Fractal dimension and lacunarity analysis of mammographic patterns in assessing breast cancer risk related to HRT treated population: a longitudinal and cross-sectional study

Structural texture measures are used to address the aspect of breast cancer risk assessment in screening mammograms. The current study investigates whether texture properties characterized by local Fractal Dimension (FD) and Lacunarity contribute to asses breast cancer risk. FD represents the complexity while the Lacunarity characterize the gappiness of a fractal. Our cross-sectional case-control study includes mammograms of 50 patients diagnosed with breast cancer in the subsequent 2-4 years and 50 matched controls. The longitudinal double blind placebo controlled HRT study includes 39 placebo and 36 HRT treated volunteers for two years. ROIs with same dimension (250*150 pixels) were created behind the nipple region on these radiographs. Box counting method was used to calculate the fractal dimension (FD) and the Lacunarity. Paired t-test and Pearson correlation coefficient were calculated. It was found that there were no differences between cancer and control group for FD (P=0.8) and Lacunarity (P=0.8) in crosssectional study whereas earlier published heterogeneity examination of radiographs (BC-HER) breast cancer risk score separated groups (p=0.002). In the longitudinal study, FD decreased significantly (P<0.05) in the HRT treated population while Lacunarity remained insignificant (P=0.2). FD is negatively correlated to Lacunarity (-0.74, P<0.001), BIRADS (-0.34, P<0.001) and Percentage Density (-0.41, P<0.001). FD is invariant to the mammographic texture change from control to cancer population but marginally varying in HRT treated population. This study yields no evidence that lacunarity or FD are suitable surrogate markers of mammographic heterogeneity as they neither pick up breast cancer risk, nor show good sensitivity to HRT.

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