Open vs robotic gastrectomy with D2 lymphadenectomy: a propensity score-matched analysis on 1469 patients from the IMIGASTRIC prospective database.

BACKGROUND: Comparative data on D2-robotic gastrectomy (RG) vs D2-open gastrectomy (OG) are lacking in the Literature. Aim of this paper is to compare RG to OG with a focus on D2-lymphadenectomy. STUDY DESIGN: Data of patients undergoing D2-OG or RG for gastric cancer were retrieved from the international IMIGASTRIC prospective database and compared. RESULTS: A total of 1469 patients were selected for inclusion in the study. After 1:1 propensity score matching, a total of 580 patients were matched and included in the final analysis, 290 in each group, RG vs OG. RG had longer operation time (210 vs 330 min, p < 0.0001), reduced intraoperative blood loss (155 vs 119.7 ml, p < 0.0001), time to liquid diet (4.4 vs 3 days, p < 0.0001) and to peristalsis (2.4 vs 2 days, p < 0.0001), and length of postoperative stay (11 vs 8 days, p < 0.0001). Morbidity rate was higher in OG (24.1% vs 16.2%, p = 0.017). CONCLUSION: RG significantly expedites recovery and reduces the risk of complications compared to OG. However, long-term survival is similar.

Prognostic value of the lymph node ratio in surgically treated stage III colorectal cancer patients with high numbers of harvested lymph nodes.

BACKGROUND: The lymph node ratio (LNR), defined as the number of positive lymph nodes (LN) divided by the total number of harvested LN, has been demonstrated to be an independent factor in the prognosis of surgically treated colorectal cancer (CRC) patients. This study aims to establish the prognostic value of LNR in stage III CRC patients with high numbers of LN removed. METHODS: Stage III CRC patients who underwent curative resections over an 8-year period were included to the study. Demographics, clinicopathological features, surgical as well as recurrence and survival outcomes were recorded and statistically analyzed. Calculations for LNR were carried out as a function of percentage rates and Cox proportional hazards regression analyses were performed to determine its effect on disease-free and overall survival. RESULTS: Among a total of 493 surgically treated CRC cases, 104 patients were included to the study consisting of 68 (65.4%) men and 36 (34.6%) women with a median age of 64 (inter-quartile range: 55-74) years. The mean number of harvested LN was 31.6 ± 21.0 (range: 12-103). Multivariate Cox regression analyses proved LNR to be a significant factor in both disease-free and overall survival (p = 0.007 and p = 0.003, respectively). Forward elimination analyses showed that a 1% increase in LNR resulted with a 2% increase in both the risks of recurrence and mortality. CONCLUSIONS: The LNR may be assessed as an adjunct to the current staging systems for the prediction of oncological outcomes and survival of surgically treated stage III CRC patients.

Microorganisms isolated from the bile of the patients who have undergone cholecystectomy and their antibiotic resistance pattern: multicenter prospective study.

BACKGROUND: Gallbladder and biliary tract infections are diseases with high mortality rates if they are not treated properly. Microbiological evaluation of perioperatively collected samples both ensures proper treatment of patients and guides empirical treatment due to the determination of microorganism susceptibility. AIMS: This study aimed to isolate the microorganisms in bile cultures from patients who underwent cholecystectomy and to determine sensitivity results of these microorganisms. METHODS: This study was a multi-center and prospective design, included 360 patients, and was performed between 2019 and 2020. Culture results of bile taken during cholecystectomy were evaluated. RESULTS: Bacterial growth was found in the bile cultures of 84 out of 360 (23.3%) patients. Patients were divided into two groups according to whether they had risk factors for resistant microorganisms or not. While Escherichia coli (n = 11, 13%), Enterococcus spp. (n = 8, 9.5%), and Enterobacter spp. (n = 4, 4.7%) were detected most frequently in patients without risk. Staphylococcus spp. (n = 17, 20.2%), Enterococcus spp. (n = 16, 19%), and E. coli (n = 8, 9.5%) were the most frequently found microorganism at-risk patients. In multivariate analysis, bile culture positivity was found higher in patients who had history of biliary disease (p = 0.004), operation performed concurrently with a cholecystectomy (p = 0.035), and high rate of polymorphonuclear leukocytes (PNL) in total leukocyte count (p = 0.001). CONCLUSIONS: Our study shows that when starting empirical antibiotic treatment for bile ducts, whether patients are at risk for the development of resistant bacterial infection should be evaluated after which antibiotic selection should be made accordingly.

Comparison of Magnetic Resonance Imaging With Positron Emission Tomography/Computed Tomography in the Evaluation of Response to Neoadjuvant Therapy of Breast Cancer.

