{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:21:41Z","timestamp":1784085701246,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T00:00:00Z","timestamp":1724889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003200","name":"Kementerian Sains, Teknologi dan Inovasi","doi-asserted-by":"publisher","award":["FRGS\/ 1\/2019\/SKK03\/UM\/01\/1"],"award-info":[{"award-number":["FRGS\/ 1\/2019\/SKK03\/UM\/01\/1"]}],"id":[{"id":"10.13039\/501100003200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004625","name":"Universiti Teknologi MARA","doi-asserted-by":"publisher","award":["600\/RMC-LESTARI SDG-T5\/3"],"award-info":[{"award-number":["600\/RMC-LESTARI SDG-T5\/3"]}],"id":[{"id":"10.13039\/501100004625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Accurate subtyping of breast cancer is crucial for its diagnosis, management, and prognostication. This study aimed to determine the association of magnetic resonance imaging (MRI) breast features with the molecular subtype and aggressiveness of breast cancer in a multi-ethnic population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Treatment-naive patients with invasive breast carcinoma were included in this retrospective study. Breast MRI features were recorded based on the American College of Radiology-Breast Imaging Reporting and Data System (ACR-BIRADS) criteria, with tumour size, and apparent diffusion coefficient value (ADC). The statistical association was tested with Pearson Chi-Square Test of Independence for categorical data or the Kruskal-Wallis\/ Mann Whitney U test for numerical data between the MRI features and molecular subtype, receptor status, tumour grade, lymphovascular infiltration (LVI) and axillary lymph node (ALN). Multinomial logistic regression was used to test the predictive likelihood of the significant features. The breast cancer subtypes were determined via immunohistochemistry (IHC) and dual-color dual-hapten in-situ hybridization (D-DISH). The expression statuses of ER, PR, and HER-2, LVI, and ALN were obtained from the histopathology report. The ER \/ PR \/ HER-2 was evaluated according to the American Society of Clinical Oncology \/ College of American Pathologists.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study included 194 patients; 41.8% (n = 81) Chinese, 40.7% (n = 79) Malay, and 17.5% (n = 34) Indian, involving 71.6%(n = 139) luminal-like, 12.9%(n = 25) HER-2 enriched, and 15.5%(n = 30) Triple-negative breast cancer (TNBC). TNBC was associated with rim enhancement (p = 0.002) and peritumoral oedema (p = 0.004). HER-2 enriched tumour was associated with larger tumour size (p = 0.041). Luminal-like cancer was associated with irregular shape (p = 0.005) with circumscribed margin (p = 0.003). Other associations were ER-negative tumour with circumscribed margin (p = 0.002) and PR-negative with round shape (p = 0.001). Tumour sizes were larger in ER-negative (p = 0.044) and PR-negative (p = 0.022). Rim enhancement was significantly associated with higher grade (p = 0.001), and moderate peritumoral oedema with positive axillary lymph node (p = 0.002).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Certain MRI features can be applied to differentiate breast cancer molecular subtypes, receptor status and aggressiveness, even in a multi-ethnic population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0309131","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T19:07:10Z","timestamp":1724958430000},"page":"e0309131","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Investigation of breast cancer molecular subtype in a multi-ethnic population using MRI"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8720-5700","authenticated-orcid":true,"given":"Nazimah","family":"Ab 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Seminars in cancer biology; 1992."},{"issue":"10","key":"pone.0309131.ref016","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1093\/annonc\/mdp062","article-title":"Significantly higher levels of vascular endothelial growth factor (VEGF) and shorter survival times for patients with primary operable triple-negative breast cancer","volume":"20","author":"BK Linderholm","year":"2009","journal-title":"Annals of Oncology"},{"key":"pone.0309131.ref017","doi-asserted-by":"crossref","unstructured":"Net JM, Whitman GJ, Morris E, Brandt KR, Burnside ES, Giger ML, et al. Relationships Between Human-Extracted MRI Tumor Phenotypes of Breast Cancer and Clinical Prognostic Indicators Including Receptor Status and Molecular Subtype. 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