Digital breast tomosynthesis-based peritumoral radiomics approaches in the differentiation of benign and malignant breast lesions.

PURPOSE We aimed to evaluate digital breast tomosynthesis (DBT)-based radiomics in the differentiation of benign and malignant breast lesions in women. METHODS A total of 185 patients who underwent DBT scans were enrolled between December 2017 and June 2019. The features of handcrafted and deep learning-based radiomics were extracted from the tumoral and peritumoral regions with different radial dilation distances outside the tumor. A 3-step method was used to select discriminative features and develop the radiomics signature. Discriminative clinical factors were identified by univariate logistic regression. The clinical fac- tors with P < .05 were used to build a clinical model with multivariate logistic regression. The radiomics nomogram was developed by integrating the radiomics signature and discriminative clinical factors. Discriminative performance of the radiomics signature, clinical model, nomo- gram, and breast imaging reporting and data system assessment were evaluated and compared with the receiver operating characteristic and decision curves analysis (DCA). RESULTS A total of 2 handcrafted and 2 deep features were identified as the most discriminative features from the peritumoral regions with 2 mm dilation distances and used to develop the radiomics signature. The nomogram incorporating the radiomics signature, age, and menstruation status showed the best discriminative performance with area under the curve (AUC) values of 0.980 (95% CI, 0.960 to 1.000; sensitivity =0.970, specificity =0.946) in the training cohort and 0.985 (95% CI, 0.960 to 1.000; sensitivity = 0.909, specificity = 0.966) in the validation cohort. DCA con- firmed the potential clinical usefulness of our nomogram. CONCLUSION Our results illustrate that the radiomics nomogram integrating the DBT imaging features and clinical factors (age and menstruation status) can be considered as a useful tool in aiding the clinical diagnosis of breast cancer.