Hierarchical diagnosis of breast phyllodes tumors enabled by deep learning of ultrasound images: a retrospective multi-center study

作者：Yuqi Yan, Yuanzhen Liu, Yao Wang, Tian Jiang, Jiayu Xie, Yahan Zhou, Xin Liu, Meiying Yan, Qiuqing Zheng, Haifei Xu, Jingxiao Chen, Sui Lin, Chen Chen, Rongrong Ru, Kai Wang, Anli Zhao, Shiyan Li, Ying Zhu, Yang Zhang, Vicky Yang Wang, Dong Xu · 发表于：Cancer Imaging · 年份：2025 · DOI：10.1186/s40644-025-00879-9 · 被引用次数：5 · 研究领域：Breast Lesions and Carcinomas、Breast Cancer Treatment Studies、AI in cancer detection

OBJECTIVE: Phyllodes tumors (PTs) are rare breast tumors with high recurrence rates, current methods relying on post-resection pathology often delay detection and require further surgery. We propose a deep-learning-based Phyllodes Tumors Hierarchical Diagnosis Model (PTs-HDM) for preoperative identification and grading. METHODS: Ultrasound images from five hospitals were retrospectively collected, with all patients having undergone surgical pathological confirmation of either PTs or fibroadenomas (FAs). PTs-HDM follows a two-stage classification: first distinguishing PTs from FAs, then grading PTs into benign or borderline/malignant. Model performance metrics including AUC and accuracy were quantitatively evaluated. A comparative analysis was conducted between the algorithm's diagnostic capabilities and those of radiologists with varying clinical experience within an external validation cohort. Through the provision of PTs-HDM's automated classification outputs and associated thermal activation mapping guidance, we systematically assessed the enhancement in radiologists' diagnostic concordance and classification accuracy. RESULTS: A total of 712 patients were included. On the external test set, PTs-HDM achieved an AUC of 0.883, accuracy of 87.3% for PT vs. FA classification. Subgroup analysis showed high accuracy for tumors < 2 cm (90.9%). In hierarchical classification, the model obtained an AUC of 0.856 and accuracy of 80.9%. Radiologists' performance improved with PTs-HDM ...