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Peer-reviewedCC BY 4.0Cancers

Is the MRI Phenotype Associated with Survival in Patients with Different Breast Cancer Subtypes?

  • Carla Chizuru Tajima1,2
  • Soraia Quaranta Damião3
  • Cynthia Aparecida Bueno de Toledo Osorio4
  • Marina Sonagli5
  • Solange Moraes Sanches6
  • Almir Galvão Vieira Bitencourt3
6 affiliations
  1. 1Department of Imaging, Beneficência Portuguesa de São Paulo, São Paulo 01323-001, Brazil
  2. 2Graduate Program, A.C. Camargo Cancer Center, São Paulo 01509-010, Brazil
  3. 3Department of Imaging, A.C. Camargo Cancer Center, São Paulo 01509-010, Brazil
  4. 4Department of Pathology, A.C. Camargo Cancer Center, São Paulo 01509-010, Brazil
  5. 5Department of Breast Surgery, A.C. Camargo Cancer Center, São Paulo 01509-010, Brazil
  6. 6Department of Clinical Oncology, A.C. Camargo Cancer Center, São Paulo 01509-010, Brazil
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Abstract

Background: Breast cancer exhibits marked molecular and phenotypic heterogeneity, with important implications for prognosis and therapeutic response. Although magnetic resonance imaging (MRI) is widely used for detection and staging, its potential role as a prognostic biomarker across molecular subtypes remains incompletely understood. This study aimed to evaluate the association between MRI-defined tumor imaging phenotypes and disease-free survival (DFS) among different breast cancer molecular subtypes. Methods: This retrospective single-center study included 407 patients with invasive breast carcinoma of no special type who underwent pre-treatment breast MRI between October 2015 and May 2021. Tumors were classified into molecular subtypes and three MRI phenotypes based on lesion morphology and distribution. Associations between imaging phenotype, molecular subtype, and DFS were assessed using Kaplan–Meier analysis and Cox proportional hazards models. Results: Type 3 was the most prevalent imaging phenotype overall (60%), followed by Type 2 (21.9%) and Type 1 (18.2%). Imaging phenotype distribution differed significantly among molecular subtypes. Over a median follow-up of 57 months, imaging phenotype was not associated with DFS in Luminal A, Luminal B, or HER2-overexpressed tumors. However, in the triple-negative/ER-low subgroup, imaging phenotype demonstrated an independent association with DFS. In multivariable analysis, patients with the Type 1 phenotype had an 8.16-fold higher risk of recurrence compared with those with the Type 2 phenotype (95% CI: 1.49–44.60; p = 0.015). Type 2 lesions showed the most favorable survival outcomes. Conclusions: In this exploratory analysis, MRI phenotype was associated with disease-free survival in triple-negative and ER-low breast cancers. Circumscribed, unifocal tumors are associated with improved survival, whereas spiculated or multifocal patterns are associated with worse outcomes. However, given the small number of events in this subgroup, these exploratory findings need to be confirmed in larger studies before MRI morphology can be considered a prognostic imaging biomarker in aggressive breast cancer subtypes.

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Cite

BibTeXRIS
BibTeX
@article{tajima2026phenotype,
  title = {{Is the MRI Phenotype Associated with Survival in Patients with Different Breast Cancer Subtypes?}},
  author = {Carla Chizuru Tajima and Soraia Quaranta Damião and Cynthia Aparecida Bueno de Toledo Osorio and Marina Sonagli and Solange Moraes Sanches and Almir Galvão Vieira Bitencourt},
  journal = {Cancers},
  year = {2026},
  month = oct,
  doi = {10.3390/cancers18203309},
  url = {https://www.mdpi.com/2072-6694/18/20/3309},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Is the MRI Phenotype Associated with Survival in Patients with Different Breast Cancer Subtypes?
AU  - Carla Chizuru Tajima
AU  - Soraia Quaranta Damião
AU  - Cynthia Aparecida Bueno de Toledo Osorio
AU  - Marina Sonagli
AU  - Solange Moraes Sanches
AU  - Almir Galvão Vieira Bitencourt
PY  - 2026
DA  - 2026/10/01
JO  - Cancers
DO  - 10.3390/cancers18203309
UR  - https://www.mdpi.com/2072-6694/18/20/3309
AB  - Background: Breast cancer exhibits marked molecular and phenotypic heterogeneity, with important implications for prognosis and therapeutic response. Although magnetic resonance imaging (MRI) is widely used for detection and staging, its potential role as a prognostic biomarker across molecular subtypes remains incompletely understood. This study aimed to evaluate the association between MRI-defined tumor imaging phenotypes and disease-free survival (DFS) among different breast cancer molecular subtypes. Methods: This retrospective single-center study included 407 patients with invasive breast carcinoma of no special type who underwent pre-treatment breast MRI between October 2015 and May 2021. Tumors were classified into molecular subtypes and three MRI phenotypes based on lesion morphology and distribution. Associations between imaging phenotype, molecular subtype, and DFS were assessed using Kaplan–Meier analysis and Cox proportional hazards models. Results: Type 3 was the most prevalent imaging phenotype overall (60%), followed by Type 2 (21.9%) and Type 1 (18.2%). Imaging phenotype distribution differed significantly among molecular subtypes. Over a median follow-up of 57 months, imaging phenotype was not associated with DFS in Luminal A, Luminal B, or HER2-overexpressed tumors. However, in the triple-negative/ER-low subgroup, imaging phenotype demonstrated an independent association with DFS. In multivariable analysis, patients with the Type 1 phenotype had an 8.16-fold higher risk of recurrence compared with those with the Type 2 phenotype (95% CI: 1.49–44.60; p = 0.015). Type 2 lesions showed the most favorable survival outcomes. Conclusions: In this exploratory analysis, MRI phenotype was associated with disease-free survival in triple-negative and ER-low breast cancers. Circumscribed, unifocal tumors are associated with improved survival, whereas spiculated or multifocal patterns are associated with worse outcomes. However, given the small number of events in this subgroup, these exploratory findings need to be confirmed in larger studies before MRI morphology can be considered a prognostic imaging biomarker in aggressive breast cancer subtypes.
SN  - 2072-6694
ER  -