Recent Advances in Breast Cancer Imaging

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 30 September 2025 | Viewed by 3171

Special Issue Editor

Special Issue Information

Dear Colleagues,

We are delighted to extend an invitation for the submission of your cutting-edge original or review research papers on breast cancer imaging. As breast cancer remains one of the most prevalent and pressing health concerns globally, the significance of advanced imaging techniques in its detection, characterization, and treatment evaluation cannot be overstated. We welcome submissions exploring a wide array of topics, including the following:

  • The development and optimization of novel imaging modalities such as magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), and contrast-enhanced mammography for early detection and risk stratification of breast lesions;
  • Advancements in quantitative imaging biomarkers and artificial intelligence algorithms to improve diagnostic accuracy, prognostication, and treatment response assessment; elucidation of the role of imaging in guiding personalized treatment strategies, including neoadjuvant chemotherapy planning, surgical margin assessment, and post-treatment surveillance;
  • Exploration of imaging-based techniques for assessing tumor heterogeneity, microenvironmental factors, and molecular subtypes to inform precision medicine approaches;
  • The integration of multimodal imaging approaches to provide comprehensive insights into the complex biology of breast cancer progression and metastasis.

We also welcome machine learning analysis of breast images. Your contributions have the potential to revolutionize breast cancer care by enhancing early detection, optimizing treatment strategies, and improving patient outcomes.

Prof. Dr. Tim Duong
Guest Editor

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Keywords

  • breast cancer
  • neoadjuvant chemotherapy
  • axillary lymph nodes
  • molecular subtypes
  • hormonal receptor positive
  • medical oncology
  • breast surgery
  • breast cancer metastasis
  • pathological complete response
  • breast cancer recurrence

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Published Papers (3 papers)

