Download This Paper
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
MRI-Based Radiomic Models to Predict the Surgical Margin Status and Infer the Tumor Immune Microenvironment in Breast Cancer Patients With Breast-Conserving Surgery: A Multicenter Validation Study
37 Pages Posted: 7 Feb 2022
More...Abstract
Background: Accurate preoperative estimation of the risk of breast-conserving surgery (BCS) surgical margin positivity would be beneficial to surgical planning. In this multicenter validation study, we developed an MRI-based radiomic model to predict the surgical margin status.
Methods: We retrospectively collected preoperative breast MRI of patients undergoing BCS from three hospitals (SYSMH, n=296; SYSUCC, n=131; TSPH, n=143). The radiomic-based models for risk prediction of the margin positivity was trained in the SYSMH patients (7:3 ratio splitted for the training and testing cohorts), and externally validated in the SYSUCC and TSPH cohorts. The model was able to divide patients into different subgroups with varied risk of margin positivity. Moreover, we used the immune-radiomic models and epithelial-mesenchymal transition (EMT) signature to infer the distribution patterns of immune cells and tumor cell EMT status under different marginal status.
Findings: The areas under the curve of the radiomic-based model were 0·78, 0·88, and 0·76 in the testing cohort and two external validation cohorts, respectively. The actual margin positivity rates ranged between 0-10% and 27·3-87·2% in low-risk and high-risk subgroup, respectively. Positive surgical margin was associated with higher levels of EMT and B cell infiltration in the tumor area, as well as the enrichment of B cells, immature dendritic cells, and neutrophil infiltration in the peritumoral area.
Interpretation: This MRI-based predictive model can be used as a reliable tool to predict the risk of margin positivity of BCS and assist the pre-operative surgical planning. Tumor immune-microenvironment alteration was associated with surgical margin status.
Funding Information: No funding.
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: This study has been approved by the ethics committee of each participating institution and was conducted in accordance with the Declaration of Helsinki.
Keywords: Breast cancer, Surgery, Radiomics, Microenvironment, Margin assessment
Suggested Citation: Suggested Citation