An expert system for histological typing and grading of invasive breast cancer. First set up

This article describes the set up of a rule-based expert system for histologic typing and grading of invasive breast cancer, which is designed to be a user-friendly tool that may be helpful for teaching and to support diagnosis making. The system raises questions and offers fixed choices to the user (usually yes/no) until a histologic diagnosis can be made with reasonable probability or enough data are available to assign a grade. As to histologic typing, the expert system is able to make the following diagnoses: ductal carcinoma, lobular carcinoma, medullary carcinoma, colloidal carcinoma, tubular carcinoma, and invasive cribriform carcinoma. If the diagnosis 'ductal carcinoma' is arrived, the system offers the option to assign a histologic grade to the lesion. A first evaluation of the system in 30 cases (five each of the different subtypes) with unequivocal diagnoses by two human experts showed that the system classified 29 of the tumours in the same way as the human experts. The discrepancy case was solved after adding one rule to the system. Ten cases where a discrepancy existed between the original diagnosis of a referring centre and a reviewing human expert were all classified by the expert system in the same way as the human expert. The expert system thus seems to perform well. Further plans for evaluating, modifying and expanding the system are disclosed.