An artificial intelligence (AI) decision-support system may help radiologists in diagnosing small invasive lobular carcinoma (ILC) on breast ultrasound images, according to research published May 16 in Clinical Imaging.
A team led by Dr. Tali Amir from Memorial Sloan Kettering Cancer Center in New York City found that their tested system demonstrated perfect accuracy in deeming imaging findings as suspicious or probably malignant.
"As AI evolves, the ability of a system to detect potential areas of interest on ultrasound for radiologist review may prove useful and help to decrease interval cancers in the setting of ILC," Amir and co-authors wrote.
ILC can be challenging to detect since they show a variety of appearances on imaging. Previous studies found that for detecting these cancers, mammography has a sensitivity range between 57% and 81% while breast ultrasound has a significantly higher sensitivity range.
While breast radiologists are using AI to help with breast cancer diagnosis, the researchers noted that there is limited data on the technology's potential role in cases of invasive ILC.
Amir and colleagues wanted to see how well an AI decision support system could perform in assessing ILC from breast ultrasound images. Using retrospective data, the team tested the system on 75 women with a total of 83 cases of invasive lobular carcinoma. These cases were diagnosed by core biopsy or surgery.
The researchers found that the AI decision support interpreted 100% of invasive lobular carcinomas in the study as suspicious or probably malignant. This included 100% sensitivity and a 0% false-negative rate.
The group also found that 82 of the 83 detected carcinomas were initially recommended for biopsy by the interpreting breast radiologist, and all were recommended for biopsy after one additional ILC was identified on same-day repeat diagnostic ultrasound.
Additionally, lesions identified as probably malignant by the decision support, but assigned a BI-RADS 4 assessment by radiologists had a median lesion size of one cm. To compare, the median lesion size for BI-RADS 5 cases was 1.4 cm (p = 0.006). Finally, the team reported that 20% of patients with invasive lobular carcinoma were assigned a BI-RADS 5 assessment by the radiologist.
"These results suggest that AI may offer more useful decision support in smaller sub-centimeter lesions in which shape, margin status, or vascularity is more difficult to discern," the study authors wrote.
They added that future research should explore the impact of AI decision support on the confidence of radiologists in assessing and recommending for biopsy.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