INTRODUCTION: The present study aims to determine the diagnostic accuracy of magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) in predicting a pathological response of molecular subtypes of breast cancer to neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: We retrospectively analyzed patients with breast cancer who were operated after NAC between January 2018 and May 2020. Radiological responses were evaluated as per the Response Evaluation Criteria in Solid Tumors (RECIST) and changes in contrast enhancement patterns on MRI and the classification of PET Response Criteria in Solid Tumors (PERCIST) on PET-CT. The presence of a pathological response was evaluated based on the Sataloff classification. The agreement between the radiological response determined through imaging modalities before and after the NAC and the postoperative pathological complete response (pCR) was evaluated and compared statistically. Among the patients diagnosed with breast cancer between the ages of 18 and 80 y, those with N (+) at the time of diagnosis, those with T2 and advanced tumors, and those who were planned for breast conserving surgery were included in our study. Male patients, patients with distant metastases at the time of diagnosis, and patients with other system malignancies were excluded. RESULTS: The study included 88 patients who had undergone surgery for breast cancer after NAC between January 2018 and May 2020. The study was conducted retrospectively in a single center. The tumor diameters and standard uptake values significantly decreased after NAC (P < 0.001). Estrogen receptor (ER) and progesterone receptor (PR) positivity were negatively associated with pCR (P = 0.03 and P = 0.03, respectively), whereas there was a significant positive association between HER-2 positivity and pCR (P = 0.004). There was a moderate agreement between the RECIST criteria used with MRI and pCR (k: 0.46). Moreover, a good agreement between PET-CT-PERCIST and pCR was detected (k: 0.61). In predicting pCR after NAC, MRI showed a selectivity of 80.7%, a sensitivity of 65.2%, a positive predictive value (PPV) of 75%, and a negative predictive value (NPV) of 72.4%. The corresponding rates for PET-CT were 75.7%, 100%, 57.9%, and 100%. CONCLUSIONS: When evaluating pCR after NAC, MRI was found to be more sensitive in patients with ER-positive cancer cell nuclei with weak to medium staining intensity and a loss of E-cadherin expression, whereas PET-CT was found to be more sensitive in patients with HER-2 overexpression, Luminal B, or Ki-67 proliferation >14% (P = 0.01).

Breast cancer epidemiology among surgically treated patients in Jordan: A retrospective study.

Background: Multiple risk factors contribute to the development of breast cancer, including age, positive family history, early menarche, late menopause and the strongest factor being female gender. In this study, we aimed to investigate the proportion of breast cancer patients with certain risk factors, the prevalence of each cancer type, in addition to the surgical procedures performed. Methods: The medical records of patients diagnosed with breast cancer from January 2010 to November 2015 were evaluated retrospectively regarding demographics, breast cancer risk factors, comorbidities, diagnostic methods, tumor location, cancer type and stage, pathological findings, tumor markers, harvested lymph nodes and the types of surgical procedures. The collected data were statistically analyzed as number, mean, and frequency as percentages. Cases with deficient medical records were excluded from the analysis of certain parameters. Results: The sample consisted of 120 patients, 118 (98.3%) of whom were women. The mean age was 56.5±12.0 years. The most common diagnostic method at presentation was self-exam in 93.3% of patients. Invasive ductal carcinoma was the most common type of tumor (80.0%). The pathological stages could be determined for only 106 patients, and 26 patients (24.5%) were at stage 1 disease, 45 patients (42.5%) were at stage 2 whereas 34 patients (32.1%) were at stage 3. According to the results of pathological examinations, 72.6% (85 patients) of the cases were estrogen receptor positive, 61.2% (71 patients) were progesterone receptor positive while 24.8% (27 patients) were HER positive. Modified radical mastectomy (MRM) was performed in 52 (43.3%) patients and wide local excision (WLE) was preferred in 46 (38.3%) cases. Conclusion: Advanced age, positive family history, and prolonged estrogen exposure were remarkable in the majority of patients. Moreover, the most common type of breast cancer was invasive ductal carcinoma, and around half of the patients presented at stage 2 disease. Modified radical mastectomy and WLE were the most commonly performed surgical procedures.

Protective effects of thymoquinone on the healing process of experimental left colonic anastomosis.

