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Analysis of institutional authors

Conti, GAuthorSerrano-Olmedo, JjAuthorCasanova-Carvajal, OCorresponding Author

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January 1, 2026
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Article

Artificial Intelligence Pipeline for Mammography-Based Breast Cancer Detection: An Integrated Systematic Review and Large-Scale Experimental Validation

Publicated to: Medicina-Lithuania. 61 (12): 2237- - 2025-12-18 61(12), DOI: 10.3390/medicina61122237

Authors:

Anez, Daniel; Conti, Giuseppe; Uriarte, Juan Jose; Serrano-Olmedo, Jose-Javier; Martinez-Murillo, Ricardo; Casanova-Carvajal, Oscar
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Affiliations

CSIC, Inst Cajal, Dept Translat Neurosci, Neurovasc Res Grp - Author
Inst Salud Carlos III, Ctr Invest Biomed Red Bioingn Biomat & Nanomed - Author
Univ Antonio Nebrija, Escuela Politecn Super, ARIES Res Ctr - Author
Univ Int Empresa UNIE, Escuela Super Ingn Ciencia & Tecnol - Author
Univ Politecn Madrid, Ctr Tecnol Biomed, Campus Montegancedo - Author
Univ Politecn Madrid, Informat Proc & Telecommun Ctr IP&T Ctr - Author
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Abstract

Background and Objectives: Breast cancer remains a leading cause of cancer-related morbidity and mortality worldwide, and robust, interpretable artificial intelligence (AI) pipelines are increasingly being explored to support mammography-based detection. This study combines a PRISMA 2020-compliant systematic review with an original experimental validation to characterize current evidence and address identified gaps in reproducibility and interpretability. Materials and Methods: A PRISMA 2020-guided systematic review and an original experimental study were conducted. The review searched PubMed and Scopus/ScienceDirect for studies using convolutional neural networks (CNNs), support vector machines (SVMs) or eXtreme Gradient Boosting (XGBoost) for breast cancer detection in mammography and related imaging modalities, and identified 45 eligible articles. In parallel, we implemented and evaluated representative CNN (ResNet-50, EfficientNetB0 and MobileNetV3-Small) and classical machine learning (SVM and XGBoost) pipelines on the CBIS-DDSM dataset, following a CRISP-DM-inspired workflow and using Grad-CAM and SHAP to provide image- and feature-level explanations within a reproducible machine-learning-operations (MLOps)-oriented framework. Results: The systematic review revealed substantial heterogeneity in datasets, preprocessing pipelines, and validation strategies, with a predominant reliance on internal validation and limited use of explainable AI methods. In our experimental evaluation, ResNet-50 achieved the best performance (AUC-ROC 0.95; sensitivity 89%), followed by XGBoost (AUC-ROC 0.90; sensitivity 74%) and SVM (AUC-ROC 0.84; sensitivity 66%), while EfficientNetB0 and MobileNetV3-Small showed lower discrimination. Grad-CAM produced qualitatively plausible heatmaps centered on annotated lesions, and SHAP analyses indicated that simple global image-intensity and size descriptors dominated the predictions of the classical models. Conclusions: By integrating systematic evidence and large-scale experiments on CBIS-DDSM, this study highlights both the potential and the limitations of current AI pipelines for mammography-based breast cancer detection, underscoring the need for more standardized preprocessing, rigorous external validation, and routine use of explainable AI before clinical deployment.
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Keywords

Artificial intelligenceBreast cancerBreast neoplasmsClassification modelsComputer-assisted diagnostic systemsConvolutional neural networksDeep learningFemaleHumansMachine learningMammographyNeural networks, computerReproducibility of resultsSupport vector machineSupport vector machines

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Medicina-Lithuania due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 78/332, thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine, General & Internal.

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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-25:

  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 11 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

    It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

    • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
    • Assignment of a Handle/URN as an identifier within the deposit in the Institutional Repository: https://oa.upm.es/92468/

    As a result of the publication of the work in the institutional repository, statistical usage data has been obtained that reflects its impact. In terms of dissemination, we can state that, as of

    • Views: 53
    • Downloads: 16
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    Leadership analysis of institutional authors

    There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (CASANOVA CARVAJAL, OSCAR ERNESTO).

    the author responsible for correspondence tasks has been CASANOVA CARVAJAL, OSCAR ERNESTO.

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    Project objectives

    Los objetivos perseguidos en esta aportación se centran en avanzar el conocimiento sobre la detección de cáncer de mama mediante inteligencia artificial aplicada a mamografías. Se pretende analizar sistemáticamente la literatura existente conforme a PRISMA 2020 para caracterizar la evidencia actual y detectar brechas en reproducibilidad e interpretabilidad. Asimismo, se busca evaluar experimentalmente el rendimiento de modelos representativos de redes neuronales convolucionales (ResNet-50, EfficientNetB0, MobileNetV3-Small) y métodos clásicos (SVM, XGBoost) en el conjunto de datos CBIS-DDSM. Otro objetivo es proporcionar explicaciones a nivel de imagen y características mediante Grad-CAM y SHAP en un marco reproducible orientado a MLOps. Finalmente, se aspira a identificar limitaciones y necesidades para la estandarización, validación externa rigurosa y uso habitual de IA explicable antes de su implementación clínica.
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    Most relevant results

    Los resultados más relevantes de esta aportación incluyen: la revisión sistemática identificó 45 estudios con alta heterogeneidad en conjuntos de datos, preprocesamiento y validación, predominando la validación interna y escaso uso de métodos explicables; en la validación experimental, ResNet-50 alcanzó un AUC-ROC de 0.95 y sensibilidad del 89%, seguido por XGBoost con AUC-ROC 0.90 y sensibilidad 74%, y SVM con AUC-ROC 0.84 y sensibilidad 66%, mientras EfficientNetB0 y MobileNetV3-Small mostraron menor discriminación; Grad-CAM generó mapas de calor plausibles centrados en lesiones anotadas; y SHAP reveló que descriptores globales de intensidad y tamaño dominaron las predicciones de modelos clásicos.
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    Contextual narrative

    En este trabajo, presento una contribución integral al campo de la detección del cáncer de mama mediante inteligencia artificial, combinando una revisión sistemática rigurosa siguiendo las directrices PRISMA 2020 con una validación experimental a gran escala. Nuestro estudio analiza en profundidad 45 trabajos que aplican modelos como CNN, SVM y XGBoost a la mamografía y otras modalidades de imagen, identificando limitaciones persistentes en reproducibilidad e interpretabilidad dentro del estado del arte. Este enfoque dual permite no solo sintetizar el conocimiento existente, sino también contrastarlo con resultados propios bajo un marco experimental sólido, proporcionando una visión completa y fundamentada de las capacidades reales de la IA en este ámbito. 

    Como director del estudio y último firmante, he guiado la visión conceptual, el diseño metodológico y la supervisión científica global del proyecto, asegurando la coherencia entre la revisión crítica y el aporte experimental. Este rol ha sido clave para articular un pipeline de IA robusto, interpretable y orientado a la práctica clínica, en un contexto en el que la comunidad internacional enfatiza cada vez más la necesidad de sistemas confiables que complementen las limitaciones actuales del cribado mamográfico y la escasez de radiólogos. Con esta publicación, consolidamos una referencia metodológica y aplicada que impulsa el desarrollo de herramientas más transparentes y eficaces para la detección precoz del cáncer de mama.

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