MRI-based habitat imaging for predicting the efficacy of neoadjuvant therapy in axillary lymph node-positive breast cancer
ZHENG Jinlong
ZHAI Zihan
CHEN Sheng
GU Yajia
YOU Chao
Abstract：Objective To investigate a model based on MRI habitat imaging analysis of axillary lymph node(ALN)heterogeneity combined with clinicopathological features for assessing the response to neoadjuvant therapy(NAT)in breast cancer patients with ALN positivity(ALN+).Methods A total of 369 female patients with pathologically confirmed ALN+breast cancer were retrospectively enrolled and randomly divided into a training set(n=259)and a validation set(n=1 10)in a 7∶3 ratio.All patients underwent dynamic contrast-enhanced MRI before treatment.Stable 3D radiomic features were used,and the optimal number of clusters was determined using Gaussian mixture modeling and the Bayesian information criterion to generate habitat imaging and extract subregional features.Four support vector machine(SVM)-based models were constructed:a clinical model,a habitat radiomics model,an ALN heterogeneity score model,and a late-fusion combined model.Predictive performance was evaluated using receiver operating characteristic(ROC)curve analysis,and the area under the curve(AUC)values were compared using the Delong test.Clinical utility was assessed using decision curve analysis.Results The clinical model was constructed based on PR status,HER2 status,and Ki-67 index.The habitat radiomics model was developed using 17 non-zero radiomic features extracted from four subregions.An ALN heterogeneity score model and a combined model were also established.In the validation set,the AUCs of the clinical model,habitat radiomics model,ALN heterogeneity score model,and combined model were 0.79,0.60,0.69,0.85,respectively.The Delong test showed that the AUC of the combined model was significantly higher than those of all individual models(all P＜0.05).Decision curve analysis demonstrated that the combined model consistently provided a high net benefit within the threshold probability range of 0.2-0.8,indicating favorable clinical applicability.Conclusion A combined model integrating MRI-based habitat radiomics features,ALN heterogeneity scores,and clinicopathological characteristics may assist in evaluating post-NAT lymph node status and support individualized clinical decision-making.
Keywords：Axillary lymph node-positive breast cancerMagnetic resonance imagingHabitat imagingHeterogeneityNeoadjuvant therapy
Publication Date：2025-11-15
Online Publishing Date：2025-12-15(First online date of this platform, not the publication date of the document)
Pages：9( 632-639,645 )