Vision transformer-based multimodal fusion network for classification of tumor malignancy on breast ultrasound: A retrospective multicenter study.

Abstract

In the context of routine breast cancer diagnosis, the precise discrimination between benign and malignant breast masses holds utmost significance. Notably, few prior investigations have concurrently explored the integration of imaging histology features, deep learning characteristics, and clinical parameters. The primary objective of this retrospective study was to pioneer a multimodal feature fusion model tailored for the prediction of breast tumor malignancy, harnessing the potential of ultrasound images. We compiled a dataset that included clinical features from 1065 patients and 3315 image datasets. Specifically, we selected data from 603 patients for training our multimodal model. The comprehensive experimental workflow involves identifying the optimal unimodal model, extracting unimodal features, fusing multimodal features, gaining insights from these fused features, and ultimately generating prediction results using a classifier. Our multimodal feature fusion model demonstrates outstanding performance, achieving an AUC of 0.994 (95 % CI: 0.988-0.999) and an F1 score of 0.971 on the primary multicenter dataset. In the evaluation on two independent testing cohorts (TCs), it maintains strong performance, with AUCs of 0.942 (95 % CI: 0.854-0.994) for TC1 and 0.945 (95 % CI: 0.857-1.000) for TC2, accompanied by corresponding F1 scores of 0.872 and 0.857, respectively. Notably, the decision curve analysis reveals that our model achieves higher accuracy within the threshold probability range of approximately [0.210, 0.890] (TC1) and [0.000, 0.850] (TC2) compared to alternative methods. This capability enhances its utility in clinical decision-making, providing substantial benefits. The multimodal model proposed in this paper can comprehensively evaluate patients' multifaceted clinical information, achieve the prediction of benign and malignant breast ultrasound tumors, and obtain high performance indexes.