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Ultrasound radiomics-based nomogram to predict lymphovascular invasion in invasive breast cancer: a multicenter, retrospective study

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Abstract

Objectives

To develop and validate an ultrasound (US) radiomics-based nomogram for the preoperative prediction of the lymphovascular invasion (LVI) status in patients with invasive breast cancer (IBC).

Materials and methods

In this multicentre, retrospective study, 456 consecutive women were enrolled from three institutions. Institutions 1 and 2 were used to train (n = 320) and test (n = 136), and 130 patients from institution 3 were used for external validation. Radiomics features that reflected tumour information were derived from grey-scale US images. The least absolute shrinkage and selection operator and the maximum relevance minimum redundancy (mRMR) algorithm were used for feature selection and radiomics signature (RS) building. US radiomics-based nomogram was constructed by using multivariable logistic regression analysis. Predictive performance was assessed with the receiving operating characteristic curve, discrimination, and calibration.

Results

The nomogram based on clinico-ultrasonic features (menopausal status, US-reported lymph node status, posterior echo features) and RS yielded an optimal AUC of 0.88 (95% confidence interval [CI], 0.84–0.91), 0.89 (95% CI, 0.84–0.94) and 0.95 (95% CI, 0.92–0.99) in the training, internal and external validation cohort. The nomogram outperformed the clinico-ultrasonic and RS model (p < 0.05). The nomogram performed favourable discrimination (C-index, 0.88; 95% CI: 0.84–0.91) and was confirmed in the validation (0.88 for internal, 0.95 for external) cohorts. The calibration and decision curve demonstrated the nomogram showed good calibration and was clinically useful.

Conclusions

The radiomics nomogram incorporated in the RS and US and the clinical findings exhibited favourable preoperative individualised prediction of LVI.

Clinical relevance statement

The US radiomics-based nomogram incorporating menopausal status, posterior echo features, US reported-ALN status, and radiomics signature has the potential to predict lymphovascular invasion in patients with invasive breast cancer.

Key Points

• The clinico-ultrsonic model of menopausal status, posterior echo features, and US-reported ALN status achieved a better predictive efficacy for LVI than either of them alone.

• The radiomics nomogram showed optimal prediction in predicting LVI from patients with IBC (ROC, 0.88 and 0.89 in the training and validation sets).

• A nomogram demonstrated favourable performance (area under the receiver operating characteristic curve, 0.95) and well calibration (C-index, 0.95) in an independent validation cohort (n = 130).

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Abbreviations

ALN:

Axillary lymph node

AUC:

Area under the ROC curve

GLSZM:

Grey-level size zone matrix

IBC:

Invasive breast cancer

LVI:

Lymphovascular invasion

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiving operating characteristics

RS:

Radiomics signature

VIF:

Variance inflation factor

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Funding

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

Author information

Author notes

  1. Yu Du and Mengjun Cai contributed equally to this study.

Authors and Affiliations

  1. Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China

    Yu Du, Mengjun Cai, Hailing Zha, Manqi Zhang, Wei Liu, Xinpei Liu & Cuiying Li

  2. Department of Ultrasound, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, 212050, China

    Baoding Chen

  3. Department of Ultrasound, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, China

    Jun Gu

  4. Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China

    Xiaoan Liu

  5. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China

    Min Zong

Authors
  1. Yu Du
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Corresponding authors

Correspondence to Min Zong or Cuiying Li.

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Guarantor

The scientific guarantor of this publication is Prof. Min Zong and Prof. Cuiying Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

This retrospective study was approved by the institutional review board, the approval number was 2022-SR-421.

Study subjects or cohorts overlap

None.

Methodology

• retrospective

• Observational

• multicentre study

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Du, Y., Cai, M., Zha, H. et al. Ultrasound radiomics-based nomogram to predict lymphovascular invasion in invasive breast cancer: a multicenter, retrospective study. Eur Radiol 34, 136–148 (2024). https://doi.org/10.1007/s00330-023-09995-1

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