Biomedical Signal Processing and Control 60 (2020) 101945

Contents lists available at ScienceDirect

Biomedical Signal Processing and Control

journal homepage: www.elsevier.com/locate/bspc

Saliency-guided automatic detection and segmentation of tumor in

breast ultrasound images
Hiba Ramadan a,∗ , Chaymae Lachqar b , Hamid Tairi a
a
University of Sidi Mohamed Ben Abdellah, Faculty of Sciences Dhar El Mahraz, Department of Informatics, B.P. 1796, Atlas-Fez, Fez, 30000, Morocco
b
University of Sidi Mohamed Ben Abdellah, Faculty of Medicine and Pharmacy, Fez, 30000, Morocco

a r t i c l e i n f o a b s t r a c t

Article history: The development of computer aided diagnosis (CAD) systems for the task of tumor detection and seg-
Received 30 September 2019 mentation in breast ultrasound (BUS) images presents one of the most active research fields. In this paper,
Received in revised form 26 February 2020 a saliency-guided approach for fast and automatic tumor segmentation in BUS images is proposed. We
Accepted 28 March 2020
explore the ability of the concept of saliency to emulate radiologist expertise for tumor lesion detection in
Available online 16 April 2020
BUS images. For that, we compute BUS image saliency to generate effective tumor seeds and background
seeds. Then, a graph-based interactive image segmentation method is applied automatically using the
Keywords:
generated seeds to extract tumor region. For more accurate segmentation, we propose a novel saliency
Computer aided diagnosis
Breast ultrasound
score measure to apply a post-processing step for result refinement. Our results have been compared
Tumor detection with other approaches in challenged datasets and demonstrated the effectiveness of our saliency-guided
Tumor segmentation approach for tumor detection and segmentation using different evaluation metrics.
Saliency detection © 2020 Elsevier Ltd. All rights reserved.
Graph-based segmentation
Saliency score
Active contours

1. Introduction
According recent statistics [1], breast cancer is the most com-
monly occurring cancer in women and the second most common
cancer overall. Many cancers have a high chance of cure if diagnosed
early and treated adequately. Although mammography is the most
used modality for the diagnosis of breast cancer, recently breast
ultrasound (BUS) imaging is suggested to be comparable to mam-
mography for breast cancer screening [2]. In fact, BUS can be very
benefic in computer aided diagnosis (CAD) systems especially for
selected women who are pregnant and should not be exposed to
x-rays used in mammography, and for women with dense breast
tissue where the sensitivity of mammography is reduced [3]. Fur-
thermore, BUS is characterized by its low cost, safety, and real-time
imaging capability and can be used in conjunction with mammog-
raphy to improve breast cancer diagnosis [4]. One of the most
challenging tasks in BUS-based CAD systems is automatic tumor
detection and segmentation. Due to the limitations of the ultra-
sound image quality caused by different factors such as noise,
speckle, etc. [5]. and the time consuming by experts to generate
∗ Corresponding author.
E-mail addresses: hiba.ramadan@usmba.ac.ma (H. Ramadan),
chaymae.lachqar@usmba.ac.ma (C. Lachqar), hamid.tairi@usmba.ac.ma (H. Tairi).
lesions segmentation manually [6], the need of automatic CAD sys-
tem that is able to emulate human cognitive capacity to detect and
segment accurately desired regions of interest (ROI) while being
fast remains more and more necessary.
BUS image segmentation methods can be classified according to
human intervention into: semi-automatic methods [7–9] and fully
automatic ones [10]. The first category requires radiologist inter-
action to mark the ROI containing the tumor either using seeds or
enclosing contour. The fully automatic methods do not need any
human intervention and process directly BUS images by exploiting
prior knowledge extracted from images using different techniques
[11]. In this work, we tackle the task of automatic BUS image seg-
mentation.
1.1. Automatic BUS image segmentation
According to the recent survey presented in [10] the dominant
categories of automatic BUS image segmentation approaches are:
deformable models (DMs), graph-based approaches, and learning-
based approaches. DMs have been firstly proposed by [12] and
became very popular in computer vision applications, especially
in medical imaging, with the great success of the snakes [13].
Generally, image segmentation based on DMs requires two steps:
contour initialization and contour evolution processes. The seg-
mentation framework of DMs is flexible and can incorporate

