on three public breast ultrasound datasets demonstrate that ThreeF-Net outperforms existing methods across multiple key evaluation metrics.

The demand for breast imaging services continues to grow, driven by expanding indications in breast cancer diagnosis and treatment. This increasing demand underscores the potential role of artificial intelligence (AI) to enhance workflow efficiency as well as to further unlock the abundant imaging data to achieve improvements along the breast cancer pathway. Although AI has made significant advancements in mammography and digital breast tomosynthesis, with commercially available computer-aided detection (CAD systems) widely used for breast cancer screening and detection, its adoption in breast MRI has been slower. This lag is primarily attributed to the inherent complexity of breast MRI examinations and also hence the more limited availability of large, well-annotated publicly available breast MRI datasets. Despite these challenges, interest in AI implementation in breast MRI remains strong, fueled by the expanding use and indications for breast MRI. This article explores the implementation of AI in breast MRI across the breast cancer care pathway, highlighting its potential to revolutionize the way we detect and manage breast cancer. By addressing current challenges and examining emerging AI applications, we aim to provide a comprehensive overview of how AI is reshaping breast MRI and improving outcomes for patients.

Breast cancer remains a leading cause of cancer-related mortality worldwide, making early detection and accurate treatment response monitoring critical priorities. We present BreastDCEDL, a curated, deep learning-ready dataset comprising pre-treatment 3D Dynamic Contrast-Enhanced MRI (DCE-MRI) scans from 2,070 breast cancer patients drawn from the I-SPY1, I-SPY2, and Duke cohorts, all sourced from The Cancer Imaging Archive. The raw DICOM imaging data were rigorously converted into standardized 3D NIfTI volumes with preserved signal integrity, accompanied by unified tumor annotations and harmonized clinical metadata including pathologic complete response (pCR), hormone receptor (HR), and HER2 status. Although DCE-MRI provides essential diagnostic information and deep learning offers tremendous potential for analyzing such complex data, progress has been limited by lack of accessible, public, multicenter datasets. BreastDCEDL addresses this gap by enabling development of advanced models, including state-of-the-art transformer architectures that require substantial training data. To demonstrate its capacity for robust modeling, we developed the first transformer-based model for breast DCE-MRI, leveraging Vision Transformer (ViT) architecture trained on RGB-fused images from three contrast phases (pre-contrast, early post-contrast, and late post-contrast). Our ViT model achieved state-of-the-art pCR prediction performance in HR+/HER2- patients (AUC 0.94, accuracy 0.93). BreastDCEDL includes predefined benchmark splits, offering a framework for reproducible research and enabling clinically meaningful modeling in breast cancer imaging.

We developed an automated photoacoustic and ultrasound breast tomography system that images the patient in the standing pose. The system, named OneTouch-PAT, utilized linear transducer arrays with optical-acoustic combiners for effective dual-modal imaging. During scanning, subjects only need to gently attach their breasts to the imaging window, and co-registered three-dimensional ultrasonic and photoacoustic images of the breast can be obtained within one minute. Our system has a large field of view of 17 cm by 15 cm and achieves an imaging depth of 3 cm with sub-millimeter resolution. A three-dimensional deep-learning network was also developed to further improve the image quality by improving the 3D resolution, enhancing vasculature, eliminating skin signals, and reducing noise. The performance of the system was tested on four healthy subjects and 61 patients with breast cancer. Our results indicate that the ultrasound structural information can be combined with the photoacoustic vascular information for better tissue characterization. Representative cases from different molecular subtypes have indicated different photoacoustic and ultrasound features that could potentially be used for imaging-based cancer classification. Statistical analysis among all patients indicates that the regional photoacoustic intensity and vessel branching points are indicators of breast malignancy. These promising results suggest that our system could significantly enhance breast cancer diagnosis and classification.

This study introduces a novel multimodal deep learning model tailored for the differentiation of benign and malignant breast masses using dual-view breast ultrasound images (radial and anti-radial views) in conjunction with corresponding radiology reports. The proposed multimodal model architecture includes specialized image and text encoders for independent feature extraction, along with a transformation layer to align the multimodal features for the subsequent classification task. The model achieved an area of the curve of 85% and outperformed unimodal models with 6% and 8% in Youden index. Additionally, our multimodal model surpassed zero-shot predictions generated by prominent foundation models such as CLIP and MedCLIP. In direct comparison with classification results based on physician-assessed ratings, our model exhibited clear superiority, highlighting its practical significance in diagnostics. By integrating both image and text modalities, this study exemplifies the potential of multimodal deep learning in enhancing diagnostic performance, laying the foundation for developing robust and transparent AI-assisted solutions.

This meta-analysis evaluates the diagnostic accuracy of machine learning (ML)-based magnetic resonance imaging (MRI) models in distinguishing benign from malignant breast lesions and explores factors influencing their performance. A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science identified 12 eligible studies (from 3,739 records) up to August 2024. Data were extracted to calculate sensitivity, specificity, and area under the curve (AUC) using bivariate models in R 4.4.1. Study quality was assessed via QUADAS-2. Pooled sensitivity and specificity were 0.86 (95% CI: 0.82-0.90) and 0.82 (95% CI: 0.78-0.86), respectively, with an overall AUC of 0.90 (95% CI: 0.85-0.90). Diagnostic odds ratio (DOR) was 39.11 (95% CI: 25.04-53.17). Support vector machine (SVM) classifiers outperformed Naive Bayes, with higher sensitivity (0.88 vs. 0.86) and specificity (0.82 vs. 0.78). Heterogeneity was primarily attributed to MRI equipment (P = 0.037). ML-based MRI models demonstrate high diagnostic accuracy for breast cancer classification, with pooled sensitivity of 0.86 (95% CI: 0.82-0.90), specificity of 0.82 (95% CI: 0.78-0.86), and AUC of 0.90 (95% CI: 0.85-0.90). These results support their clinical utility as screening and diagnostic adjuncts, while highlighting the need for standardized protocols to improve generalizability.