Three-dimensional segmentation of breast masses from digital breast tomosynthesis images

Assessment of three-dimensional (3-D) morphology and volume of breast masses is important for cancer diagnosis, staging, and treatment but cannot be derived from conventional mammography. Digital breast tomosynthesis (DBT) provides data from which 3-D mass segmentation could be obtained. Our method combined Gaussian mixture models based on intensity and a texture measure indicative of in-focus structure, gray-level variance. Thresholding these voxel probabilities, weighted by distance to the estimated mass center, gave the final 3-D segmentation. Evaluation used 40 masses annotated twice by a consultant radiologist on in-focus slices in two diagnostic views. Human intraobserver variability was assessed as the overlap between repeated annotations (median 77% and range 25% to 91%). Comparing the segmented mass outline with probability-weighted ground truth from these annotations, median agreement was 68%, and range was 7% to 88%. Annotated and segmented diameters correlated well with histological mass size (both Spearman’s rank correlations ρ=0.69). The volumetric segmentation demonstrated better agreement with tumor volumes estimated from pathology than volume derived from radiological annotations (95% limits of agreement −16 to 11 ml and −23 to 41 ml, respectively). We conclude that it is feasible to assess 3-D mass morphology and volume from DBT, and the method has the potential to aid breast cancer management.