https://doi.org/10.1016/j.bspc.2020.101945
1746-8094/© 2020 Elsevier Ltd. All rights reserved.
2 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945
various image features (edge, shape, intensity, region information.
For BUS images, many works have been proposed in the litera-
ture to perform automatic lesion segmentation using DMs either
using parametric [14] or geometric [15] modeling. In the first
family of DMs i.e. parametric DMs, curve or surface, which can
evolve toward to the object contours, is represented by its paramet-
ric form explicitly. The methods belonging to this category suffer
from high sensitivity to contour initialization compared to the geo-
metric DMs. These last ones apply level set functions to model
curves and surfaces implicitly and can segment multiple objects.
Although geometric DMs have achieved great success in BUS image
segmentation, active research is still focusing to deal with the inho-
mogeneity of BUS images and decrease the computational time
during the curve evolution process [10]. The second dominant cat-
egory of BUS image segmentation is graph-based approaches [16].
In the graph-based method, pixels or regions in the BUS image are
represented as nodes in a graph and each two adjacent nodes are
connected via an edge associated with a defined weight. By con-
sidering Markov random field, the BUS image segmentation can
be transformed into a graph-based energy minimization problem
that can be solved via the graph-cut framework [17]. For more
details about energy formulation/ optimization in the graph-based
models, refer to [18]. Despite the big success of graph-cut-based
approaches for automatic BUS tumor image segmentation [19,20],
the “shrink” problem presents the common issue of all these tech-
niques. Learning-based methods are also widely used in ultrasound
CAD systems [21] and especially in the task of BUS image seg-
mentation either in a supervised or unsupervised manner [22–24].
However, according to the survey in [18], some approaches belong-
ing to this category are slow such as [25] or depend on parameters
initialization [10]. Besides the afro-minded classes there are other
methods that use thresholding techniques, region growing process,
watershed segmentation and others [10,18].
1.2. Motivation and contribution
Due to the challenging nature of BUS images and to deal with the
different disadvantages of existing BUS image segmentation meth-
ods (computational time, need of human intervention, “shrink”
problem, unsatisfactory results), we propose a robust hybrid sys-
tem able to detect and segment automatically tumor regions in
BUS images with the guide of saliency. Our framework integrates
many computer vision algorithms and consists of five main steps
as shown in Fig. 1:
䊏 Pre-processing step (Step 1): In this stage the input BUS image is
pre-processed via contrast enhancement and speckle suppres-
sion to enhance its quality without affecting important image
features in order to exploit them in next steps.
䊏 BUS saliency detection and tumor seeds generation (Step 2): the
goal of this step is to extract the salient region in the BUS image
containing the tumor. To prepare the segmentation process in
the following step, regions having high saliency probability are
marked as tumor seeds and those having low probability are
marked as background. Both of the tumor and the background
seeds will be used to initialize the next stage.
䊏 Tumor segmentation (Step 3): In this step, the Lazy Snapping
(LS) algorithm [26] is applied to segment the tumor region. The
LS is a graph-cut-based model that has widely used in many
computer vision applications to perform segmentation due to its
performance and speed. The LS operates on superpixels instead
of pixels and need user input seeds to segment the object of
interest via an energy minimization framework. Those seeds are
provided automatically in our system as described in the previ-
ous step.
䊏 Saliency score computation and result refinement (Step 4 and
5): To avoid mis-segmentation results, we develop a pixel-based
refinement scheme using saliency score computation and active
contours model (ACM). We define a new saliency score to decide
if this refinement operation is needed, then an ACM is applied
to post-process the segmentation result and extract an accurate
tumor boundary.
Our algorithm is compared to other methods and has produced
competitive results while being faster and doesn’t need any expert
intervention. To demonstrate the performance of our system, we
have evaluated our results in term of tumor detection accuracy as
well as in term of segmentation precision. The remainder of this
paper is given as follows: Section 2 describes in details the different
steps of the proposed framework, and experimental results with
discussion are given in Section 3.
2. Proposed framework
2.1. Pre-processing
Due to the low contrast and the interference with speckle in
BUS images, a pre-processing step remains necessary to enhance
the quality of the input image while preserving important image
features in order to exploit them in next steps. The pre-processing
of BUS images consists of two stages: contrast enhancement and
speckle reduction.
2.1.1. Contrast enhancement
The main goal of contrast enhancement is to apply an inten-
sity transformation to image pixels using a mapping function such
as histogram equalization (HEQ) [27], contrast limited adaptive
histogram equalization (CLAHE) [28], fuzzy logic-based contrast
enhancement (FEN) [29] and sigmoidal mapping-based adaptive
contrast enhancement (SACE) [5]. All these methods (HEQ, CLAHE,
FEN and SACE) have been applied successfully for BUS images
enhancement. The evaluation study conducted in [5] resulted in the
outperformance of SACE in term of contrast enhancement quality
and segmentation accuracy using the watershed-based segmen-
tation method of [30]. Since we have conducted our experiments
in two different BUS image datasets (see subsection 3.1) obtained
with different imaging devices and presenting different contrast
distributions, to achieve an optimal compromise between preci-
sion of segmentation and runtime execution in our framework, we
have tested the four contrast enhancement methods to select the
appropriate technique for each dataset. We found that the results
of tumor segmentation in BUS images by using CLAHE and HEQ
in the pre-processing step produce high segmentation accuracy
in less execution time. More details about the validation of the
choice of these contrast enhancement methods are presented in
the experimental subsection (3.3).
CLAHE is a local contrast enhancement technique often used
to process BUS images [30]. Instead of mapping of the whole of
image pixels such as in the classic HEQ, CLAHE performs histogram
equalization mappings on contextual regions to preserve local fea-
tures. Furthermore, the enhancement of uniform regions is limited
to avoid the over enhancement of the noise.
2.1.2. Speckle suppression
One of the most challenges of BUS CAD is the negative effect
of the speckle noise on image processing. Many works have been
proposed in the literature for feature-preserving BUS despeckling
[31,32]. The authors in [33] classified BUS despeckle filters into five
categories: the local adaptive filter, the anisotropic diffusion fil-
ter, the multi-scale filter, the nonlocal means filter (NLM), and the
hybrid filter. By inspecting a recent work in the field [34] that had
 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945 3

Fig. 1. Flowchart of the proposed saliency-guided framework for tumor segmentation in BUS image.

conducted evaluations of different despeckling methods applied
as pre-processing step for the task of BUS image segmentation,
we found that the state of the art methods in ascending order
of performance are: Optimized Bayesian NLM (OBNLM) [35], the
anisotropic diffusion guided by Log-Gabor filters (ADLG) [36], the
non-local mean filter combined with local statistics (NLMLS) [37]
and the non-local low-rank framework (NLLR) [34]. However, using
the implementation provided by the authors, the runtime execu-
tion of the NLLR method is greater than 3 min to pre-process an
image of 200 × 300 pixels and ADLG requires 4 s to filter the same
image. OBNLM takes only 2.5 s and NLMLS should run in more time
than OBNLM since its model combines local statistics with NLM to
remove speckle. Since OBNLM achieves comparable segmentation
results with the state-of-the-art methods in term of segmentation
accuracy either using a level set-based segmentation model (more
than 91 % of accuracy) or a graph-cut model (more than 93 % of
accuracy), we adopt OBNLM for speckle removal in the preprocess-
ing step. The reader can refer to the original work [35] for detailed
description.
2.2. BUS image saliency detection and tumor seeds generation
The goal of saliency detection is to distinguish the most attrac-
tive and informative, so called salient, region in a scene. Recently,
the concept of saliency has been applied in many areas of computer
vision and gains more and more interest in biomedical appli-
cations [38–40]. The Contrast prior and boundary prior are the
most used principles to compute bottom up saliency models [41].
The first supposes that appearance contrasts between objects and
their surrounding regions are high. The second prior supposes that
4 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945
Fig. 2. Example of saliency BUS image generation with the sets of foreground and background seeds. (a) input BUS image. (b) enhanced BUS image after pre-processing. (c)
generation of superpixels using the SLIC algorithm. (d) BUS saliency map obtained by SO method. (e) sets of tumor (red regions) and background (green regions) seeds.
Fig. 3. Example of pixel-based refinement scheme using saliency score computation and ACM. (a) input BUS image. (b) BUS saliency map. (c) tumor (red region) and
background (green region) seeds. (d) segmented tumor using LS (red region) and unknown region (blue region). (e) refined segmented tumor (red region). (f) groundtruth.
image boundary regions are mostly belonging to the background.
However, when a part of the salient object touches the image
boundaries, the use of the boundary prior may affect the saliency
computation. To overcome this issue, a robust boundary connectiv-
ity measure is proposed in [42] to compute saliency and assumes
that object regions are much less connected to image boundaries
than background ones.
Since the main goal of this step is to compute a saliency map
of the BUS image in order to provide visual clues of tumors that
can be used as input seeds for the segmentation process, and based
on the observation that tumor regions are much less connected to
image boundaries than background ones, the use of saliency opti-
misation (SO) method of [42] seems a good choice. To validate this
step, in addition to the SO method, we have tested three other
saliency methods based on boundary prior: geodesic saliency (GS)
[43], manifold ranking-based saliency (MR) [44] and minimum bar-
rier distance-based saliency (MB) [45]. According to the results in
our experiment (see subsection 3.4), we found that SO produces the
best compromise between accuracy and runtime execution overall
the BUS images used in our test.
Since the SO method is a superpixel-level model, to build the
BUS saliency map, first we over-segment the input image using
the SLIC algorithm [46] to generate N image regions. Let I be the
enhanced input BUS image and {spk }N k=1
is the set of N image super-
pixels. We apply the SO method to the image I to generate the
saliency map S = {sk }N
k=1
where sk designs the saliency value of the
superpixel spk . To provide initial seeds for the segmentation in the
next step, image superpixels with the highest saliency value are
taken as tumor seeds while those with lowest saliency value are
taken as background seeds. Let F and B be the sets of foreground
and background seeds respectively. F and B are defined as follows:
   
