{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:34:59Z","timestamp":1785429299035,"version":"3.56.0"},"reference-count":26,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001348","name":"Agency for Science, Technology and Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001348","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/036wvzt09","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Background breast features are frequently noted in pathology reports alongside invasive breast cancer but rarely factor into prognosis or treatment decisions. Their relationship to tumor characteristics and patient outcomes remains incompletely characterized. Methods: We conducted a retrospective cohort study of 7603 patients with Stage I\u2013III invasive breast cancer (diagnosed 1991\u20132022, age &lt; 80 years) from the Joint Breast Cancer Registry in Singapore. Natural language processing (NLP) was applied to 9754 free-text pathology reports to extract co-existing background breast features, with accuracy validated by dual-reviewer assessment of 200 reports. Because background features are most reliably assessed on excision specimens, the primary analytic cohort comprised 3988 patients with available excision pathology reports. Unsupervised hierarchical clustering grouped extracted features into three categories. Associations with tumor characteristics were assessed with multinomial logistic regression and ten-year overall survival by Cox proportional hazards models (median follow-up 9.6 years; 620 deaths). Results: Here, we show that NLP-based extraction of background breast features from routine pathology reports achieves an accuracy of over 90% across features. Lobular neoplasia and benign proliferative changes are associated with less aggressive tumor characteristics, whereas early neoplastic and papillary lesions are more prevalent in HER2-enriched and luminal B tumor subtypes. Benign proliferative changes are associated with better survival in age- and year-adjusted models (hazard ratio 0.91, 95% CI 0.86\u20130.97), but this association is attenuated after adjustment for stage and subtype. Conclusions: NLP-enabled extraction of background breast features from pathology text is feasible at scale. These features reflect tumor biology but do not independently add prognostic information beyond established clinical variables.<\/jats:p>","DOI":"10.3390\/cancers18121965","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:56:31Z","timestamp":1781675791000},"page":"1965","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrospective Cohort Study: Extracting Coexisting Background Breast-Lesion Features from Stage I\u2013III Invasive Breast Cancer"],"prefix":"10.3390","volume":"18","author":[{"given":"Ryan Jak Yang","family":"Lim","sequence":"first","affiliation":[{"name":"Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore 138632, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyu","family":"Nitar","sequence":"additional","affiliation":[{"name":"Department of Cancer Informatics, National Cancer Centre Singapore, Singapore 168583, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kah Weng","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Pathology, National University Hospital and National University Health System, Singapore 119074, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lester Chee Hao","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique Kiak Mien","family":"Tan","sequence":"additional","affiliation":[{"name":"Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore Health Services, Singapore 169610, Singapore"},{"name":"Department of Breast Surgery, Singapore General Hospital, Singapore Health Services, Singapore 169608, Singapore"},{"name":"SingHealth Duke-NUS Breast Centre, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8573-4606","authenticated-orcid":false,"given":"Benita Kiat Tee","family":"Tan","sequence":"additional","affiliation":[{"name":"Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore Health Services, Singapore 169610, Singapore"},{"name":"Department of Breast Surgery, Singapore General Hospital, Singapore Health Services, Singapore 169608, Singapore"},{"name":"SingHealth Duke-NUS Breast Centre, Singapore 169857, Singapore"},{"name":"Department of Surgery, Sengkang General Hospital, Singapore 544886, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ern Yu","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore"},{"name":"Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), Singapore 138673, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4916-2142","authenticated-orcid":false,"given":"Serene Si Ning","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore"},{"name":"Department of Surgery, National University Hospital and National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5726-9965","authenticated-orcid":false,"given":"Mikael","family":"Hartman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore"},{"name":"Department of Surgery, National University Hospital and National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6658-3371","authenticated-orcid":false,"given":"Fuh Yong","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Cancer Informatics, National Cancer Centre Singapore, Singapore 168583, Singapore"},{"name":"Division of Radiation Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5296-3437","authenticated-orcid":false,"given":"Geok Hoon","family":"Lim","sequence":"additional","affiliation":[{"name":"SingHealth Duke-NUS Breast Centre, Singapore 169857, Singapore"},{"name":"Breast Department, KK Women\u2019s and Children\u2019s Hospital, Singapore 229899, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8587-7511","authenticated-orcid":false,"given":"Jingmei","family":"Li","sequence":"additional","affiliation":[{"name":"Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore 138632, Singapore"},{"name":"Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore"},{"name":"National Cancer Centre Singapore, Singapore Health Services (SingHealth), Singapore 168583, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Joint Breast Cancer Registry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/CM9.0000000000003921","article-title":"Global burden and trends of breast cancer: GLOBOCAN 2022 estimates of incidence and mortality in 185 countries","volume":"139","author":"Gu","year":"2025","journal-title":"Chin. 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