Prognostic assessment of triple-negative breast cancer based on ecological positional analysis of preoperative dynamic enhanced MRI perfusion

Objective To assess the prognosis of triple-negative breast cancer (TNBC) using habitat analysis of preoperative DCE-MRI perfusion. Materials and Methods This study retrospectively collected consecutive patients with pathologically confirmed triple-negative breast cancer from January 2019 to November 2024 at our institution for evaluation. Ratio maps of (peak enhancement-unenhanced period)/unenhanced ROI mean wash-in ratio map, (peak enhancement-delayed period)/enhanced ROI mean washout ratio map were obtained by DCE perfusion. Habitat was calculated based on the clustering of the two perfusion ratio maps, and intratumour heterogeneity (ITH) was calculated based on the proportion of each cluster. Recurrence of TNBC was determined using Kaplan-Meier survival analysis, and multivariable Cox regression analyses were used to identify independent risk factors for TNBC recurrence. Results A total of 145 patients with triple-negative breast cancer were finally enrolled, of whom 29 patients experienced recurrence. The results of DCE habitat analysis showed that the habitat ITH was higher in the high-risk recurrence group than that in the low-risk recurrence group (0.59 ± 0.14 vs. 0.42 ± 0.22, P  < .001). In the ROC curve for diagnosis of triple-negative breast cancer recurrence, the AUC for habitat ITH was 0.71 (95% CI: 0.616–0.805, P  < .05). Habitat ITH (HR 1.465, P  = .013) was an independent predictor of poorer DFS in multivariable analysis. Conclusion Habitat analysis of preoperative DCE-MRI perfusion contributes to the prognostic assessment of TNBC.