F= spk ∈ I, k ∈ 1, . . ., N / spk = argmaxi ∈ {1,...,N} (si )
   
B= spk ∈ I, k ∈ 1, . . ., N / spk = argmini ∈ {1,...,N} (si )
Fig. 2 shows an example of BUS image with the corresponding
saliency map and the sets of foreground and background seeds.
2.3. Tumor segmentation and result refinement
Using the sets F and B of foreground and background seeds
defined by Eqs. (1) and (2) respectively, we apply the LS algo-
rithm [26] to the BUS image I to segment the tumor region. LS is
a graph-based interactive image segmentation method proposed
to improve the graph cut [47] in terms of speed and accuracy by
using small image regions (the set of N superpixels in our case) as
nodes of the graph instead of image pixels. Although the use of the
SLIC method reduces the runtime and generates accurate bound-
ary regions, our algorithm may produce mis-segmentation results
in some BUS images (see example in Fig. 3). To overcome this issue,
we develop a pixel-based refinement scheme using saliency score
computation and ACM. We define a saliency score measure of the
regions that don’t belong to either background in (2) or segmented
tumor region. We consider that the labels of those superpixels are
unknown and we investigate their average saliency values. If the
computed average saliency score is greater than a threshold th, we
admit that there are still salient regions that are omitted during the
segmentation stage and candidates to belong to the tumor region. In
this case, we apply a pixel-wise segmentation method using ACM
of [48] by considering the contour of the LS-based segmentation
result as initial contour. Otherwise, i.e. if the average score of the
saliency is less than the value of the threshold, we keep the result
of the LS segmentation and we do not apply this post-treatment to
avoid the risk of including non-tumor regions in the final result.
Let Bg be the binary image corresponding to the effective back-
ground pixels defined in (2) and Bseg the binary segmentation of
the BUS image I obtained by the LS method. The unknown region
Ur is defined as follows:
Ur = Bg ∩ Bseg (3)
Where the operator .̄ is used to compute the image complement.
The saliency score is given as the average saliency value among
the superpixels belonging to Ur :
average
score =   (S (spk )) (4)
spk ∈ Ur , k ∈ 1, . . ., N
To decide wherever the pixel-based refinement step based on
the ACM [48] should be adopted or no, we compare the computed
average saliency value to a fixed threshold th as follows:
(1) 
if score > th then apply ACM to I based on the contour in Bseg
(2) else keep Bseg as the final result
The value of th is set experimentally to 60.
Fig. 3 describes with an example the proposed pixel-based
refinement scheme using saliency score computation and ACM.
After pre-processing the input BUS image (Fig. 3-(a)), the saliency
map of the enhanced image is computed (Fig. 3-(b)) and the sets
of tumor and background seeds are shown in red and green col-
ors (Fig. 3-(c)) respectively. The result of the segmentation using LS
and the unknown region are shown in red and blue colors (Fig. 3-
(d)) respectively. The saliency score of the unknown region Ur (3) is
computed: in this example it is equal to 95 and greater to the fixed
threshold th = 60. The refinement step is then applied by taking the
boundary of the segmented region as initial contour for the ACM.
The final segmentation result is shown in Fig. 3-(e) (red region) and
the ground-truth image in Fig. 3-(f).
 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945 5

Table 1
Comparison of segmentation accuracy and pre-processing time of our framework using different contrast enhancement methods in the two experimented datasets. All values
are given as mean ± std.

D (%) J (%) TPR (%) BF (%) time (s)

Dataset 1
Ours using CLAHE 62.14 ± 5.17 54.65 ± 4.01 54.17 ± 5.78 50.08 ± 10.15 0.01 ± 0.00
Ours using HEQ 45.38 ± 10.11 36.25 ± 10.02 48.91 ± 4.87 36.42 ± 8.61 <0.01
Ours using FEN 9.41 ± 2.45 7.88 ± 1.12 10.91 ± 3.06 8.60 ± 2.11 0.12 ± 0.02
Our method using SACE 35.24 ± 8.38 27.42 ± 4.43 31.22 ± 6.18 23.45 ± 3.87 14.47 ± 2.45
Dataset 2
Ours using CLAHE 55.37 ± 2.70 43.69 ± 1.56 46.97 ± 1.87 78.82 ± 7.17 <0.01
Ours using HEQ 84.07 ± 10.95 73.29 ± 12.73 76.81 ± 8.58 98.15 ± 2.47 <0.01
Ours using FEN 66.90 ± 9.35 58.54 ± 7.17 63.66 ± 1.01 92.60 ± 6.93 0.08 ± 0.01
Ours using SACE 56.03 ± 1.32 42.22 ± 0.16 42.86 ± 0.99 87.07 ± 3.23 3.88 ± 0.02

3. Results and discussion Table 2

MAE measures of the different saliency methods (SO, MB, GS and MR) on Dataset
1 and Dataset 2 and the average runtime saliency detection computed among the
3.1. Datasets two datasets given in second (s). All values are as mean ± std.

We have conducted the experiments on two datasets which
we name Dataset 1 and Dataset 2. Dataset 1 is the BUS Lesions
Dataset (Dataset B) [49] provided under the release agreement. It
contains 163 lesion images with a mean size of 760 × 570 pixels.
53 images present cancerous masses while 110 concern benign
lesions. The lesions were delineated by experienced radiologists
to provide ground truth for each BUS image. In our experiments,
each image is resized using a scale factor equal to 0.5 to reduce
the runtime execution. Dataset 2 has been recently made available
online from the authors in [50]. It contains 160 BUS images with
benign tumors and 160 BUS images with malignant tumors. The
size of all the images is 128 × 128 and the labels of tumor regions
are provided. Following the authors in [50], 100 BUS images (50
with benign tumors and 50 with malign tumors) from Dataset 2
have been used in the experiments to evaluate the different results.
All the results were calculated on a Windows 7 64-bit operating
system running MATLAB 2017 with an Intel i5-2430 M 2.40 GHz
CPU and 8 GB of RAM.
3.2. Evaluation metrics
To evaluate the binary segmentation results obtained by the
different methods, we follow previous works [10] by using the
Dice similarity index (D), the Jaccard index (J), the True Positive
Rate (TPR) in addition to the mis-segmentation rate (Err) and the
Boundary F1(BF) score [51].
Given a segmented BUS image S and its ground truth G, these
metrics are defined as follows:
     
