title: Computer-aided heterogeneity analysis in breast MR imaging assessment of ductal carcinoma in situ: Correlating histologic grade and receptor status.
abstract: To identify breast MR imaging biomarkers to predict histologic grade and receptor status of ductal carcinoma in situ (DCIS).
  
  
  
  Informed consent was waived in this Health Insurance Portability and Accountability Act-compliant Institutional Review Board-approved study. Case inclusion was conducted from 7332 consecutive breast MR studies from January 1, 2009, to December 31, 2012. Excluding studies with benign diagnoses, studies without visible abnormal enhancement, and pathology containing invasive disease yielded 55 MR-imaged pathology-proven DCIS seen on 54 studies. Twenty-eight studies (52%) were performed at 1.5 Tesla (T); 26 (48%) at 3T. Regions-of-interest representing DCIS were segmented for precontrast, first and fourth postcontrast, and subtracted first and fourth postcontrast images on the open-source three-dimensional (3D) Slicer software. Fifty-seven metrics of each DCIS were obtained, including distribution statistics, shape, morphology, Renyi dimensions, geometrical measure, and texture, using the 3D Slicer HeterogeneityCAD module. Statistical correlation of heterogeneity metrics with DCIS grade and receptor status was performed using univariate Mann-Whitney test.
  
  
  
  Twenty-four of the 55 DCIS (44%) were high nuclear grade (HNG); 44 (80%) were estrogen receptor (ER) positive. Human epidermal growth factor receptor-2 (HER2) was amplified in 10/55 (18%), nonamplified in 34/55 (62%), unknown/equivocal in 8/55 (15%). Surface area-to-volume ratio showed significant difference (P < 0.05) between HNG and non-HNG DCIS. No metric differentiated ER status (0.113 < p ≤ 1.000). Seventeen metrics showed significant differences between HER2-positive and HER2-negative DCIS (0.016 < P < 0.050).
  
  
  
  Quantitative heterogeneity analysis of DCIS suggests the presence of MR imaging biomarkers in classifying DCIS grade and HER2 status. Validation with larger samples and prospective studies is needed to translate these results into clinical applications.
  
  
  
  3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1748-1759.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.|Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Shinn-Huey S
authors.initials: SS
authors.lastname: Chou
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Eva C
authors.initials: EC
authors.lastname: Gombos
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Sona A
authors.initials: SA
authors.lastname: Chikarmane
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Giess
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Jagadeesan
authors.initials: J
authors.lastname: Jayender
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies
keywords: breast; computer-aided detection; ductal carcinoma in situ; heterogeneity; magnetic resonance imaging; nuclear grade