Article Figures & Data
Figures
- FIGURE 1.
Flowchart of included and excluded participants. G3 = grade 3; Her2neu = human epidermal growth factor receptor type 2.
- FIGURE 2.
Examples of morphologic and metabolic features for assessment of axillary lymph nodes in axial T1-weighted, volume-interpolated breath-hold examination, fat-saturated, contrast-enhanced images. Enlarged lymph node has short-axis diameter of 31 mm. Lymph node with increased 18F-FDG uptake has SUVmax of 13.1.
- FIGURE 3.
ROC AUC for random forest model performance on testing data and for prediction of lymph node status by radiologists on MRI and PET/MRI. LN = lymph node.
- FIGURE 4.
Importance of different morphologic and metabolic features of lymph nodes.
- FIGURE 5.
Precision and recall scores as function of decision threshold on internal validation sample. x represents threshold values, and y is score of precision or recall. Adjusted decision threshold for optimized sensitivity is indicated by dashed line.
- FIGURE 6.
(A) Decision tree for predicting lymph node status in MRI and PET/MRI. (B) ROC AUC for size and for SUVmax ratio of lymph node to mediastinal blood pool for prediction of lymph node status. Ao = aorta; LN = lymph node.
Tables
Parameter Training sample Testing sample P Total participants 255 48 Mean age (±SD) 51.2 ± 11.9 y 52.2 ± 12.2 y 0.689 Lymph node status (reference standard) Negative 154 (60.4%) 26 (54.2%) 0.420 Positive 101 (39.6%) 22 (45.8%) Menopause status Premenopausal 111 (43.5%) 18 (37.5%) 0.737 Perimenopausal 25 (9.8%) 5 (10.4%) Postmenopausal 119 (46.7%) 25 (52.1%) Ki-67 Positive > 14% 226 (88.6%) 41 (85.4%) 0.528 Negative < 14% 29 (11.4%) 7 (14.6%) Progesterone status Positive 169 (66.3%) 29 (60.4%) 0.433 Negative 86 (33.7%) 19 (39.6%) Estrogen status Positive 187 (73.3%) 28 (58.3%) <0.01 Negative 68 (26.7%) 20 (41.7%) HER2neu expression 0 97 (38.0%) 23 (47.9%) 0.479 1+ 73 (28.6%) 14 (29.2%) 2+ 34 (13.3%) 5 (10.4%) 3+ 51 (20.0%) 6 (12.5%) Tumor grade 1 10 (3.9%) 4 (8.3%) 0.025 2 137 (53.7%) 16 (33.3%) 3 108 (42.4%) 28 (58.3%) Histology No special type 222 (87.1%) 42 (87.5%) < 0.01 Lobular invasive 25 (9.8%) 0 (0%) Other 8 (3.1%) 6 (12.5%) HER2neu = human epidermal growth factor receptor type 2.
Data are number and percentage, except for age.
- TABLE 2.
Diagnostic Performance of MRI and PET/MRI in Assessment of Lymph Node Status of Radiologists and Random Forest Classifier Within Testing Sample
Assessor MRI PET/MRI Radiologists Sensitivity 84.6 (65.1–95.6) 92.3 (74.9–99.1) Specificity 90.9 (70.8–98.9) 86.4 (65.1–97.1) PPV 91.7 (74.4–97.7) 88.9 (73.5–96.8) NPV 83.3 (66.8–92.6) 90.5 (71.3–97.3) Accuracy 87.5 (74.8–95.3) 89.6 (77.3–96.5) Random forest algorithm Sensitivity 88.5 (69.9–97.6) 88.5 (69.9–97.6) (reader 1), 88.5 (69.9–97.6) (reader 2) Specificity 86.4 (65.1–97.1) 86.4 (65.1–97.1) (reader 1), 81.8 (59.7–94.8) (reader 2) PPV 88.5 (72.6–95.7) 88.5 (72.6–95.7) (reader 1), 85.2 (70.1–93.4) (reader 2) NPV 86.4 (68.3–94.9) 86.4 (68.3–94.9) (reader 1), 85.7 (67.0–94.7) (reader 2) Accuracy 87.5 (74.8–96.3) 87.5 (74.8–96.3) (reader 1), 85.4 (72.2–93.9) (reader 2) Data are percentages, with 95% CIs in parentheses.
Actual Predicted Negative Positive Negative 15 7 Positive 1 25 Metric Data Sensitivity 96.2% (80.4%–99.9%) Specificity 68.2% (45.1%–86.1%) PPV 78.1% (65.9%–86.9%) NPV 93.8% (68.2%–99.1%) Accuracy 83.3% (69.8%–92.5%) Data in parentheses are ranges.
Actual Predicted MRI PET/MRI Negative Positive Negative Positive Negative 20 2 21 1 Positive 3 23 4 22 Metric Data MRI Sensitivity 88.5% (69.9%–97.6%) Specificity 90.9% (70.8%–98.9%) PPV 92.0% (75.3%–97.8%) NPV 87.0% (69.5%–95.1%) Accuracy 89.6% (77.3%–96.5%) PET/MRI Sensitivity 84.6% (65.1%–95.6%) Specificity 95.5% (77.2%–99.9%) PPV 95.7% (76.3%–99.3%) NPV 84.0% (68.0–92.9. %) Accuracy 89.6% (77.3%–96.5%) Data in parentheses are ranges.
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