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To determine the feasibility of using a deep learning (DL) approach to identify benign and malignant BI-RADS 4 lesions with preoperative breast DCE-MRI images and compare two 3D segmentation methods. The patients admitted from January 2014 to October 2020 were retrospectively analyzed. Breast MRI examination was performed before surgical resection or biopsy, and the masses were classified as BI-RADS 4. The first postcontrast images of DCE-MRI T1WI sequence were selected. There were two 3D segmentation methods for the lesions, one was manual segmentation along the edge of the lesion slice by slice, and the other was the minimum bounding cube of the lesion. Then, DL feature extraction was carried out; the pixel values of the image data are normalized to 0-1 range. The model was established based on the blueprint of the classic residual network ResNet50, retaining its residual module and improved 2D convolution module to 3D. At the same time, an attention mechanism was added to transform the attention mechanism module, which only fit the 2D image convolution module, into a 3D-Convolutional Block Attention Module (CBAM) to adapt to 3D-MRI. After the last CBAM, the algorithm stretches the output high-dimensional features into a one-dimensional vector and connects 2 fully connected slices, before finally setting two output results (P1, P2), which, respectively, represent the probability of benign and malignant lesions. Accuracy, sensitivity, specificity, negative predictive value, positive predictive value, the recall rate and area under the ROC curve (AUC) were used as evaluation indicators. A total of 203 patients were enrolled, with 207 mass lesions including 101 benign lesions and 106 malignant lesions. The data set was divided into the training set ( n = 145 ), the validation set ( n = 22 ), and the test set ( n = 40 ) at the ratio of 7 : 1 : 2; fivefold cross-validation was performed. The mean AUC based on the minimum bounding cube of lesion and the 3D-ROI of lesion itself were 0.827 and 0.799, the accuracy was 78.54% and 74.63%, the sensitivity was 78.85% and 83.65%, the specificity was 78.22% and 65.35%, the NPV was 78.85% and 71.31%, the PPV was 78.22% and 79.52%, the recall rate was 78.85% and 83.65%, respectively. There was no statistical difference in AUC based on the lesion itself model and the minimum bounding cube model ( Z = 0.771 ,  p = 0.4408 ). The minimum bounding cube based on the edge of the lesion showed higher accuracy, specificity, and lower recall rate in identifying benign and malignant lesions. Based on the lesion 3D-ROI segmentation using a minimum bounding cube can more effectively reflect the information of the lesion itself and the surrounding tissues. Its DL model performs better than the lesion itself. Using the DL approach with a 3D attention mechanism based on ResNet50 to identify benign and malignant BI-RADS 4 lesions was feasible.

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Feasibility of Using Improved Convolutional Neural Network to Classify BI-RADS 4 Breast Lesions: Compare Deep Learning Features of the Lesion Itself and the Minimum Bounding Cube of Lesion