Abstract
BACKGROUND: Breast cancer is a heterogeneous disease with different morphological and biological characteristics. The molecular subtypes of breast cancer are closely related to the treatment and prognosis of patients. In order to predict the luminal type of breast cancer in a noninvasive manner, our study developed and validated a radiomics nomogram combining clinical factors with a radiomics score based on the features of the intratumoral subregion to distinguish between luminal and nonluminal breast cancer. METHODS: From January 2018 to January 2020, 153 women with clinically and pathologically diagnosed breast cancer with an average age of 50.08 years were retrospectively analyzed. Using a semiautomatic segmentation method, the whole tumor was divided into 3 subregions on the basis of the time required for the contrast agent to reach its peak; 540 features were extracted from 3 subregions and the whole tumor region. Subsequently, 2 machine learning classifiers were developed. The least absolute shrinkage and selection operator method was used for feature selection and radiomics score (Rad-score) construction. Moreover, multivariable logistic regression analysis was applied to select independent factors from the Rad-score and clinical factors to establish a prediction model in the form of a nomogram. The performance of the nomogram was evaluated through calibration, discrimination, and clinical usefulness. RESULTS: The prediction performance of texture features from the rapid subregion was the best in the 3 intratumoral subregions, and the area under the receiver operating characteristic curve (AUC) values in the training and validation cohort were 0.805 (95% CI: 0.719-0.892) and 0.737 (95% CI: 0.581-0.893), respectively. The Rad-score, consisting of 5 features from the rapid subregion, was associated with the luminal type of breast cancer (P=0.001 and P=0.035 in the training and validation cohorts, respectively). The predictors included in the personalized prediction nomogram included Rad-score, human epidermal growth factor receptor 2 (HER2) status, and tumor histological grade. The nomogram showed good discrimination, with an area under the receiver operating characteristic curve in the training and validation cohorts of 0.830 (95% CI: 0.746-0.896) and 0.879 (95% CI: 0.748-0.957), respectively. The calibration curve of the 2 cohorts and decision curve analysis demonstrated that the nomogram had good calibration and clinical usefulness. CONCLUSIONS: We proposed a nomogram model that combined clinical factors and Rad-score, which showed good performance in predicting the luminal type of breast cancer.