ArticleGland surgery2026
Dynamic contrast-enhanced magnetic resonance imaging-derived three-dimensional tumor volume improves prognostic stratification in breast cancer: a retrospective cohort study.
Article in Gland surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Breast cancer prognosis and treatment planning largely depend on the tumor-node-metastasis (TNM) staging system, with T category mainly based on maximum tumor diameter (TD). Irregular three-dimensional (3D) growth of most breast tumors means that a single linear measurement cannot fully reflect tumor burden. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows tumor volume (TV) assessment, yet its incremental prognostic value remains uncertain. This study aimed to compare MRI-derived TV and conventional TD-based T staging for prognostic stratification of breast cancer. Methods: This single-center retrospective cohort study included 574 consecutive women with non-metastatic invasive breast cancer who underwent surgery at The First Affiliated Hospital of Nanjing Medical University between January 2016 and June 2019. Eligible patients had histologically confirmed invasive ductal carcinoma, preoperative 3.0-T breast MRI suitable for three-dimensional volumetric analysis, complete clinicopathological and follow-up data, no neoadjuvant therapy, and standardized treatment according to contemporaneous clinical practice guidelines. TV was measured using semi-automatic segmentation in 3D Slicer (version 5.5.0). Follow-up commenced at surgery and was conducted through outpatient visits, telephone interviews, and electronic medical record review until September 30, 2024. Disease-free survival (DFS) was defined as the interval from surgery to the first occurrence of local, regional, or distant recurrence, disease progression, or death from any cause; overall survival (OS) was defined as the interval from surgery to death from any cause. Cox regression and concordance index (C-index) analyses with 1,000 bootstrap resampling iterations were performed. Results: In the overall cohort, TV was strongly correlated with TD (r=0.781, 95% CI: 0.734-0.820, P<0.001), but this correlation weakened markedly when TD was >2.5 cm (r=0.341, 95% CI: 0.141-0.494, P<0.001). In multivariable Cox regression for DFS, compared with V1 (TV ≤2 cm Conclusions: MRI-derived three-dimensional TV may complement conventional diameter-based staging by providing additional prognostic information in non-metastatic breast cancer. TV-based models showed higher discrimination in this cohort, particularly in selected biologically aggressive subgroups, although further prospective multicenter validation is warranted.
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