Angiovolume and Peak Enhancement on Preoperative CAD-Derived MRI as Prognostic Factors in Primary Operable Triple-Negative Breast Cancer

<b>Background/Objectives:</b> To identify preoperative MRI features using computer-assisted diagnosis (CAD) that are associated with invasive disease-free survival (IDFS) and distant metastasis-free survival (DDFS) in patients with primarily operable triple-negative breast cancer (TNBC). <b>Methods:</b> This retrospective study was approved by the institutional review board with informed consent was waived. Between January 2012 and December 2014, 74 consecutive women with primary TNBC (mean age, 51 years; range, 29-77 years) who underwent preoperative MRI were included and followed until August 2021. Dynamic contrast-enhanced and T2-weighted images were obtained using 3T scanners. Peritumoral edema and central necrosis were evaluated retrospectively. CAD was used to extract 3D diameters, angiovolume, and kinetic parameters, and kinetic heterogeneity was calculated. Cox proportional hazards models were used to assess associations between MRI features and IDFS and DDFS, adjusting for clinicopathologic factors. <b>Results:</b> During a median follow-up of 80.9 months, 12 patients developed invasive disease, and 8 developed distant metastasis. In multivariable analysis, peak enhancement (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.06-1.84; <i>p</i> = 0.019) and angiovolume (HR, 2.86; 95% CI, 1.26-6.47; <i>p</i> = 0.012) were independently associated with IDFS, whereas angiovolume (HR, 2.47; 95% CI: 1.28-4.78; <i>p</i> = 0.007) was independently associated with DDFS. <b>Conclusions:</b> Preoperative CAD-derived MRI features, particularly peak enhancement and angiovolume, were associated with IDFS in TNBC patients whereas angiovolume alone was associated with DDFS.