Two-stage multi-scale breast mass segmentation for full mammogram analysis without user intervention

Mammography is the primary imaging modality used for early detection and diagnosis of breast cancer. X-ray mammogram analysis mainly refers to the localization of suspicious regions of interest followed by segmentation, towards further lesion classification into benign versus malignant. Among diverse types of breast abnormalities, masses are the most important clinical findings of breast carcinomas. However, manually segmenting breast masses from native mammograms is time-consuming and error-prone. Therefore, an integrated computer-aided diagnosis system is required to assist clinicians for automatic and precise breast mass delineation. In this work, we present a two-stage multi-scale pipeline that provides accurate mass contours from high-resolution full mammograms. First, we propose an extended deep detector integrating a multi-scale fusion strategy for automated mass localization. Second, a convolutional encoder-decoder network using nested and dense skip connections is employed to fine-delineate candidate masses. Unlike most previous studies based on segmentation from regions, our framework handles mass segmentation from native full mammograms without any user intervention. Trained on INbreast and DDSM-CBIS public datasets, the pipeline achieves an overall average Dice of 80.44% on INbreast test images, outperforming state-of-the-art. Our system shows promising accuracy as an automatic full-image mass segmentation system. Extensive experiments reveals robustness against the diversity of size, shape and appearance of breast masses, towards better interaction-free computer-aided diagnosis.