Abstract
PurposeTo explore the value of texture analysis (TA) based on dynamic contrast-enhanced MR (DCE-MR) images in the differential diagnosis of benign phyllode tumors (BPTs) and borderline/malignant phyllode tumors (BMPTs).MethodsA total of 47 patients with histologically proven phyllode tumors (PTs) from November 2012 to March 2020, including 26 benign BPTs and 21 BMPTs, were enrolled in this retrospective study. The whole-tumor texture features based on DCE-MR images were calculated, and conventional imaging findings were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS). The differences in the texture features and imaging findings between BPTs and BMPTs were compared; the variates with statistical significance were entered into logistic regression analysis. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of models from image-based analysis, TA, and the combination of these two approaches.ResultsRegarding texture features, three features of the histogram, two features of the gray-level co-occurrence matrix (GLCM), and three features of the run-length matrix (RLM) showed significant differences between the two groups (all p < 0.05). Regarding imaging findings, however, only cystic wall morphology showed significant differences between the two groups (p = 0.014). The areas under the ROC curve (AUCs) of image-based analysis, TA, and the combination of these two approaches were 0.687 (95% CI, 0.518–0.825, p = 0.014), 0.886 (95% CI, 0.760–0.960, p < 0.0001), and 0.894 (95% CI, 0.754–0.970, p < 0.0001), respectively.ConclusionTA based on DCE-MR images has potential in differentiating BPTs and BMPTs.
Highlights
Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, accounting for 0.3% to 1% of all primary breast tumors
The whole-tumor texture features based on dynamic contrastenhanced MR (DCE-MR) images were calculated, and conventional imaging findings were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS)
Our results suggested that texture analysis (TA) based on DCE-MR images has potential in differentiating benign phyllode tumors (BPTs) and borderline/malignant phyllode tumors (BMPTs)
Summary
Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, accounting for 0.3% to 1% of all primary breast tumors. PTs are classified as benign, borderline, and malignant, according to the latest edition of the World Health Organization (WHO) classification of the breast, which is based on the semiquantitative evaluation of key histological features, such as stromal cellularity, stromal atypia, stromal mitosis, stromal overgrowth, and tumor margin. Surgery is an essential means to treat PTs, and different surgical methods are commonly selected according to histologic grade. The preoperative differentiation between benign and malignant PTs would be significant for surgery planning. A fine-needle biopsy is sometimes helpful in determining the preoperative diagnosis of PTs, it is insufficient for PT grading because of potential inadequate cytologic samples resulting from the heterogeneous nature of PTs [2]
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