MRI-based texture analysis for breast cancer subtype classification in a multi-ethnic population

Breast cancer, the most prevalent cancer among women globally, is classified into molecular subtypes (luminal, HER2-enriched, and triple-negative) to guide treatment and prognosis. Traditional subtyping methods, such as gene profiling and immunohistochemistry, are invasive and limited by intratumoural heterogeneity. MRI radiomics analysis offers a non-invasive alternative by extracting quantitative imaging features, yet its application in diverse, multi-ethnic populations remains underexplored.

This study aimed to identify predictive radiomic features from multiple MRI sequences to classify breast cancer subtypes, compare the performance of four MRI sequences, and determine the optimal machine learning (ML) model for this task. A total of 162 retrospective breast cancer MRI cases were semi-automatically segmented, and 256 radiomic features were extracted. A multimodal ML framework integrating random forest and recursive feature elimination was developed to identify the most predictive features based on the area under the receiver operating characteristic curve (AUROC).

Key predictive features included age, tumour size, margin characteristics, and intensity patterns within the tumour. Among MRI sequences, inversion recovery and T1 post-contrast performed best for subtyping. In addition, texture-based ML models effectively emulated visual assessment, demonstrating the potential of radiomics in non-invasive breast cancer subtyping. With the top ten features, the AUROC values are 0.735, 0.630, and 0.747 for luminal, HER2-enriched, and triple-negative, respectively.

These findings highlight the role of MRI-based texture features and advanced ML in enhancing breast cancer diagnosis, offering a non-invasive tool for personalised treatment planning while complementing existing clinical workflows.