Post-operative breast imaging: a management dilemma. Can mammographic artificial intelligence help?

Abstract Background Imaging of the postoperative breast is a challenging issue for the interpreting physician with many variable findings that may require additional assessment through targeted ultrasound, more mammography views, or other investigations. Artificial intelligence (AI) is a fast-developing field with various applications in the breast imaging including the detection and classification of lesions, the prediction of therapy response, and the prediction of breast cancer risk. This study aimed to identify whether Artificial Intelligence improves the mammographic detection and diagnosis of breast post-operative changes and hence improves follow-up and diagnostic workflow and reduces the need for additional exposure to extra radiation or contrast material doses as in Contrast Enhanced Mammography, and the need for interventional procedures as biopsy. Methods This cross-sectional analytic study included 66 female patients following breast-conserving surgeries coming with breast complaints or for follow-up, with mammographically diagnosed changes. Results Mammography had a sensitivity of 91.7%, a specificity of 94.4%, a positive predictive value (PPV) of 78.6%, a negative predictive value (NPV) of 98.1%, and an accuracy of 93.9%, while the AI method indices were sensitivity 91.7%, specificity 92.6%, (PPV) 73.3%, (NPV) 98%, and accuracy 92.4%. The calculated cut-off point for the quantitative AI (probability of malignancy “POM” score) was 51.5%. There was a statistically significantly higher average in the percentage of POM in malignant cases (76.5 ± 27.3%) compared to benign cases (27.1 ± 19.7%). However, the final indices for the combined use of mammography and (AI) were sensitivity 100%, specificity 88.9%, (PPV) 66.7%, (NPV) 100%, and accuracy 90.9%. Conclusion Applying the AI algorithm on mammograms showed positive impacts on the sensitivity of the post-operative breast assessment, with an excellent reduction of the mammographic missed cancers.