Diagnostic performance of perilesional radiomics analysis of contrast-enhanced mammography for the differentiation of benign and malignant breast lesions

To conduct perilesional region radiomics analysis of contrast-enhanced mammography (CEM) images to differentiate benign and malignant breast lesions. This retrospective study included patients who underwent CEM from November 2017 to February 2020. Lesion contours were manually delineated. Perilesional regions were automatically obtained. Seven regions of interest (ROIs) were obtained for each lesion, including the lesion ROI, annular perilesional ROIs (1 mm, 3 mm, 5 mm), and lesion + perilesional ROIs (1 mm, 3 mm, 5 mm). Overall, 4,098 radiomics features were extracted from each ROI. Datasets were divided into training and testing sets (1:1). Seven classification models using features from the seven ROIs were constructed using LASSO regression. Model performance was assessed by the AUC with 95% CI. Overall, 190 women with 223 breast lesions (101 benign; 122 malignant) were enrolled. In the testing set, the annular perilesional ROI of 3-mm model showed the highest AUC of 0.930 (95% CI: 0.882–0.977), followed by the annular perilesional ROI of 1 mm model (AUC = 0.929; 95% CI: 0.881–0.978) and the lesion ROI model (AUC = 0.909; 95% CI: 0.857–0.961). A new model was generated by combining the predicted probabilities of the lesion ROI and annular perilesional ROI of 3-mm models, which achieved a higher AUC in the testing set (AUC = 0.940). Annular perilesional radiomics analysis of CEM images is useful for diagnosing breast cancers. Adding annular perilesional information to the radiomics model built on the lesion information may improve the diagnostic performance. • Radiomics analysis of the annular perilesional region of 3 mm in CEM images may provide valuable information for the differential diagnosis of benign and malignant breast lesions. • The radiomics information from the lesion region and the annular perilesional region may be complementary. Combining the predicted probabilities of the models constructed by the features from the two regions may improve the diagnostic performance of radiomics models.