Predicting Lymph Node Metastases in Patients with Biopsy-Proven Ductal Carcinoma In Situ of the Breast: Development and Validation of the DCIS-met Model

Racial/ethnic differences in tumor biology and treatment outcomes in women with ductal carcinoma in situ

BACKGROUND

Racial differences in invasive breast cancer exist, but less is known about ductal carcinoma in situ. Our aim was to assess racial/ethnic differences in ductal carcinoma in situ tumor biology and treatment.

METHODS

Adults with ductal carcinoma in situ were identified from the National Cancer Database, 2012-2021. Pairwise comparisons were evaluated among racial/ethnic groups with χ2 or Wilcoxon tests. Multivariable logistic regression models evaluated outcome predictors for treatment and time to treatment.

RESULTS

Non-Hispanic Black patients had larger mean tumor size (2.2 cm, P ≤ .001). Non-Hispanic Black and Hispanic patients more frequently presented with multicentric disease (14.7% and 14.3%, P < .001). Non-Hispanic White patients had more grade III (45.1%, P < .01) and estrogen receptor-negative disease (14.2%, P < .04). On multivariable analysis, non-White race/ethnicity patients were less likely to undergo primary-site surgery (non-Hispanic Black odds ratio, 1.80; Hispanic odds ratio, 1.23; Asian/Pacific Islander odds ratio; 1.45, vs non-Hispanic White each P ≤ .002), as were uninsured and Medicaid-insured (uninsured odds ratio, 2.76; Medicaid odds ratio, 1.39; vs private insurance, both P < .002). Asian patients were more likely to undergo mastectomy (odds ratio, 1.08; 95% confidence interval, 1.02-1.15, P = .007), along with younger age (odds ratio, 0.64, P < .001), and multicentricity (hazard ratio, 2.23, P < .001). For breast conservation, radiation was less frequent among Hispanic patients (68.8%, P < .001). For estrogen receptor-positive ductal carcinoma in situ, non-Hispanic Black patients had the greatest receipt of endocrine therapy (61.9%%, P < .001) and Asian patients the lowest (56.9%, P < .001). On multivariable analysis, non-White race/ethnicity, uninsured, and Medicaid were associated with longer times from diagnosis to first surgery and from definitive surgery to radiation start.

CONCLUSIONS

Racial/ethnic differences exist in ductal carcinoma in situ tumor biology and treatment, both of which may contribute to poorer outcomes in disparate groups.

Role of combined clinical-radiomics model based on contrast-enhanced MRI in predicting the malignancy of breast non-mass enhancements without an additional diffusion-weighted imaging sequence

Background

In our previous study, we developed a combined diagnostic model based on time-intensity curve (TIC) types and radiomics signature on contrast-enhanced magnetic resonance imaging (CE-MRI) for non-mass enhancement (NME). The model had a high diagnostic ability for differentiation without the additional diffusion-weighted imaging (DWI) sequence. In this study, we aimed to compare the diagnostic performance of the combined clinical-radiomics model based on CE-MRI and DWI in discriminating Breast Imaging-Reporting and Data System (BI-RADS) 4 NME breast lesions, ductal carcinoma in situ (DCIS), and invasive carcinoma.

Methods

This retrospective study enrolled 364 NME lesions (343 patients). Of these, 183 malignant and 84 benign breast lesions classified as BI-RADS 4 NMEs by the initial diagnosis were reclassified based on the combined clinical-radiomics model and DWI, respectively. The nomogram score (NS) values for malignancy risk derived from the combined clinical-radiomics model and the minimal apparent diffusion coefficient (ADC) values from DWI were calculated and compared. The percentage of false positives were estimated in comparison with the original classification. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic value of the NS and minimal ADC values in distinguishing benign and malignant lesions, DCIS, and invasive breast carcinoma. An ablation experiment was used to test the value of the additional DWI sequence.

Results

The diagnostic value of the NS values [area under curve (AUC) =0.843; 95% CI: 0.789-0.896] for discriminating the 267 NME breast lesions categorized as BI-RADS 4 was significantly higher than the minimal ADC values (AUC =0.662; 95% CI: 0.590-0.735). The NS values showed higher sensitivity, specificity, and accuracy compared with the minimal ADC values (sensitivity: 80.3% vs. 65.6%; specificity: 79.8% vs. 65.5%; accuracy: 80.1% vs. 65.5%). The NS values and minimal ADC values did not achieve high diagnostic accuracy in discriminating between DCIS and invasive cancer. However, the diagnostic performance of the combined NS-ADC model (AUC =0.731; 95% CI: 0.655-0.806) was higher than that of the NS values alone (P=0.008) and comparable to that of the minimal ADC values (P=0.440).

Conclusions

The combined clinical-radiomics model based on CE-MRI could improve the diagnostic performance in discriminating the BI-RADS 4 NME lesions without an additional DWI sequence. However, DWI may improve the diagnostic performance in discriminating DCIS from invasive cancer.