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Research

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23 pages, 6234 KiB  
Article
Characterizing Breast Tumor Heterogeneity Through IVIM-DWI Parameters and Signal Decay Analysis
by Si-Wa Chan, Chun-An Lin, Yen-Chieh Ouyang, Guan-Yuan Chen, Chein-I Chang, Chin-Yao Lin, Chih-Chiang Hung, Chih-Yean Lum, Kuo-Chung Wang and Ming-Cheng Liu
Diagnostics 2025, 15(12), 1499; https://doi.org/10.3390/diagnostics15121499 - 12 Jun 2025
Viewed by 1236
Abstract
Background/Objectives: This research presents a novel analytical method for breast tumor characterization and tissue classification by leveraging intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) combined with hyperspectral imaging techniques and deep learning. Traditionally, dynamic contrast-enhanced MRI (DCE-MRI) is employed for breast tumor diagnosis, but [...] Read more.
Background/Objectives: This research presents a novel analytical method for breast tumor characterization and tissue classification by leveraging intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) combined with hyperspectral imaging techniques and deep learning. Traditionally, dynamic contrast-enhanced MRI (DCE-MRI) is employed for breast tumor diagnosis, but it involves gadolinium-based contrast agents, which carry potential health risks. IVIM imaging extends conventional diffusion-weighted imaging (DWI) by explicitly separating the signal decay into components representing true molecular diffusion (D) and microcirculation of capillary blood (pseudo-diffusion or D*). This separation allows for a more comprehensive, non-invasive assessment of tissue characteristics without the need for contrast agents, thereby offering a safer alternative for breast cancer diagnosis. The primary purpose of this study was to evaluate different methods for breast tumor characterization using IVIM-DWI data treated as hyperspectral image stacks. Dice similarity coefficients and Jaccard indices were specifically used to evaluate the spatial segmentation accuracy of tumor boundaries, confirmed by experienced physicians on dynamic contrast-enhanced MRI (DCE-MRI), emphasizing detailed tumor characterization rather than binary diagnosis of cancer. Methods: The data source for this study consisted of breast MRI scans obtained from 22 patients diagnosed with mass-type breast cancer, resulting in 22 distinct mass tumor cases analyzed. MR images were acquired using a 3T MRI system (Discovery MR750 3.0 Tesla, GE Healthcare, Chicago, IL, USA) with axial IVIM sequences and a bipolar pulsed gradient spin echo sequence. Multiple b-values ranging from 0 to 2500 s/mm2 were utilized, specifically thirteen original b-values (0, 15, 30, 45, 60, 100, 200, 400, 600, 1000, 1500, 2000, and 2500 s/mm2), with the last four b-value images replicated once for a total of 17 bands used in the analysis. The methodology involved several steps: acquisition of multi-b-value IVIM-DWI images, image pre-processing, including correction for motion and intensity inhomogeneity, treating the multi-b-value data as hyperspectral image stacks, applying hyperspectral techniques like band expansion, and evaluating three tumor detection methods: kernel-based constrained energy minimization (KCEM), iterative KCEM (I-KCEM), and deep neural networks (DNNs). The comparisons were assessed by evaluating the similarity of the detection results from each method to ground truth tumor areas, which were manually drawn on DCE-MRI images and confirmed by experienced physicians. Similarity was quantitatively measured using the Dice similarity coefficient and the Jaccard index. Additionally, the performance of the detectors was evaluated using 3D-ROC analysis and its derived criteria (AUCOD, AUCTD, AUCBS, AUCTDBS, AUCODP, AUCSNPR). Results: The findings objectively demonstrated that the DNN method achieved superior performance in breast tumor detection compared to KCEM and I-KCEM. Specifically, the DNN yielded a Dice similarity coefficient of 86.56% and a Jaccard index of 76.30%, whereas KCEM achieved 78.49% (Dice) and 64.60% (Jaccard), and I-KCEM achieved 78.55% (Dice) and 61.37% (Jaccard). Evaluation using 3D-ROC analysis also indicated that the DNN was the best detector based on metrics like target detection rate and overall effectiveness. The DNN model further exhibited the capability to identify tumor heterogeneity, differentiating high- and low-cellularity regions. Quantitative parameters, including apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (PF), were calculated and analyzed, providing insights into the diffusion characteristics of different breast tissues. Analysis of signal intensity decay curves generated from these parameters further illustrated distinct diffusion patterns and confirmed that high cellularity tumor regions showed greater water molecule confinement compared to low cellularity regions. Conclusions: This study highlights the potential of combining IVIM-DWI, hyperspectral imaging techniques, and deep learning as a robust, safe, and effective non-invasive diagnostic tool for breast cancer, offering a valuable alternative to contrast-enhanced methods by providing detailed information about tissue microstructure and heterogeneity without the need for contrast agents. Full article
(This article belongs to the Special Issue Recent Advances in Breast Cancer Imaging)
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11 pages, 6381 KiB  
Article
Relationships Between Breast Edema and Axillary Lymph Node Metastasis in Breast Cancer
by Derya Deniz Altıntaş, Gul Esen Icten, Füsun Taşkın and Cihan Uras
Diagnostics 2025, 15(11), 1300; https://doi.org/10.3390/diagnostics15111300 - 22 May 2025
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Abstract
Background/Objectives: To investigate the association between MRI features of primary breast cancers with axillary status, aiming to identify possible imaging biomarkers. Methods: Patients diagnosed with breast cancer between 2021 and 2023 in our clinic were retrospectively evaluated, and those that presented as mass [...] Read more.
Background/Objectives: To investigate the association between MRI features of primary breast cancers with axillary status, aiming to identify possible imaging biomarkers. Methods: Patients diagnosed with breast cancer between 2021 and 2023 in our clinic were retrospectively evaluated, and those that presented as mass lesions on preoperative MRI examinations (n: 123) were included in the study. Patients with and without metastatic axillary lymph nodes (mALN) were compared in terms of breast density, background parenchymal enhancement, tumor size, location in the breast, distance from the skin, patient age, presence of edema, multiple foci, histopathological type and molecular subtype of tumors. In multifocal/multicentric cases, the largest lesion was taken into consideration. Prepectoral and subcutaneous edema were considered diffuse edema, while perilesional edema was considered focal edema. MannWhitney U/Student-t test, Chi- square/Fischer Exact tests and logistic regression analysis were used for statistical analyses as appropriate. Results: Axilla was positive in 88 patients. There was a statistically significant difference in terms of edema, age, molecular subtype, Ki-67 index, number of lesions, tumor size, and laterality between the two groups (p < 0.05). Univariate logistic regression analysis showed that all included variables were statistically significant (p < 0.05). Multivariate logistic regression analysis revealed that presence of edema (OR: 2.46 CI; 1.11–5.48, p = 0.027) and multiple lesions (OR: 1.86 CI; 1.01–3.43, p = 0.046) were significantly associated with mALN. There was no significant difference between peritumoral edema and diffuse edema. Conclusions: Our study showed a statistically significant relationship between the axillary status and the presence of edema and multiple tumoral lesions on MRI. These findings have a potential to serve as prognostic imaging biomarkers for predicting the presence of mALN. Further studies with larger case series are needed to support our findings. Full article
(This article belongs to the Special Issue Recent Advances in Breast Cancer Imaging)
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15 pages, 587 KiB  
Systematic Review
Radiomics Analysis of Breast MRI to Predict Oncotype Dx Recurrence Score: Systematic Review
by Nathan Kim, Richard Adam, Takouhie Maldjian and Tim Q. Duong
Diagnostics 2025, 15(9), 1054; https://doi.org/10.3390/diagnostics15091054 - 22 Apr 2025
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Abstract
Background/Objectives: The Oncotype DX recurrence score (ODXRS) has emerged as an important tool for predicting recurrence risk and guiding treatment decisions in estrogen receptor-positive, human epidermal growth factor receptor 2-negative early-stage breast cancer. This review summarizes the current evidence on the clinical [...] Read more.
Background/Objectives: The Oncotype DX recurrence score (ODXRS) has emerged as an important tool for predicting recurrence risk and guiding treatment decisions in estrogen receptor-positive, human epidermal growth factor receptor 2-negative early-stage breast cancer. This review summarizes the current evidence on the clinical utility of the Oncotype DX RS and explores emerging research on potential imaging-based alternatives. The 21-gene assay provides a recurrence score that stratifies patients into low, intermediate, and high-risk groups, helping to identify patients who may benefit from adjuvant chemotherapy. Multiple validation studies have demonstrated the prognostic and predictive value of the ODXRS. However, the test is costly and requires tumor tissue samples. Methods: This paper systemically reviewed the current literature on the use of radiomic analysis of breast MRI to predict Oncotype DX. The literature search was performed from 2016 to 2024 using PubMed. We compared different image types, methods of analysis, sample size, numbers of high/intermediate and low scores, MRI image types, performance indices, among others. We also discussed lessons learned and suggested future research directions. Results: Recent studies have investigated the potential of radiomics applied to breast MRI to non-invasively predict the Oncotype DX RS. Quantitative imaging features extracted from dynamic contrast-enhanced MRI, diffusion-weighted imaging, and T2-weighted sequences have shown promise for distinguishing between low and high RS groups. Multiparametric MRI-based models integrating multiple sequences have achieved the highest performance. Conclusions: While further validation is needed, MRI radiomics may offer a non-invasive, cost-effective alternative for assessing recurrence risk. Full article
(This article belongs to the Special Issue Recent Advances in Breast Cancer Imaging)
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