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Yang Y, Liao T, Lin XH, Ouyang R, Chen Q, Ma J. Dual-region MRI radiomic analysis indicates increased risk in high-risk breast lesions: bridging intratumoral and peritumoral radiomics for precision decision-making. BMC Cancer 2025; 25:828. [PMID: 40329236 PMCID: PMC12054140 DOI: 10.1186/s12885-025-14165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 04/15/2025] [Indexed: 05/08/2025] Open
Abstract
OBJECTIVE To evaluate the clinical utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-derived clinicoradiological characteristics and intratumoral/peritumoral radiomic features in predicting pathological upgrades (malignant transformation) in high-risk breast lesions. MATERIALS AND METHODS Retrospectively collected the data of 174 patients with high-risk breast lesions who underwent preoperative breast MRI examinations and were confirmed by biopsy pathology in Shenzhen People's Hospital between January 1, 2019 and January 1, 2024. The dataset was randomly divided into a training set (n = 121) and a test set (n = 53) at a ratio of 7:3. Initially, during the second stage of DCE-MRI, the region of interest (ROI) was delineated along the maximum cross-section of the lesion, and then automatically expanded outward by 3 mm, 5 mm, and 7 mm as the peritumoral ROIs. The intratumoral, each peritumoral, and the combined intratumoral and peritumoral radiomic models were established respectively. Independent risk factors predictive of malignant upgrades in high-risk lesions were identified through univariate and multivariable logistic regression analyses, which were subsequently incorporated as clinical and imaging characteristics. Finally, a combined model was established by integrating the intratumoral and peritumoral radiomic features with the clinical and imaging features. The performance of each model was analyzed using the receiver operating characteristic (ROC) curves, and the area under the curve (AUC) was calculated. RESULTS The peritumoral 3 mm radiomics model achieved the highest diagnostic performance among all the peritumoral models, with the AUC values of 0.704 and 0.654 for the training and test sets, respectively. In the training set, the combined model showed the highest diagnostic performance (AUC = 0.883), which was superior to that of the clinical and imaging features model (AUC = 0.745, P = 0.003), the intratumoral radiomics model (AUC = 0.791, P = 0.027), the peritumoral 3 mm radiomics model (AUC = 0.704, P = 0.001), and the combined intratumoral and peritumoral radiomic model (AUC = 0.830, P = 0.004). In the test set, the combined model also showed the highest diagnostic performance (AUC = 0.851). The combined model constructed by integrating the intratumoral and peritumoral radiomics features with the clinical and imaging features had the best diagnostic performance, with the sensitivity, specificity, and accuracy of 79.4%, 82.7%, and 81.8% in the training set, and 72.7%, 85.7%, and 83.0% in the test set, respectively. CONCLUSION The combined predictive model, which integrates intratumoral and peritumoral radiomic features with clinical and imaging data, exhibited strong diagnostic performance and a clinically applicable nomogram was constructed to stratify individualized upgrade risk, assisting clinicians in making more precise decisions.
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Affiliation(s)
- Yuting Yang
- Department of Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Tingting Liao
- Department of Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Xiao-Hui Lin
- Department of Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Rushan Ouyang
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 528406, China
| | - Qiu Chen
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jie Ma
- Department of Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China.
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Liao T, Yang Y, Lin X, Ouyang R, Deng Y, Ma J. High-risk breast lesions: a combined intratumoral and peritumoral radiomics nomogram model to predict pathologic upgrade and reduce unnecessary surgical excision. Front Oncol 2024; 14:1479565. [PMID: 39744004 PMCID: PMC11688276 DOI: 10.3389/fonc.2024.1479565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 12/06/2024] [Indexed: 01/04/2025] Open
Abstract
Objective This study aimed to develop a nomogram that combines intratumoral and peritumoral radiomics based on multi-parametric MRI for predicting the postoperative pathological upgrade of high-risk breast lesions and sparing unnecessary surgeries. Methods In this retrospective study, 138 patients with high-risk breast lesions (January 1, 2019, to January 1, 2023) were randomly divided into a training set (n=96) and a validation set (n=42) at a 7:3 ratio. The best-performing MRI sequence for intratumoral radiomics was selected to develop individual and combined radiomics scores (Rad-Scores). The best Rad-Score was integrated with independent clinical and radiological risk factors by a nomogram. The diagnostic performance of the nomogram was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve, along with accuracy, specificity, and sensitivity analysis. Results The nomogram based on the combined intratumoral and peritumoral Rad-Score of the dynamic contrast-enhanced MRI and clinical-radiological features achieved superior diagnostic efficacy in the training (AUC=0.914) and validation set (AUC=0.867) compared to other models. It also achieved a specificity and accuracy of 85.1% and 82.3% during training and 66.7% and 76.2% during validation. Conclusion The nomogram encapsulating the combined intratumoral and peritumoral radiomics demonstrated superior diagnostic efficacy in postoperative pathological upgrades of high-risk breast lesions, enabling clinicians to make more informed decisions about interventions and follow-up strategies.
