Preoperative prediction of extensive intraductal component in invasive breast cancer based on intra- and peri-tumoral heterogeneity in high-resolution ultrafast DCE-MRI

Preoperatively predicting extensive intraductal component in invasive breast cancer through imaging is crucial for informed decision-making, guiding surgical planning to mitigate risks of incomplete resection or re-operation for positive margins in breast-conserving surgery. This study aimed to characterize intra- and peri-tumor heterogeneity using high-spatial resolution ultrafast DCE-MRI to predict the extensive intraductal component in invasive breast cancer (IBC-EIC) preoperatively. A retrospective analysis included invasive breast cancer patients who underwent preoperative high-spatial resolution ultrafast DCE-MRI, categorized based on intraductal component status (IBC-EIC vs. IBC without EIC). Propensity score matching (PSM) was employed to balance clinicopathological covariates between the groups. Personalized kinetic intra-tumor heterogeneity (ITH kinetic ) and peri-tumor heterogeneity (PTH kinetic ) scores were quantified using clustered voxels with similar enhancement patterns. An image combined model, incorporating MRI features, ITH kinetic , and PTH kinetic scores, was developed and assessed. Of 368 patients, 26.4% (97/368) had IBC-EIC. PSM yielded well-matched pairs of 97 patients each. After PSM, ITH kinetic and PTH kinetic scores were significantly higher in the IBC-EIC group (ITH kinetic : 0.68 ± 0.23; PTH kinetic : 0.58 ± 0.19) compared to IBC without EIC (ITH kinetic : 0.32 ± 0.25; PTH kinetic : 0.42 ± 0.18; p