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William H. Wolberg, MD; W. Nick Street, PhD; Dennis M. Heisey, PhD; Olvi L. Mangasarian, PhD

Arch Surg. 1995;130(5):511-516.

Abstract
Objective
To use digital image analysis and machine learning to (1) improve breast mass diagnosis based on fine-needle aspirates and (2) improve breast cancer prognostic estimations.

Design
An interactive computer system evaluates, diagnoses, and determines prognosis based on cytologic features derived from a digital scan of fine-needle aspirate slides.

Setting
The University of Wisconsin (Madison) Departments of Computer Science and Surgery and the University of Wisconsin Hospital and Clinics.

Patients
Five hundred sixty-nine consecutive patients (212 with cancer and 357 with benign masses) provided the data for the diagnostic algorithm, and an additional 118 (31 with malignant masses and 87 with benign masses) consecutive, new patients tested the algorithm. One hundred ninety of these patients with invasive cancer and without distant metastases were used for prognosis.

Interventions
Surgical biopsy specimens were taken from all cancers and some benign masses. The remaining cytologically benign masses were followed up for a year and surgical biopsy specimens were taken if they changed in size or character. Patients with cancer received standard treatment.

Outcome Measures
Cross validation was used to project the accuracy of the diagnostic algorithm and to determine the importance of prognostic features. In addition, the mean errors were calculated between the actual times of distant disease occurrence and the times predicted using various prognostic features. Statistical analyses were also done.

Results
The predicted diagnostic accuracy was 97% and the actual diagnostic accuracy on 118 new samples was 100%. Tumor size and lymph node status were weak prognosticators compared with nuclear features, in particular those measuring nuclear size. Compared with the actual time for recurrence, the mean error of predicted times for recurrence with the nuclear features was 17.9 months and was 20.1 months with tumor size and lymph node status (P=.11).

Conclusion
Computer technology will improve breast fine-needle aspirate accuracy and prognostic estimations.

(Arch Surg. 1995;130:511-516)

Author Affiliations
From the Departments of Surgery (Drs Wolberg, Street, and Heisey), Human Oncology (Dr Wolberg), and Computer Sciences (Drs Street and Mangasarian), University of Wisconsin, Madison.

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