D = 2 × S ∩ G  / S  + G 
   
J = S ∩ G  / S ∪ G 
   
TPR = S ∩ G / G
 
Err = xor(S, G)/ G
BF = 2 * Pb * Rb / (Pb + Rb )
In (9), Pb is the ratio of the number of points on the boundary
S that are close enough to the boundary of G to the length of the
predicted boundary and Rb is the ratio of the number of points on
the boundary of G that are close enough to the boundary of S to the
length of boundary of S. The computed values of these metrics are
expressed as mean ± std on BUS datasets.
3.3. Validation of the choice of the pre-processing method
To validate the choice of the contrast enhancement method
among HEQ, CLAHE, FEN and SACE methods (see subsection 2.1.1),
SO MB GS MR
Dataset 1 19.23 ± 1.30 28.54 ± 2.11 24.32 ± 0.78 25.04 ± 2.63
Dataset 2 17.55 ± 0.96 14.99 ± 1.15 19.64 ± 2.11 26.79 ± 2.31
Time (s) 0.16 ± 0.01 0.03 ± 0.01 0.14 ± 0.02 0.17 ± 0.01
we test our algorithm using the four techniques and evaluate the
tumor segmentation results using different metrics (defined in
subsection 3.2) in addition to the pre-processing time in second
(s). Table 1 presents the obtained results and some examples of
pre-processed BUS images using the different methods are shown
in Fig. 4.
According the results in Table 1, the highest average segmen-
tation accuracy scores (D, J, TPR, BF) in Dataset 1 are achieved
using the CLAHE method while FEN has affected dramatically the
process of tumor segmentation. In the other hand, the results of pre-
processed BUS images from Dataset 2 using CLAHE are the worst.
Whereas the use of HEQ has produced the best results in Dataset
2 by improved segmentation accuracy over 20 % than the results
obtained using the other contrast enhancement methods. If we take
into consideration the pre-processing time, both of CLAHE and HEQ
take less than 0.01 s to process one image. Since CLAHE and HEQ
outperform the other contrast enhancement methods by producing
the best results in tumor segmentation in a less time in Dataset 1
and Dataset 2 respectively, CLAHE is adopted to pre-process the BUS
images in Dataset 1 and HEQ is selected for contrast enhancement
in Dataset 2.
(5) 3.4. Validation of the choice of saliency detection model
(6) To validate the choice of the saliency method in our pipeline for
tumor seeds generation, we have tested four saliency models based
(7) on boundary prior: GS [43], MR [44], MB [45] and SO [42]. Some
samples of BUS saliency maps obtained by the different methods
(8) are shown in Fig. 5.
(9) To decide what model is the most performing for our system, we
follow previous works and evaluate the different saliency results
using two criteria: the standard precision-recall (PR) curve and the
mean absolute error (MAE) [29]. The resulting MAE measures and
PR curves are illustrated in Table 2 and Fig. 6 respectively.
By inspecting Fig. 6 and Table 2, we found that SO is the best
performing method in term of PR analysis and MAE measure by
producing the lower error value in Dataset 1. In Dataset 2, all of SO,
MB and GS generate high PR scores, however MB has the lower MAE
rate. If we compare the average running time of the four saliency
methods reported in Table 2, all of them consume less than 20 s
to detect image saliency and MB is the faster one. For more deep
analysis, we have tested our BUS segmentation algorithm using the
6 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945

Fig. 4. Examples of pre-processed images of the BUS image (a) using the different contrast enhancement methods: (b) CLAHE, (c) FEN, (d) HEQ and (e) SACE. The BUS image
in the first row is from Dataset 1 and the image in the second row is from Dataset 2.

Fig. 5. Some samples of saliency maps of the BUS image (a) obtained by the methods: MB (b), GS (c), MR (d) and SO (e). The BUS image in the first row is from Dataset 1 and
the image in the second row is from Dataset 2.

Fig. 6. Evaluation of different saliency models (GS [43], MR [44], MB [45] and SO [42]) using PR curve on (a) Dataset 1 and (b) Dataset 2.

Table 3
Segmentation performance using different metrics with the four saliency models on Dataset 1 and Dataset 2. All values are given as mean ± std.

D (%) J (%) TPR (%) BF (%) Err (%)

Dataset 1
Ours with SO 62.14 ± 5.17 54.65 ± 4.01 54.17 ± 5.78 50.08 ± 10.15 4.11 ± 0.35
Ours with GS 35.86 ± 6.41 40.73 ± 5.42 27.86 ± 2.26 45.75 ± 7.70 5.46 ± 1.06
Ours with MB 37.47 ± 4.93 39.78 ± 3.19 49.56 ± 6.11 47.24 ± 12.05 28.52 ± 3.42
Dataset 2
Ours with SO 84.07 ± 10.95 73.29 ± 12.73 76.81 ± 8.58 98.15 ± 2.47 13.35 ± 7.21
Ours with GS 80.18 ± 8.10 70.05 ± 6.81 72.36 ± 1.76 96.70 ± 1.01 14.31 ± 2.01
Ours with MB 80.01 ± 8.31 67.75 ± 7.11 69.42 ± 0.30 96.92 ± 3.05 15.18 ± 1.59
 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945 7

Table 4
Segmentation performance using different metrics on Dataset 1 with benign tumor. All values are given as mean ± std.

Method Detection ratio (%) D (%) J (%) TPR (%) BF (%) Err (%)

[52] 81.65 47.62 ± 8.52 41.88 ± 7.68 39.87 ± 5.13 36.15 ± 9.21 4.50 ± 0.35
[53] 83.49 42.15 ± 1.15 35.67 ± 5.20 34.97 ± 10.11 33.50 ± 2.67 5.37 ± 0.88
ours (1) 100 62.84 ± 3.75 61.17 ± 5.24 58.79 ± 2.63 52.08 ± 6.36 4.17 ± 0.62
ours 100 67.75 ± 6.32 64.62 ± 2.45 62.82 ± 5.02 58.11 ± 9.88 3.92 ± 0.10

Table 5
Segmentation performance using different metrics on Dataset 1 with malign tumor. All values are given as mean ± std.

Method Detection ratio (%) D (%) J (%) TPR (%) BF (%) Err (%)

[52] 61.09 37.15±12.75 28.46±10.12 30.12±13.65 22.08±6.25 6.22±0.15

[53] 75.91 36.87±8.04 27.54±5.71 26.68±11.50 19.02±12.75 6.38±0.23
ours (1) 100 40.87±7.14 31.38±8.60 34.55±9.12 24.04±11.35 5.91±0.16
ours 100 51.11±10.05 38.86±8.14 41.09±3.15 34.45±10.33 5.63±0.03

Table 7
Segmentation performance using different metrics on Dataset 2 with benign tumor. All values are given as mean ± std.

Method Detection ratio (%) D (%) J (%) TPR (%) BF (%) Err (%)

[8] 100 74.83 ± 13.42 61.36 ± 15.14 72.10 ± 16.46 97.01 ± 3.46 19.12 ± 8.49
[9] 100 77.81 ± 7.46 64.26 ± 9.63 71.82 ± 9.87 92.39 ±4.76 17.34 ± 6.59
ours (1) 100 81.34 ± 10.57 69.77 ± 14.05 73.17 ± 10.61 97.74 ± 3.23 15.12 ± 8.15
ours 100 84.13 ± 8.84 73.48 ± 11.77 76.90 ± 8.96 98.18 ± 2.14 13.19 ± 6.73

Table 6 Table 9
Average runtime in second (s) of the different methods among all the BUS images Average runtime in second (s) of the different methods among all the BUS images
in Dataset 1. All values are given as mean ± std. in Dataset 2. All values are given as mean ± std.

