Preoperative prediction of sentinel lymph node metastasis in breast cancer by radiomic signatures from dynamic contrast-enhanced MRI

Background Sentinel lymph node (SLN) status is an important prognostic factor for patients with breast cancer, which is currently determined in clinical practice by invasive SLN biopsy. Purpose To noninvasively predict SLN metastasis in breast cancer using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) intra- and peritumoral radiomics features combined with or without clinicopathologic characteristics of the primary tumor. Study Type Retrospective. Population A total of 163 breast cancer patients (55 positive SLN and 108 negative SLN). Field Strength/Sequence 1.5T, T-1-weighted DCE-MRI. Assessment A total of 590 radiomic features were extracted for each patient from both intratumoral and peritumoral regions of interest. To avoid overfitting, the dataset was randomly separated into a training set (similar to 67%) and a validation set (similar to 33%). The prediction models were built with the training set using logistic regression on the most significant radiomic features in the training set combined with or without clinicopathologic characteristics. The prediction performance was further evaluated in the independent validation set. Statistical Tests Mann-Whitney U-test, Spearman correlation, least absolute shrinkage selection operator (LASSO) regression, logistic regression, and receiver operating characteristic (ROC) analysis were performed. Results Combining radiomic features with clinicopathologic characteristics, six features were automatically selected in the training set to establish the prediction model of SLN metastasis. In the independent validation set, the area under ROC curve (AUC) was 0.869 (NPV = 0.886). Using radiomic features alone in the same procedure, 4 features were selected and the validation set AUC was 0.806 (NPV = 0.824). Data Conclusion This is the first attempt to demonstrate the feasibility of using DCE-MRI radiomics to predict SLN metastasis in breast cancer. Clinicopathologic characteristics improved the prediction performance. This study provides noninvasive methods to evaluate SLN status for guiding further treatment of breast cancer patients, and can potentially benefit those with negative SLN, by eliminating unnecessary invasive lymph node removal and the associated complications, which is a step further towards precision medicine. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:131-140.