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Updated: Jun 17, 2026
Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging
Published on: December 15, 2014
Dynamic contrast-enhanced magnetic resonance imaging-derived three-dimensional tumor volume improves prognostic
Juan Mao1, Jiangni Song1, Yitao Liu1
1Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Background:
Breast cancer prognosis and treatment planning largely depend on the tumor-node-metastasis (TNM) staging system, with T category mainly based on maximum tumor diameter (TD). Irregular three-dimensional (3D) growth of most breast tumors means that a single linear measurement cannot fully reflect tumor burden. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows tumor volume (TV) assessment, yet its incremental prognostic value remains uncertain. This study aimed to compare MRI-derived TV and conventional TD-based T staging for prognostic stratification of breast cancer.
Methods:
This single-center retrospective cohort study included 574 consecutive women with non-metastatic invasive breast cancer who underwent surgery at The First Affiliated Hospital of Nanjing Medical University between January 2016 and June 2019. Eligible patients had histologically confirmed invasive ductal carcinoma, preoperative 3.0-T breast MRI suitable for three-dimensional volumetric analysis, complete clinicopathological and follow-up data, no neoadjuvant therapy, and standardized treatment according to contemporaneous clinical practice guidelines. TV was measured using semi-automatic segmentation in 3D Slicer (version 5.5.0). Follow-up commenced at surgery and was conducted through outpatient visits, telephone interviews, and electronic medical record review until September 30, 2024. Disease-free survival (DFS) was defined as the interval from surgery to the first occurrence of local, regional, or distant recurrence, disease progression, or death from any cause; overall survival (OS) was defined as the interval from surgery to death from any cause. Cox regression and concordance index (C-index) analyses with 1,000 bootstrap resampling iterations were performed.
Results:
In the overall cohort, TV was strongly correlated with TD (r=0.781, 95% CI: 0.734-0.820, P<0.001), but this correlation weakened markedly when TD was >2.5 cm (r=0.341, 95% CI: 0.141-0.494, P<0.001). In multivariable Cox regression for DFS, compared with V1 (TV ≤2 cm3), V2 (>2-5 cm3) and V3 (>5 cm3) were independently associated with poorer DFS, with hazard ratios (HRs) of 2.721 (95% CI: 1.181-6.271, P=0.02) and 6.069 (95% CI: 2.640-13.950, P<0.001), respectively. In the TD-based model, compared with T1, the HRs were 2.227 (95% CI: 1.185-4.187, P=0.01) for T2 and 4.691 (95% CI: 1.424-15.457, P=0.01) for T3. The TV-based model had a C-index of 0.744, compared with 0.702 for the TD-based model; the corresponding bootstrap-corrected values were 0.749 (95% CI: 0.674-0.818) and 0.704 (95% CI: 0.619-0.795), respectively. In subgroup analyses, the TV-based model also showed higher discrimination in lymph node-positive disease (0.778 vs. 0.752, P=0.02), HER2- tumors (0.717 vs. 0.683, P=0.02), and Ki-67-high tumors (0.715 vs. 0.680, P=0.03).
Conclusions:
MRI-derived three-dimensional TV may complement conventional diameter-based staging by providing additional prognostic information in non-metastatic breast cancer. TV-based models showed higher discrimination in this cohort, particularly in selected biologically aggressive subgroups, although further prospective multicenter validation is warranted.