Method [52] [53] ours (1) ours Method [8] [9] ours (1) ours

Time (s) 8.10 ± 1.16 36.65 ± 1.48 3.45 ± 0.76 3.28 ± 0.05 Time (s) >720 ≈0.12 2.52 ± 0.08 2.43 ± 0.06

four saliency methods. The quantitative results of segmentation
performance in the two datasets are summarized Table 3.
According to the different measures in Table 3, the highest scores
of the different metrics and the lowest error rate are produced by
our results of BUS segmentation using SO in the two datasets. There-
fore, the SO model has been used to compute BUS image saliency
in our framework.
demonstrate the effectiveness of the saliency score computation in
the refinement step, we have generated the results of tumor seg-
mentation using our same pipeline without computing the saliency
score, i.e. by applying directly the ACM to refine the graph-based
segmentation result. Thereafter we designate by ‘ours’ the pro-
posed method and ‘ours (1)’ the proposed method without saliency
score computation.

3.5. Evaluation of tumor segmentation results 3.5.1. Quantitative results

To show the performance of our system, we compare our lesion
segmentation results with two fully automatic methods presented
in [52,53] and two semi-automatic ones proposed in [8,9]. The
method in [52] proposed a BUS lesion segmentation based on
Quickshift [54] followed by a post-processing step. The work of [53]
used the Normalized Cut approach [55] and the Kmeans classifier to
segment tumor regions. The authors in [8] proposed a parameter-
automatically optimized robust graph-based lesion segmentation
model. In [9], an efficient and rapid BUS segmentation method was
developed using the mean shift and the graph-cut.
We compared our results on Dataset 1 with those obtained by
[52,53] based on the codes provided by their authors online. The
comparison with the methods in [8] and [9] was performed on
Dataset 2 using the pre-computed segmentation masks recently
available from the authors of Dataset 2 in [50]. Furthermore, to
In addition to the different evaluation measures defined in sub-
section 3.2, we have computed the detection ratio which is equal
to the number of BUS images where a tumor is found, to the total
number of BUS images. We notice that BUS images where no tumor
was detected have been excluded from the evaluation to give sig-
nificative comparison between the different methods.
The quantitative results and the runtime of each method in sec-
ond (s) on Dataset 1 are presented in Tables 4–6 and those on
Dataset 2 are presented in Tables 7–9.
In regards to the results obtained in Dataset 1, we observe that
our method is able to detect a tumor in each image in the dataset
while the other methods fail to find the ROI in about 20 % of the
BUS images containing benign tumors (Table 4) and more than 25
% of the BUS images with malign tumors (Table 5). Furthermore,
the best performing approach in terms of D, J, TPR and BF measures
is our method with improved segmentation accuracy over 20 % for

Table 8
Segmentation performance using different metrics on Dataset 2 with malign tumor. All values are given as mean ± std.

Method Detection ratio (%) D (%) J (%) TPR (%) BF (%) Err (%)

[8] 100 74.74 ± 11.37 60.84 ± 13.22 72.73 ± 11.02 96.72 ± 3.95 18.26 ± 6.44
[9] 100 76.86 ± 5.65 62.76 ±7.57 71.45 ± 7.78 92.15 ± 3.87 16.90 ± 4.61
ours (1) 100 79.58 ± 14.47 67.93 ± 15.95 70.14 ± 7.41 97.06 ± 2.26 15.88 ± 8.30
ours 100 84.00 ± 13.08 73.09 ± 13.70 76.73 ± 8.21 98.13 ± 2.80 13.51 ± 7.69
8 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945
Fig. 7. Some examples of tumor segmentation on BUS images (a) using our method without saliency score computation (b) and with saliency score computation (c).
ground-truth images are shown in row (d).
the methods in [50,51] in BUS images with benign tumors (Table 4)
and 10 % in the case of malign tumor (Table 5). In term of mis-
segmentation error rate (Err), the proposed method produces the
lowest value in both of BUS images with benign and malign lesions.
By inspecting the results of the experiments on Dataset 2, our
method and the methods in [8,9] have detected successively the
tumor region among all the BUS images either with benign or
malign lesions (Tables 7 and 8). If we compare our segmentation
results with the results of [8,9], the proposed method achieved the
highest D, J, TPR and BF scores and the lowest error among all the
BUS images in Dataset 2 with benign tumors (Table 7) and malign
ones (Table 8).
By analysing the results obtained by our method with saliency
score computation and without, a significant improvement of seg-
mentation performance is shown in the BUS images with either
benign or malign tumors on both of the two experimented datasets
when we use the saliency score to decide if a refinement step is
required or no. This improvement is due to the fact that the use
of saliency score excludes non salient regions to be segmented as
tumor regions in the refinement step.
If we focus on the type of lesions, it can be seen that all the
methods perform better on BUS images with benign tumor than
those with malign tumor in the two experimented datasets.
In term of runtime analysis, our system can segment tumor
region in less than 3.5 s while the methods of [52,53] needs about
36 s and 8 s respectively to process the same BUS image in Dataset
1 (Table 6). In Dataset 2, we notice that the runtimes of the
methods in [8,9] are reported from [50] and have been computed
with a more powerful machine than ours. According the values in
Table 9, the method in [9] is the fastest one and can segment a
BUS image in less than 0.2 s while the method in [9] needs more
than 720 s to extract the tumor region. The runtime of the pro-
posed method in Dataset 2 is reasonable (about 2.5 s) especially
if we take into consideration that our system is fully automatic
and outperforms the other methods in term of tumor segmenta-
tion.
3.5.2. Qualitative results
For visual comparison, Fig. 7 presents some examples of seg-
mented BUS images from Dataset 1 using our method without
(Fig. 7-(b)) and with (Fig. 7-(c)) saliency score computation. By
comparing the segmentation results with the ground-truth ((Fig. 7-
(d)), we can see that the application of ACM directly to refine the
segmented tumor may produce an over segmentation result by
including no tumor regions to the final result as shown in Fig. 7-(b).
On the other hand, the investigation of saliency score is effective to
decide the (no) requirement of a post-processing step.
Fig. 8 presents some examples of segmented lesions in BUS
images from Dataset 1 using our method and the other approaches
in [52,53]. Visually; the proposed method outperforms the other
works either in the case of benign lesions (the first two rows in
Fig. 8) or malign ones (the two last rows). Some qualitative results
obtained from Dataset 2 of our method and the works in [8,9] are
also presented in Fig. 9 where the two first rows correspond to
benign tumors and the two last rows to malign ones. The visual
comparison shows that our results are the closest to the ground
truth images in both of benign and malign cases compared to the
results of [8,9].
3.6. Evaluation of tumor detection results
For more intensive evaluation of our system and following the
authors in [49], we propose to compare our results on term of
lesion detection. For that, each segmented lesion is surrounded
by a bounding box where the upper-left corner location of the
box is the coordinate of the upper-left point from the boundary
of the segmented tumor, and the bottom-right corner location cor-
responds to the coordinate of the bottom-right one. Fig. 10 presents
the results of tumor detection based on our segmentation results
and the results obtained by Elawady et al. [52] and Sadek et al.
[53].
We have compared our lesion detection results with a deep
learning-based method [49] using the U-Net implementation [56]
 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945 9

Fig. 8. Some examples of BUS image segmentation results from Dataset 1. (a) original BUS images. (b), (c) and (d) results obtained by [52,53], and our method respectively.
(e) binary ground-truth. The two first rows present BUS images with benign tumors and the two last ones present malign tumors.

