ObjectivePreoperative identification of lymphovascular invasion (LVI) in patients with invasive breast cancer is challenging due to absence of reliable biomarkers or tools in clinical settings. We aimed to establish and validate multiparametric magnetic resonance imaging (MRI)-based radiomic models to predict the risk of lymphovascular invasion (LVI) in patients with invasive breast cancer.MethodsThis retrospective study included a total of 175 patients with confirmed invasive breast cancer who had known LVI status and preoperative MRI from two tertiary centers. The patients from center 1 was randomly divided into a training set (n=99) and a validation set (n = 26), while the patients from center 2 was used as a test set (n=50). A total of 1409 radiomic features were extracted from the T2-weighted imaging (T2WI), dynamic contrast-enhanced (DCE) imaging, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC), respectively. A three-step feature selection including SelectKBest, interclass correlation coefficients (ICC), and least absolute shrinkage and selection operator (LASSO) was performed to identify the features most associated with LVI. Subsequently, a Support Vector Machine (SVM) classifier was trained to develop single-layer radiomic models and fusion radiomic models. Model performance was evaluated and compared by the area under the curve (AUC), sensitivity, and specificity.ResultsBased on one feature of wavelet-HLH_gldm_GrayLevelVariance, the ADC radiomic model achieved an AUC of 0.87 (95% confidence interval [CI]: 0.80–0.94) in the training set, 0.87 (0.70-1.00) in the validation set, and 0.77 (95%CI: 0.64-0.86) in the test set. However, the combination of radiomic features derived from other MR sequences failed to yield incremental value.ConclusionsADC-based radiomic model demonstrated a favorable performance in predicting LVI prior to surgery in patients with invasive breast cancer. Such model holds the potential for improving clinical decision-making regarding treatment for breast cancer.

Ma-yi-di-li Ni-jia-ti, Di-li-are -mu Ai-hai-ti, Ai-si-ka-er-jiang Huo-jia, Pa-li-dan-mu Wu-mai-er, A-bu-duke you -mu-jiang A-bu-li-zi, Yu Shi, Nu-era -mi-na Rou-zi, Wen-jing Su, Guo-zhao Dai and Mai-he-mi-ti-jiang Da-mo-la *