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Application of Artificial Intelligence Computer-Assisted Diagnosis Originally Developed for Thyroid Nodules to Breast Lesions on Ultrasound


As thyroid and breast cancer have several US findings in common, we applied an artificial intelligence computer-assisted diagnosis (AI-CAD) software originally developed for thyroid nodules to breast lesions on ultrasound (US) and evaluated its diagnostic performance. From January 2017 to December 2017, 1042 breast lesions (mean size 20.2 ± 11.8 mm) of 1001 patients (mean age 45.9 ± 12.9 years) who underwent US-guided core-needle biopsy were included. An AI-CAD software that was previously trained and validated with thyroid nodules using the convolutional neural network was applied to breast nodules. There were 665 benign breast lesions (63.0%) and 391 breast cancers (37.0%). The area under the receiver operating characteristic curve (AUROC) of AI-CAD to differentiate breast lesions was 0.678 (95% confidence interval: 0.649, 0.707). After fine-tuning AI-CAD with 1084 separate breast lesions, the diagnostic performance of AI-CAD markedly improved (AUC 0.841). This was significantly higher than that of radiologists when the cutoff category was BI-RADS 4a (AUC 0.621, P < 0.001), but lower when the cutoff category was BI-RADS 4b (AUC 0.908, P < 0.001). When applied to breast lesions, the diagnostic performance of an AI-CAD software that had been developed for differentiating malignant and benign thyroid nodules was not bad. However, an organ-specific approach guarantees better diagnostic performance despite the similar US features of thyroid and breast malignancies.

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Availability of Data and Materials

Additional documents related to this study are available on request to the corresponding author. However, the datasets from Severance Hospital were used under license for the current study and are not publicly available.

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The authors thank Hanpyo Hong, PhD for providing the expertise needed to perform the additional statistical analysis for revision and Medical Illustration and Design, part of the Medical Research Support Services of Yonsei University College of Medicine for their help in designing the figures.


This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (2019R1A2C1002375 and 2021R1A2C2007492).

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Authors and Affiliations



SEL and JYK contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript. EL developed the AI-CAD program and obtained the results from the program. E-KK, JHY, VYP, and JHY participated in revision of the manuscript.

Corresponding author

Correspondence to Jin Young Kwak.

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The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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This retrospective study was approved by the institutional review board of Severance Hospital, Seoul, Korea, with a waiver for informed consent.

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The authors declare no competing interests.

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Lee, S.E., Lee, E., Kim, EK. et al. Application of Artificial Intelligence Computer-Assisted Diagnosis Originally Developed for Thyroid Nodules to Breast Lesions on Ultrasound. J Digit Imaging 35, 1699–1707 (2022).

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