Fig. 9. Some examples of BUS image segmentation results from Dataset 1. (a) original BUS images. (b), (c) and (d) results obtained by [52,53], and our method respectively.
(e) binary ground-truth. The two first rows present BUS images with benign tumors and the two last ones present malign tumors.

and other approaches based on Radial Gradient Index Filtering tion (TPF) and False Positives per image (FPs/image) [49] given as
[57], Multifractals Filtering [58], region ranking [25] and DMs [59]. follows:
All the compared methods are described in details in [49]. The
results of [52,53] are also included in this study. The performance of number of TPs
TPF = (10)
tumor detection in BUS images is measured by True Positive Frac- number of actual lesions
10 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945

Fig. 10. Some examples of tumor detection based on our segmentation results (a) and the results obtained by [53] (b) and [52] (c). the green color indicates the detected
tumor obtained by each method and the red color presents the ground-truth tumor bounding box. The absence of green color means that no lesion was detected.

Fig. 11. Example of failure cases. (a) original BUS images. (b) saliency maps. (c) tumor (red) and background seeds (green). (d) segmentation results. (e) groundtruth.

Table 10 into consideration that BUS images in the experimented dataset

Comparison of tumor detection accuracy using different metrics.
present many challenges making the lesion detection more diffi-
Method TPS FPS/image F-measure cult, since they were required from modern ultrasound devices and
[57] 72 247 34 may include other structures such as ribs, pectoral muscle or the air
[58] 59 51 56 in the lungs, we can affirm the effectiveness of our system in term
[25] 60 54 56 of lesion detection. In fact, our method outperforms other image
[59] 79 21 79 processing-based approaches [57,58,25,53,52] and produces com-
[53] 31 69 33
petitive results to a recent deep learning-based method [49] and
[52] 33 67 33
[49] 77 28 75 DF model [59]. Furthermore, our method remains the fastest since
ours 74 26 74 it does not require any training phase such as [49,59].

