Breast Lesion Classification with Multiparametric Breast MRI Using Radiomics and Machine Learning: A Comparison with Radiologists' Performance

Simple Summary Currently, breast contrast-enhanced MRI is the most sensitive imaging technique for breast cancer detection; however, its specificity is low given the common characteristics shared by benign breast lesions and some cancers. This leads to a high number of false-positive cases and, therefore, unnecessary biopsies. Multiparametric MRI including diffusion-weighted imaging assists in this task by increasing the specificity for breast lesion discrimination. Nevertheless, interpretation of breast MRI is still highly dependent on the reader's level of experience. Our work combines radiomic features extracted from multiparametric MRI to generate predictive models for breast cancer differentiation. Additionally, decision support models were compared with the performance of two breast dedicated radiologists for lesion differentiation. Our work proves the potential of multiparametric radiomics coupled with machine learning to be implemented in clinical practice for lesion differentiation on breast MRI. AI algorithms show value to assist less experienced readers, improving the accuracy for breast lesion discrimination. This multicenter retrospective study compared the performance of radiomics analysis coupled with machine learning (ML) with that of radiologists for the classification of breast tumors. A total of 93 consecutive women (mean age: 49 +/- 12 years) with 104 histopathologically verified enhancing lesions (mean size: 22.8 +/- 15.1 mm), classified as suspicious on multiparametric breast MRIs were included. Two experienced breast radiologists assessed all of the lesions, assigning a Breast Imaging Reporting and Database System (BI-RADS) suspicion category, providing a diffusion-weighted imaging (DWI) score based on lesion signal intensity, and determining the apparent diffusion coefficient (ADC). Ten predictive models for breast lesion discrimination were generated using radiomic features extracted from the multiparametric MRI. The area under the receiver operating curve (AUC) and the accuracy were compared using McNemar's test. Multiparametric radiomics with DWI score and BI-RADS (accuracy = 88.5%; AUC = 0.93) and multiparametric radiomics with ADC values and BI-RADS (accuracy= 88.5%; AUC = 0.96) models showed significant improvements in diagnostic accuracy compared to the multiparametric radiomics (DWI + DCE data) model (p = 0.01 and p = 0.02, respectively), but performed similarly compared to the multiparametric assessment by radiologists (accuracy = 85.6%; AUC = 0.03; p = 0.39). In conclusion, radiomics analysis coupled with the ML of multiparametric MRI could assist in breast lesion discrimination, especially for less experienced readers of breast MRIs.