Evaluation of Breast Cancer Size Measurement by Computer-Aided Diagnosis (CAD) and a Radiologist on Breast MRI.

Ji Yeon Park

doi:10.3390/jcm11051172

Abstract

Purpose: This study aimed to evaluate cancer size measurement by computer-aided diagnosis (CAD) and radiologist on breast magnetic resonance imaging (MRI) relative to histopathology and to determine clinicopathologic and MRI factors that may affect measurements. Methods: Preoperative MRI of 208 breast cancers taken between January 2017 and March 2021 were included. We evaluated correlation between CAD-generated size and pathologic size as well as that between radiologist-measured size and pathologic size. We classified size discrepancies into accurate and inaccurate groups. For both CAD and radiologist, clinicopathologic and imaging factors were compared between accurate and inaccurate groups. Results: The mean sizes as predicted by CAD, radiologist and pathology were 2.66 ± 1.68 cm, 2.54 ± 1.68 cm, and 2.30 ± 1.61 cm, with significant difference (p < 0.001). Correlation coefficients of cancer size measurement by radiologist and CAD in reference to pathology were 0.898 and 0.823. Radiologist’s measurement was more accurate than CAD, with statistical significance (p < 0.001). CAD-generated measurement was significantly more inaccurate for cancers of larger pathologic size (>2 cm), in the presence of an extensive intraductal component (EIC), with positive progesterone receptor (PR), and of non-mass enhancement (p = 0.045, 0.045, 0.03 and 0.002). Radiologist-measured size was significantly more inaccurate for cancers in presence of an in situ component, EIC, positive human epidermal growth factor receptor 2 (HER2), and non-mass enhancement (p = 0.017, 0.008, 0.003 and <0.001). Conclusion: Breast cancer size measurement showed a very strong correlation between CAD and pathology and radiologist and pathology. Radiologist-measured size was significantly more accurate than CAD size. Cancer size measurement by CAD and radiologist can both be inaccurate for cancers with EIC or non-mass enhancement.

Highlights

Breast conserving surgery has become the standard treatment strategy for early-stage, operable breast cancer, the physician’s preoperative treatment planning is critical
Song et al determined that computer-aided diagnosis (CAD) was feasible for assessment of tumor extent in 86 invasive breast cancers [15], and Levrini et al found that Magnetic resonance imaging (MRI) CAD size assessment of 52 breast lesions was as accurate as measurement performed on MRI images [16]
We reviewed the presence of associated carcinoma in situ component, extensive intraductal component (EIC), histologic grade, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2), Ki-67 index, and molecular subtype (luminal A, luminal B, HER2(+), triple-negative)

Summary

Introduction

Breast conserving surgery has become the standard treatment strategy for early-stage, operable breast cancer, the physician’s preoperative treatment planning is critical. Accurate tumor size measurement is essential for planning of breast conserving surgery and its successful completion as well as for prediction and evaluation of chemotherapy responsiveness [2,3]. CAD measurement was revealed to be more accurate than measurement by radiologists in 57 breast cancer patients receiving neoadjuvant chemotherapy [13]. DeMartini et al reported that CAD sizes were less accurate than those measured by radiologist in predicting the size of 16 residual breast malignancies after neoadjuvant chemotherapy [14]. Song et al determined that CAD was feasible for assessment of tumor extent in 86 invasive breast cancers [15], and Levrini et al found that MRI CAD size assessment of 52 breast lesions (including benign and malignant lesions) was as accurate as measurement performed on MRI images [16]

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