number of FPs 3.7. Failure cases

FPs/image =
number of images
In (10) and (11), detection is considered as a True Positive (TP) if the
center of the segmented region is placed within the bounding box of
the ground-truth. Otherwise, it was considered to be a False Positive
(FP). The different results are presented in Table 10. It should be
noted that all the measures are reported from the work of [49]
using the same dataset (Dataset 1), except the results of [52,53]
and ours are computed based on the segmentation results.
According the results presented in Table 10, the best perform-
ing methods for BUS tumor detection are [59,49], and ours. Taking
(11)
Since our BUS tumor segmentation algorithm is guided by
saliency, saliency detection errors may bring wrong tumor seeds
and therefore wrong segmentation results. Fig. 11 presents some
failure cases where no-tumor regions have been segmented as
tumor ones (Fig. 11-(d)) due to false lesion and background seeds
((Fig. 11-(c)) detected from saliency map ((Fig. 11-(b)).
Such failure cases can be easily rectified by user interaction
to mark the ROI, however since we aim in this work to present
a fully automatic CAD system for BUS image segmentation, we
will address this issue in our future work to develop a robust BUS
 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945
saliency model that integrates anatomical characteristics of breast
in BUS images and able to distinguish tumor region from the rest
of image accurately.
4. Conclusion
A new saliency-guided approach for automatic detection and
segmentation of BUS image lesion is presented in this paper. In our
CAD system, we have exploited the concept of saliency to estimate
the most salient region in BUS image to generate effective tumor
seeds and background region. These seeds have been integrated
into a graph cut-based segmentation framework to extract tumor
region. In order to avoid mis-segmentation results, we propose to
use again the BUS image saliency in order to compute a saliency
score. Based on the computed score, a decision is taken to apply
a post-processing step to refine the segmented tumor. The choice
of the different techniques in each stage of the proposed frame-
work has been validated experimentally. Our results have been
compared with different methods from the literature in challeng-
ing datasets using different evaluation metrics and have achieved
high performance in terms of segmentation accuracy as well as in
tumor detection, without need of high time execution.
CRediT authorship contribution statement
Hiba Ramadan: Conceptualization, Formal analysis, Investi-
gation, Methodology, Software, Validation, Visualization, Writing
- original draft, Writing - review & editing. Chaymae Lachqar:
Writing - original draft, Writing - review & editing. Hamid Tairi:
Validation, Supervision.
Acknowledgments
The authors thank the authors of [49] for providing the BUS
Dataset B and the authors of [50] for making available their BUS
Dataset as well as all the qualitative results of the works used in the
comparison in this paper. The authors gratefully acknowledge the
anonymous reviewers for their valuable remarks and comments,
which significantly contributed to improve the quality of this paper.
Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared to
influence the work reported in this paper.
References
[1] F. Bray, J. Ferlay, I. Soerjomataram, R.L. Siegel, L.A. Torre, A. Jemal, Global
cancer statistics 2018: GLOBOCAN estimates of incidence and mortality
worldwide for 36 cancers in 185 countries, CA Cancer J. Clin. 68 (2018)
394–424, http://dx.doi.org/10.3322/caac.21492.
[2] W.A. Berg, A.I. Bandos, E.B. Mendelson, D. Lehrer, R.A. Jong, E.D. Pisano,
Ultrasound as the primary screening test for breast cancer: analysis from
ACRIN 6666, J. Natl. Cancer Inst. 108 (2016) djv367, http://dx.doi.org/10.1093/
jnci/djv367.
[3] D. Thigpen, A. Kappler, R. Brem, The role of ultrasound in screening dense
breasts-a review of the literature and practical solutions for implementation,
Diagnostics (Basel, Switzerland) 8 (2018), http://dx.doi.org/10.3390/
diagnostics8010020.
[4] M.I. Daoud, A.A. Atallah, F. Awwad, M. Al-Najjar, R. Alazrai, Automatic
superpixel-based segmentation method for breast ultrasound images, Expert
Syst. Appl. 121 (2019) 78–96, http://dx.doi.org/10.1016/J.ESWA.2018.11.024.
[5] W.G. Flores, W.C. de A. Pereira, A contrast enhancement method for improving
the segmentation of breast lesions on ultrasonography, Comput. Biol. Med. 80
(2017) 14–23, http://dx.doi.org/10.1016/J.COMPBIOMED.2016.11.005.
[6] M. Xian, Y. Zhang, H.D. Cheng, F. Xu, K. Huang, B. Zhang, J. Ding, C. Ning, Y.
Wang, A Benchmark for Breast Ultrasound Image Segmentation (BUSIS), 2018,
http://arxiv.org/abs/1801.03182. (Accessed 19 March 2019).
11
[7] Q.-H. Huang, S.-Y. Lee, L.-Z. Liu, M.-H. Lu, L.-W. Jin, A.-H. Li, A robust
graph-based segmentation method for breast tumors in ultrasound images,
Ultrasonics 52 (2012) 266–275.
[8] Q. Huang, X. Bai, Y. Li, L. Jin, X. Li, Optimized graph-based segmentation for
ultrasound images, Neurocomputing 129 (2014) 216–224.
[9] Z. Zhou, W. Wu, S. Wu, P.H. Tsui, C.C. Lin, L. Zhang, T. Wang, Semi-automatic
breast ultrasound image segmentation based on mean shift and graph cuts,
Ultrason. Imaging 36 (2014) 256–276, http://dx.doi.org/10.1177/
0161734614524735.
[10] M. Xian, Y. Zhang, H.D. Cheng, F. Xu, B. Zhang, J. Ding, Automatic breast
ultrasound image segmentation: a survey, Pattern Recognit. 79 (2018)
340–355, http://dx.doi.org/10.1016/J.PATCOG.2018.02.012.
[11] H.D. Cheng, J. Shan, W. Ju, Y. Guo, L. Zhang, Automated breast cancer detection
and classification using ultrasound images: a survey, Pattern Recognit. 43
(2010) 299–317, http://dx.doi.org/10.1016/J.PATCOG.2009.05.012.
[12] D. Terzopoulos, Demetri, On matching deformable models to images, Opt. Soc.
Am. Top. Meet. Mach. Vis. (1980) 160–163 (SEE N89-19145 11-74).
[13] M. Kass, A. Witkin, D. Terzopoulos, Snakes: active contour models, Int. J.
Comput. Vis. 1 (1988) 321–331, http://dx.doi.org/10.1007/BF00133570.
[14] A. Madabhushi, D.N. Metaxas, Combining low-, high-level and empirical
domain knowledge for automated segmentation of ultrasonic breast lesions,
IEEE Trans. Med. Imaging 22 (2003) 155–169, http://dx.doi.org/10.1109/TMI.
2002.808364.
[15] Z. Liu, L. Zhang, H. Ren, J.-Y. Kim, A robust region-based active contour model
with point classification for ultrasound breast lesion segmentation, in: Med.
Imaging 2013 Comput. Diagnosis, SPIE, 2013, http://dx.doi.org/10.1117/12.
2006164, p. 86701P.
[16] Q. Huang, F. Yang, L. Liu, X. Li, Automatic segmentation of breast lesions for
interaction in ultrasonic computer-aided diagnosis, Inf. Sci. (Ny) 314 (2015)
293–310, http://dx.doi.org/10.1016/J.INS.2014.08.021.
[17] Y. Boykov, O. Veksler, R. Zabih, Fast approximate energy minimization via
graph cuts, IEEE Trans. Pattern Anal. Mach. Intell. 23 (2001) 1222–1239.
[18] Q. Huang, Y. Luo, Q. Zhang, Breast ultrasound image segmentation: a survey,
Int. J. Comput. Assist. Radiol. Surg. 12 (2017) 493–507, http://dx.doi.org/10.
1007/s11548-016-1513-1.
[19] Z. Hao, Q. Wang, X. Wang, J.B. Kim, Y. Hwang, B.H. Cho, P. Guo, W.K. Lee,
Learning a structured graphical model with boosted top-down features for
ultrasound image segmentation, Lect. Notes Comput. Sci. (Including Subser.
Lect. Notes Artif. Intell. Lect. Notes Bioinformatics) (2013) 227–234, http://dx.
doi.org/10.1007/978-3-642-40811-3 29.
[20] J. Zhang, S.K. Zhou, S. Brunke, C. Lowery, D. Comaniciu, Database-guided
breast tumor detection and segmentation in 2D ultrasound images, in: N.
Karssemeijer, R.M. Summers (Eds.), International Society for Optics and
Photonics, 2010, http://dx.doi.org/10.1117/12.844558, p. 762405.
[21] Q. Huang, F. Zhang, X. Li, Machine learning in ultrasound computer-aided
diagnostic systems: a survey, Biomed. Res. Int. 2018 (2018), http://dx.doi.org/
