Preliminary Evaluation of Radiomics in Contrast-Enhanced Mammography for Prognostic Prediction of Breast Cancer

Radiomics is changing clinical practice by providing quantitative information from images to improve diagnosis, prognosis, and treatment planning. This study aims to investigate a radiomics model developed from contrast-enhanced mammography (CEM) images to predict disease-free survival (DFS) and overall survival (OS) in breast cancer (BC) patients.

From January 2013 to December 2015, all consecutive BC patients who underwent CEM before biopsy at a referral center were enrolled. Clinical data included histological results, receptor profiles, and follow-up (DFS and OS). A region of interest (ROI) of the enhancing lesion was selected from recombined CEM images by experienced radiologists, and radiomic features were extracted. A Cox-LASSO model assigned coefficients to the features, generating patient radiomic scores (RSs), which were dichotomized for graphical representation. Model performance was assessed using the C index.

The study included 126 BC patients with predominantly "mass"-type lesions (95%) and a median follow-up of 6.88 years (IQR 3.10-8.15). The median age of the patients at the time of examination was 49.2 years (IQR: [42.33-56.98]). Radiomic and clinical-radiomic models showed significant associations between RS, DFS, and OS, with patients with RS below the median showing a better prognosis (p < 0.001). Bootstrap testing confirmed a good model fit for OS prediction, with median C-index values of 0.82 for the clinical model and 0.84 for the clinical-radiomic model.

Radiomic analysis of CEM images may predict DFS and OS in BC patients, offering additional prognostic value beyond clinical models alone.