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Affiliation(s)
- Tingting Liao
- Department of Radiology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Yuting Yang
- Department of Radiology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Xiaohui Lin
- Department of Radiology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Rushan Ouyang
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yaohong Deng
- Department of Research & Development, Yizhun Medical AI Co. Ltd., Beijing, China
| | - Jie Ma
- Department of Radiology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
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Motanagh SA, Dwan D, Azizgolshani N, E Muller K, diFlorio-Alexander RM, Marotti JD. Sixteen-Year Institutional Review of Magnetic Resonance Imaging-Guided Breast Biopsies: Trends in Histologic Diagnoses With Radiologic Correlation. Breast Cancer (Auckl) 2023; 17:11782234231215193. [PMID: 38034324 PMCID: PMC10685755 DOI: 10.1177/11782234231215193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Breast magnetic resonance imaging (MRI) is an important imaging tool for the management of breast cancer patients and for screening women at high risk for breast cancer. Objectives To examine long-term trends in the distribution of histologic diagnoses obtained from MRI-guided breast biopsies. Design Retrospective analysis. Methods We retrospectively reviewed the distribution of histologic diagnoses of MRI-guided breast biopsies from 2004 to 2019. All cases underwent central pathology review and lesions were classified based on the most prominent histologic finding present. Magnetic resonance imaging features were extracted from radiology reports when available and correlated with pathology diagnoses. Results Four hundred ninety-four MRI-guided biopsies were performed on 440 patients; overall, 73% of biopsies were benign and 27% were malignant. The annual percentages of benign and malignant diagnoses remained similar throughout the 16-year period. Of the benign entities commonly identified, the percentage of benign papillary and sclerosing lesions detected in the benign biopsies increased significantly (13% in 2004-2011 vs 31% in 2012-2019, P = .03). The mean size of malignant lesions was larger than benign lesions (30.1 mm compared with 14.2 mm, P = .045); otherwise, there were no distinguishing radiologic features between benign and malignant lesions. Conclusion The specificity of breast MRI remained constant over a 16-year period; however, there was a shift in the distribution of benign diagnoses with increased detection and biopsy of benign papillary and sclerosing lesions. Monitoring the distribution of breast MRI biopsy diagnoses over time with radiology-pathology correlation might improve the suboptimal specificity of breast MRI.
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Affiliation(s)
- Samaneh A Motanagh
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Dennis Dwan
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nasim Azizgolshani
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kristen E Muller
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Roberta M diFlorio-Alexander
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jonathan D Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Li X, Sun K, Chai W, Zhu H, Yan F. Role of breast MRI in predicting histologic upgrade risks in high-risk breast lesions: A review. Eur J Radiol 2021; 142:109855. [PMID: 34303150 DOI: 10.1016/j.ejrad.2021.109855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This article reviews the frequency, upgrade rate and valuable imaging characteristics for predicting the histologic upgrade risks of high-risk lesions on MRI, so as to provide a reference for the management of the lesions. METHODS A comprehensive search for relevant publications from January 2011 to January 2021 was conducted in the PubMed database. The frequency, upgrade rate and valuable imaging characteristics for predicting the upgrade risks of high-risk lesions on MRI included in the articles were reviewed, and the management of high-risk lesions was provided with a reference according to the review results. RESULTS AND CONCLUSIONS In terms of management options, Atypical ductal hyperplasia (ADH) and Lobular neoplasia (LN) (the top two high-risk lesions with the highest upgrade rate and frequency) were treated with surgical resection. However, the final treatment decision for other high-risk lesions should be made by a multidisciplinary committee. In terms of the value of breast MRI in predicting the upgrade risks of high-risk lesions, the lesions that were confirmed to upgrade after surgery showed some enhancement characteristics, especially for ADH and LN. At the same time, Dynamic contrast-enhanced MRI (DCE-MRI) has a high negative predictive value (NPV) in predicting the upgrade risks of the high-risk lesions, hence misdiagnosis and overtreatment can be reduced. Diffusion-weighted imaging (DWI) and relative apparent diffusion coefficient (rADC) can be used to predict the upgrade risks of the lesions, and the ADC of upgraded lesions is lower than that of non-upgraded lesions. However, these conclusions should be confirmed by further studies.