10.1155/2018/5137904.
[22] S.F. Huang, Y.C. Chen, K.M. Woo, Neural network analysis applied to tumor
segmentation on 3D breast ultrasound images, in: 2008 5th IEEE Int. Symp.
Biomed. Imaging From Nano to Macro, Proceedings, ISBI, 2008, pp.
1303–1306, http://dx.doi.org/10.1109/ISBI.2008.4541243.
[23] P. Jiang, J. Peng, G. Zhang, E. Cheng, V. Megalooikonomou, H. Ling,
Learning-based automatic breast tumor detection and segmentation in
ultrasound images, Proc. Int. Symp. Biomed. Imaging (2012) 1587–1590,
http://dx.doi.org/10.1109/ISBI.2012.6235878.
[24] W.K. Moon, C.-M. Lo, R.-T. Chen, Y.-W. Shen, J.M. Chang, C.-S. Huang, J.-H.
Chen, W.-W. Hsu, R.-F. Chang, Tumor detection in automated breast
ultrasound images using quantitative tissue clustering, Med. Phys. 41 (2014),
042901, http://dx.doi.org/10.1118/1.4869264.
[25] J. Shan, H.D. Cheng, Y. Wang, Completely automated segmentation approach
for breast ultrasound images using multiple-domain features, Ultrasound
Med. Biol. 38 (2012) 262–275.
[26] Y. Li, J. Sun, C.-K. Tang, H.-Y. Shum, Lazy snapping, ACM Trans. Graph. (2004)
303–308.
[27] H.D. Cheng, X.J. Shi, A simple and effective histogram equalization approach
to image enhancement, Digit. Signal Process. 14 (2004) 158–170, http://dx.
doi.org/10.1016/J.DSP.2003.07.002.
[28] K. Zuiderveld, Contrast limited adaptive histogram equalization, Graph. Gems.
(1994) 474–485, http://dx.doi.org/10.1016/b978-0-12-336156-1.50061-6.
[29] Y. Guo, H.D. Cheng, J. Huang, J. Tian, W. Zhao, L. Sun, Y. Su, Breast ultrasound
image enhancement using fuzzy logic, Ultrasound Med. Biol. 32 (2006)
237–247, http://dx.doi.org/10.1016/j.ultrasmedbio.2005.10.007.
[30] W. Gómez, L. Leija, A.V. Alvarenga, A.F.C. Infantosi, W.C.A. Pereira,
Computerized lesion segmentation of breast ultrasound based on
marker-controlled watershed transformation, Med. Phys. 37 (2009) 82–95,
http://dx.doi.org/10.1118/1.3265959.
[31] W. Cui, M. Li, G. Gong, K. Lu, S. Sun, F. Dong, Guided trilateral filter and its
application to ultrasound image despeckling, Biomed. Signal Process. Control
55 (2020), 101625, http://dx.doi.org/10.1016/j.bspc.2019.101625.
[32] X. Feng, X. Guo, Q. Huang, X. Feng, X. Guo, Q. Huang, Systematic evaluation on
speckle suppression methods in examination of ultrasound breast images,
Appl. Sci. 7 (2016) 37, http://dx.doi.org/10.3390/app7010037.
[33] J. Zhang, C. Wang, Y. Cheng, Comparison of despeckle filters for breast
ultrasound images, circuits, Syst. Signal Process. 34 (2015) 185–208, http://
dx.doi.org/10.1007/s00034-014-9829-y.
12 H. Ramadan, C. Lachqar and H. Tairi / Biomedical Signal Processing and Control 60 (2020) 101945
[34] L. Zhu, C.-W. Fu, M.S. Brown, P.-A. Heng, A non-local low-rank framework for
ultrasound speckle reduction, in: 2017 IEEE Conf. Comput. Vis. Pattern
Recognit., IEEE, 2017, pp. 493–501, http://dx.doi.org/10.1109/CVPR.2017.60.
[35] P. Coupe, P. Hellier, C. Kervrann, C. Barillot, Nonlocal means-based speckle
filtering for ultrasound images, IEEE Trans. Image Process. 18 (2009)
2221–2229, http://dx.doi.org/10.1109/TIP.2009.2024064.
[36] W. Gómez Flores, W.C. de A. Pereira, A.F.C. Infantosi, Breast ultrasound
despeckling using anisotropic diffusion guided by texture descriptors,
Ultrasound Med. Biol. 40 (2014) 2609–2621, http://dx.doi.org/10.1016/j.
ultrasmedbio.2014.06.005.
[37] J. Yang, J. Fan, D. Ai, X. Wang, Y. Zheng, S. Tang, Y. Wang, Local statistics and
non-local mean filter for speckle noise reduction in medical ultrasound
image, Neurocomputing 195 (2016) 88–95, http://dx.doi.org/10.1016/J.
NEUCOM.2015.05.140.
[38] K. Muhammad, M. Sajjad, M.Y. Lee, S.W. Baik, Efficient visual attention driven
framework for key frames extraction from hysteroscopy videos, Biomed.
Signal Process. Control 33 (2017) 161–168, http://dx.doi.org/10.1016/j.bspc.
2016.11.011.
[39] C.L. Srinidhi, P. Aparna, J. Rajan, A visual attention guided unsupervised
feature learning for robust vessel delineation in retinal images, Biomed.
Signal Process. Control 44 (2018) 110–126, http://dx.doi.org/10.1016/j.bspc.
2018.04.016.
[40] F. Deeba, F.M. Bui, K.A. Wahid, Computer-aided polyp detection based on
image enhancement and saliency-based selection, Biomed. Signal Process.
Control 55 (2020), 101530, http://dx.doi.org/10.1016/j.bspc.2019.04.007.
[41] A. Borji, M.-M. Cheng, H. Jiang, J. Li, Salient Object Detection: A Survey, ArXiv
Prepr. ArXiv1411.5878, 2014.
[42] W. Zhu, S. Liang, Y. Wei, J. Sun, Saliency optimization from robust background
detection, Proc. IEEE Conf. Comput. Vis. Pattern Recognit. (2014) 2814–2821.
[43] Y. Wei, F. Wen, W. Zhu, J. Sun, Geodesic saliency using background priors,
Comput. Vision–ECCV 2012 (2012) 29–42.
[44] C. Yang, L. Zhang, H. Lu, X. Ruan, M.-H. Yang, Saliency detection via
graph-based manifold ranking, Proc. IEEE Conf. Comput. Vis. Pattern Recognit.
(2013) 3166–3173.
[45] J. Zhang, S. Sclaroff, Z. Lin, X. Shen, B. Price, R. Mech, Minimum barrier salient
object detection at 80 fps, Proc. IEEE Int. Conf. Comput. Vis. (2015) 1404–1412.
[46] R. Achanta, A. Shaji, K. Smith, A. Lucchi, P. Fua, S. Süsstrunk, SLIC superpixels
compared to state-of-the-art superpixel methods, IEEE Trans. Pattern Anal.
Mach. Intell. 34 (2012) 2274–2282.
[47] Y.Y. Boykov, M.-P. Jolly, Interactive graph cuts for optimal boundary & region
segmentation of objects in ND images, Comput. Vision, 2001. ICCV 2001.
Proceedings. Eighth IEEE Int. Conf. (2001) 105–112.
[48] T.F. Chan, L.A. Vese, Active contours without edges, IEEE Trans. Image Process.
10 (2001) 266–277.
[49] M.H. Yap, G. Pons, J. Marti, S. Ganau, M. Sentis, R. Zwiggelaar, A.K. Davison, R.
Marti, Moi Hoon Yap, G. Pons, J. Marti, S. Ganau, M. Sentis, R. Zwiggelaar, A.K.
Davison, R. Marti, Automated breast ultrasound lesions detection using
convolutional neural networks, IEEE J. Biomed. Heal. Inf. 22 (2018)
1218–1226, http://dx.doi.org/10.1109/JBHI.2017.2731873.
[50] Q. Huang, Y. Huang, Y. Luo, F. Yuan, X. Li, Segmentation of breast ultrasound
image with semantic classification of superpixels, Med. Image Anal. 61
(2020), 101657, http://dx.doi.org/10.1016/j.media.2020.101657.
[51] G. Csurka, D. Larlus, F. Perronnin, F. Meylan, What is a good evaluation
measure for semantic segmentation? BMVC (2013), p. 2013.
[52] M. Elawady, I. Sadek, A.E.R. Shabayek, G. Pons, S. Ganau, Automatic Nonlinear
Filtering and Segmentation for Breast Ultrasound Images, Springer, Cham,
2016, pp. 206–213, http://dx.doi.org/10.1007/978-3-319-41501-7 24.
[53] I. Sadek, M. Elawady, V. Stefanovski, Automated Breast Lesion Segmentation
in Ultrasound Images, ArXiv Prepr. ArXiv1609.08364, 2016.
[54] A. Vedaldi, S. Soatto, in: D. Forsyth, P. Torr, A. Zisserman (Eds.), Computer
Vision – ECCV 2008: 10th European Conference on Computer Vision,
Marseille, France, October 12-18, 2008, Proceedings, Part IV, Springer Berlin
Heidelberg, Berlin, Heidelberg, 2008, pp. 705–718, http://dx.doi.org/10.1007/
978-3-540-88693-8 52.
[55] J. Shi, J. Malik, Normalized cuts and image segmentation, IEEE Trans. Pattern
Anal. Mach. Intell. 22 (2000) 888–905, http://dx.doi.org/10.1109/34.868688.
[56] O. Ronneberger, P. Fischer, T. Brox, U-net: convolutional networks for
biomedical image segmentation, in: Lect. Notes Comput. Sci. (Including
Subser. Lect. Notes Artif. Intell. Lect. Notes Bioinformatics), Springer Verlag,
2015, pp. 234–241, http://dx.doi.org/10.1007/978-3-319-24574-4 28.
[57] K. Drukker, M.L. Giger, K. Horsch, M.A. Kupinski, C.J. Vyborny, E.B. Mendelson,
Computerized lesion detection on breast ultrasound, Med. Phys. 29 (2002)
1438–1446.
[58] M.H. Yap, E.A. Edirisinghe, H.E. Bez, A novel algorithm for initial lesion
detection in ultrasound breast images, J. Appl. Clin. Med. Phys. 9 (2008)
181–199.
[59] G. Pons, R. Martí, S. Ganau, M. Sentís, J. Martí, Feasibility study of lesion
detection using deformable part models in breast ultrasound images, Iber.
Conf. Pattern Recognit. Image Anal. (2013) 269–276.