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. 2021 Dec 21;11:24382. doi: 10.1038/s41598-021-03806-7

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Classification results with class activation map (CAM) using the weakly-supervised deep learning (DL) algorithm on external validation set. Examples of true-positive (A), false-negative (B), false-positive (C), and true-negative (D) are shown for each network (VGG16, ResNet34, and GoogLeNet). (A) Ultrasound images show a 17-mm irregular, spiculated invasive ductal carcinoma, which was predicted as malignancy with probability of malignancy (POM) of 1.00, 1.00, and 0.999 in VGG16, ResNet34, and GoogLeNet, respectively. (B) Ultrasound images show an 11-mm oval, circumscribed, isoechoic mucinous carcinoma, which was predicted as benign with POM of 0.007, 0.000, and 0.000, respectively. (C) Ultrasound images show a 29-mm oval, hypoechoic mass with macrocalcifications considered as benign (unchanged during the 46-month follow-up period), which was predicted as malignancy with POM of 1.000, 0.994, and 1.000, respectively. (D) Ultrasound images show a 6-mm oval, circumscribed mass considered as benign (unchanged during the 55-month follow-up period), which was predicted as benign with POM of 0.434, 0.006, and 0.006, respectively.