Evaluation of molecular receptors status in breast cancer using an mpMRI-based feature fusion radiomics model: mimicking radiologists' diagnosis

To investigate the performance of a novel feature fusion radiomics (R ) model that incorporates features from multiparametric MRIs (mpMRI) in distinguishing different statuses of molecular receptors in breast cancer (BC) preoperatively. 460 patients with 466 pathology-confirmed BCs who underwent breast mpMRI at 1.5T in our center were retrospectively included hormone receptor (HR) positive (HR+) (n=336) and HR negative (HR-) (n=130). The HR- patients were further categorized into human epidermal growth factor receptor 2 (HER-2) enriched BC (HEBC) (n=76) and triple negative BC (TNBC) (n=54). All lesions were divided into a training/validation cohort (n=337) and a test cohort (n=129). Volumes of interest (VOIs) delineation, followed by radiomics feature extraction, was performed on T2WI, DWI (b=600 s/mm ), DWI (b=800 s/mm ), ADC map, and DCE (six continuous DCE-MRI) images of each lesion. Simulating a radiologist's work pattern, 150 classification base models were constructed and analyzed to determine the top four optimum sequences for classifying HR+ . HR-, TNBC . HEBC, TNBC . non-TNBC in a random selected training cohort (n=337). Building upon these findings, the optimal single sequence models (Rss) and combined sequences models (R ) were developed. The AUC, sensitivity, accuracy and specificity of each model for subtype differentiation were evaluated. The paired samples Wilcoxon signed rank test was used for performance comparison. During the three classification tasks, the optimal single sequence for classifying HR+ . HR- was DWI , while the ADC map, derived from DWI performed the best in distinguishing TNBC . HEBC, as well as identifying TNBC . non-TNBC, with corresponding training AUC values of 0.787, 0.788, and 0.809, respectively. Furthermore, the integration of the top four sequences in R models yielded improved performance, achieving AUC values of 0.809, 0.805 and 0.847, respectively. Consistent results was observed in both the training/validation and testing cohorts, with AUC values of 0.778, 0.787, 0.818 and 0.726, 0.773, 0.773, respectively (all < 0.05 except HR+ . HR-). The R model, integrating mpMRI radiomics features, demonstrated promising ability to mimic radiologists' diagnosis for preoperative identification of molecular receptors of BC.