Usefulness of imaging findings in predicting tumor-infiltrating lymphocytes in patients with breast cancer



Tumor-infiltrating lymphocytes (TILs) have been determined as a new prognostic indicator of immunotherapy response in breast cancer (BC). The aim of this study is to investigate the effectiveness of imaging features in predicting the TIL levels in invasive BC patients.


A total of 158 patients with invasive BC were included in our study. All lesions were evaluated based on the BIRADS lexicon. US was performed for all the patients and 89 of them underwent MRI. The histologic stromal TIL (sTIL) levels were assessed and associations between the sTIL levels and imaging features were evaluated.


Tumors with high sTIL levels had more circumscribed margins, round shape, heterogeneous echogenicity, and larger size on ultrasonography (p < 0.005). There was a statistically significant positive correlation between the sTIL levels and ADC value (p < 0.001). Tumors with high sTIL levels had significantly more homogeneous enhancement than the tumors with low sTIL levels (p = 0.001). Logistic regression analysis showed that the ADC was the most statistically significant parameter in predicting the sTIL levels (the odds ratio was 90.952; p = 0.002). The optimal cutoff value for ADC in predicting low and high sTIL levels was found to be 0.87 × 10−3 mm2 s−1 (AUC = 0.726, 73% specificity, and 60% sensitivity).


Imaging findings, especially the ADC, may play an important role as an adjunct tool in cases of uncertain situations and may improve the accuracy of biopsy results. The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis.

Key Points

• Preoperative assessment of TILs is an important biomarker of prognosis and treatment efficacy.

• ADC value can be a useful tool in distinguishing high and low sTIL levels as a non-invasive method.

• The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis and an optimal treatment for the BC patients.

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Apparent diffusion coefficient


Area under the curve


Breast cancer


Breast Imaging Reporting and Data System


Diffusion-weighted imaging


Estrogen receptor


Human epidermal growth factor receptor 2






Magnetic resonance imaging


Neoadjuvant chemotherapy


Pathological complete response


Receiver operating characteristic analysis


Tumor-infiltrating lymphocyte


Triple negative




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The authors would like to thank Enago ( for the English language review.


The authors state that this work has not received any funding.

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Correspondence to Filiz Çelebi.

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Written informed consent was not required for this study because the study was retrospective.

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Çelebi, F., Agacayak, F., Ozturk, A. et al. Usefulness of imaging findings in predicting tumor-infiltrating lymphocytes in patients with breast cancer. Eur Radiol 30, 2049–2057 (2020).

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  • Tumor
  • Lymphocytes
  • Breast cancer
  • Diffusion
  • Magnetic resonance imaging