title: Breast Cancer Heterogeneity: MR Imaging Texture Analysis and Survival Outcomes.
abstract: Purpose To determine the relationship between tumor heterogeneity assessed by means of magnetic resonance (MR) imaging texture analysis and survival outcomes in patients with primary breast cancer. Materials and Methods Between January and August 2010, texture analysis of the entire primary breast tumor in 203 patients was performed with T2-weighted and contrast material-enhanced T1-weighted subtraction MR imaging for preoperative staging. Histogram-based uniformity and entropy were calculated. To dichotomize texture parameters for survival analysis, the 10-fold cross-validation method was used to determine cutoff points in the receiver operating characteristic curve analysis. The Cox proportional hazards model and Kaplan-Meier analysis were used to determine the association of texture parameters and morphologic or volumetric information obtained at MR imaging or clinical-pathologic variables with recurrence-free survival (RFS). Results There were 26 events, including 22 recurrences (10 local-regional and 12 distant) and four deaths, with a mean follow-up time of 56.2 months. In multivariate analysis, a higher N stage (RFS hazard ratio, 11.15 [N3 stage]; P = .002, Bonferroni-adjusted α = .0167), triple-negative subtype (RFS hazard ratio, 16.91; P < .001, Bonferroni-adjusted α = .0167), high risk of T1 entropy (less than the cutoff values [mean, 5.057; range, 5.022-5.167], RFS hazard ratio, 4.55; P = .018), and T2 entropy (equal to or higher than the cutoff values [mean, 6.013; range, 6.004-6.035], RFS hazard ratio = 9.84; P = .001) were associated with worse outcomes. Conclusion Patients with breast cancers that appeared more heterogeneous on T2-weighted images (higher entropy) and those that appeared less heterogeneous on contrast-enhanced T1-weighted subtraction images (lower entropy) exhibited poorer RFS.©RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Jae-Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Ko
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Yaeji
authors.initials: Y
authors.lastname: Lim
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Boo-Kyung
authors.initials: BK
authors.lastname: Han
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Ko
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Soo Yeon
authors.initials: SY
authors.lastname: Hahn
authors.affiliation: From the Departments of Radiology (J.H.K., E.S.K., K.S.L., B.K.H., E.Y.K., S.Y.H.) and Surgery (S.J.N.), Samsung Medical Center Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea; and Department of Statistics, Pukyong National University, Busan, Korea (Y.L.).
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Nam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D003287:Contrast Media