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Affiliation(s)
- Xue Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Kun Sun
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Weimin Chai
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Hong Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
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High-Risk Lesions Detected by MRI-Guided Core Biopsy: Upgrade Rates at Surgical Excision and Implications for Management. AJR Am J Roentgenol 2021; 216:622-632. [PMID: 33439046 DOI: 10.2214/ajr.20.23040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE. The purpose of our study was to evaluate the upgrade rates of high-risk lesions (HRLs) diagnosed by MRI-guided core biopsy and to assess which clinical and imaging characteristics are predictive of upgrade to malignancy. MATERIALS AND METHODS. A retrospective review was performed of all women who presented to an academic breast radiology center for MRI-guided biopsy between January 1, 2015, and November 30, 2018. Histopathologic results from each biopsy were extracted. HRLs-that is, atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), radial scar, papilloma, flat epithelial atypia (FEA), benign vascular lesion (BVL), and mucocelelike lesion-were included for analysis. Clinical history, imaging characteristics, surgical outcome, and follow-up data were recorded. Radiologic-pathologic correlation was performed. RESULTS. Of 810 MRI-guided biopsies, 189 cases (23.3%) met the inclusion criteria for HRLs. Of the 189 HRLs, 30 cases were excluded for the following reasons: 15 cases were lost to follow-up, six cases were in patients who received neoadjuvant chemotherapy after biopsy, two lesions that were not excised had less than 2 years of imaging follow-up, and seven lesions had radiologic-pathologic discordance at retrospective review. Of the 159 HRLs in our study cohort, 13 (8.2%) were upgraded to carcinoma. Surgical upgrade rates were high for ADH (22.5%, 9/40) and FEA (33.3%, 1/3); moderate for LCIS (6.3%, 3/48); and low for ALH (0.0%, 0/11), radial scar (0.0%, 0/28), papilloma (0.0%, 0/26), and BVL (0.0%, 0/3). Of the upgraded lesions, 69.2% (9/13) were upgraded to ductal carcinoma in situ (DCIS) or well-differentiated carcinoma. ADH lesions were significantly more likely to be upgraded than non-ADH lesions (p = .005). CONCLUSION. ADH diagnosed by MRI-guided core biopsy warrants surgical excision. The other HRLs, however, may be candidates for imaging follow-up rather than excision, especially after meticulous radiologic-pathologic correlation.
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Nuñez DL, González FC, Ibargüengoitia MC, Fuentes Corona RE, Hernández Villegas AC, Zubiate ML, Vázquez Manjarrez SE, Ruiz Velasco CC. Papillary lesions of the breast: a review. BREAST CANCER MANAGEMENT 2020. [DOI: 10.2217/bmt-2020-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Papillary breast lesions are rare breast tumors that comprise a broad spectrum of diseases. Pathologically they present as mass-like projections attached to the wall of the ducts, supported by fibrovascular stalks lined by epithelial cells. On mammogram they appear as masses that can be associated with microcalcifications. Ultrasound is the most used imaging modality. On ultrasound papillary lesions appear as homogeneous solid lesions or complex intracystic lesions. A nonparallel orientation, an echogenic halo or posterior acoustic enhancement associated with microcalcifications are highly suggestive of malignancy. MRI has proven to be useful to establish the extent of the lesion. Core needle biopsy is the gold standard for diagnosis. Surgical excision is usually recommended, although treatment for papillomas without atypia is still controversial.
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Affiliation(s)
- Denny Lara Nuñez
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Candanedo González
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa Ibargüengoitia
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Mariana Licano Zubiate
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos Casian Ruiz Velasco
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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