PURPOSE: Colorectal cancer is globally the third most common cancer. Anastomotic complications remain to be an important issue for colorectal surgery. The aim of this study was to investigate the protective effects of thymoquinone (TQ) on the healing process of left colonic anastomosis in an experimental model. METHODS: Thirty-two male rats were divided into two groups, as the TQ group and the control group. TQ was administered to the TQ group, whereas the control group was given a standard feed and water for 2 wk. Following the creation of a left colonic anastomosis, subjects in both groups were sacrificed on the postoperative (PO) third and seventh days. Anastomotic burst pressures were measured mechanically. Immunohistochemical stainings for proliferating cell nuclear antigen, cluster of differentiation (CD) 31, CD45 were performed, and the matrix metalloproteinase-2 levels were measured. Histologic total scores were calculated according to Ehrlich-Hunt model. A value of P < 0.05 was considered as statistically significant. RESULTS: One rat in the control group that died on the PO fourth day was excluded. Anastomotic burst pressures on the PO seventh day were higher in the TQ group than the control group (P < 0.01). Histopathological total scores on the PO third and seventh days were higher in the TQ group (P < 0.01). In addition, the TQ group revealed lower matrix metalloproteinase-2 scores on the PO third day and higher hydroxyproline levels on the PO seventh day (P < 0.05 and P < 0.01, respectively). CONCLUSIONS: The use of TQ in colorectal surgery cases with left-sided colonic anastomosis resulted with increased anastomotic burst pressures and increased tissue hydroxyproline levels.

Unilateral Primary Adrenal B-Cell Lymphoma Clinically Mimicking Chronic Gastritis.

BACKGROUND: Primary adrenal lymphomas are a very rare type of extranodal lymphoma, and they usually are found bilaterally. Symptoms of the disease are variable and depend on the type of lymphoma and/ or presence of adrenal insufficiency. Magnetic resonance imaging is the best radiologic modality for differentiating lymphomas from other adrenal malignancies; however, histopathology is considered as the gold standard method for diagnosing extranodal lymphomas. CASE REPORT: We present a case of unilateral adrenal lymphoma that was initially diagnosed as an infectious disease and chronic gastritis, based on clinical and laboratory findings. Ultrasonography detected an adrenal mass, and magnetic resonance imaging excluded common lesions of the adrenal gland and showed lymphadenopathy around the major vessels of the abdomen. A percutaneous biopsy of the mass and bone marrow biopsy confirmed the diagnosis of primary adrenal lymphoma without bone marrow metastasis. CONCLUSIONS: Extranodal lymphomas can occur in almost every organ, and if nonspecific clinical findings are combined with the presence of a solid organ mass, lymphoma should be included in the differential diagnosis.

The Diagnostic and Prognostic Significance of Serum Neutrophil Gelatinase-Associated Lipocalin Levels in Patients with Colorectal Cancer.

AIM OF THE STUDY: Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory biomarker that is stored in neutrophil granules. Recent studies revealed that NGAL expression increases in tissue samples of patients with inflammatory gastrointestinal system diseases and cancers. The aim of this study was to evaluate the diagnostic and predictive significance of plasma NGAL levels in various stages of adenoma-carcinoma sequence of colorectal cancer. Materials and Methods: Eighty cases were included in the study and separated into 3 groups. "Cancer Group" consisted of 27 colorectal cancer patients who underwent curative resection, whereas 24 patients with colorectal adenomatous polyps detected by colonoscopy were classified as the "Polyp Group", and 29 patients with normal colonoscopy findings were classified as the "Control Group". The serum NGAL, CEA and CA19-9 levels and histopathology findings were determined. Results: The mean plasma NGAL levels for control group, polyp group and cancer group were found to be 91.5 ng/ml, 139.6ng/ml and 184.3ng/ml, respectively. Plasma NGAL levels were found to be significantly higher in cancer group compared to the control group (p:0.006). Plasma NGAL levels were detected statistically significant and positive correlated with tumor diameter and number of metastatic lymph nodes (p:0.047, r:%38.6 and p:0.026, r:%42.8, respectively) in cancer group. Conclusions: We are of the opinion that pre-operative plasma NGAL level is a potential diagnostic biomarker for colorectal cancer patients. Although more comprehensive studies are needed for definitive judgments, serum NGAL levels may be used as a diagnostic and/or predictive biomarker for lymph node metastasis in patients with colorectal cancer.

Intraoperative diagnosis of cecal diverticulitis during surgery for acute appendicitis: Case series.

OBJECTIVE: Cecal diverticulum is a rare entity, and can cause acute abdomen by the way of diverticulitis and perforation of diverticulitis. In this study, we aimed to perform an analysis of patients that have cecal diverticulitis, and presented with acute abdomen. MATERIAL AND METHODS: Patients who were admitted to emergency clinic between 2009-2012 and had acute abdomen due to cecal diverticulitis were included into study retrospectively. RESULTS: Six patients were included in the study with a mean age of 34 years (range 24-43). Four patients were male and two were female (male/female: 2). All six patients presented with abdominal pain, additional symptoms were nausea in five patients, and vomiting in one patient. The mean white blood cell count was 11.900/mm(3) (5850-17.400/mm(3)), while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. The surgical exploration revealed an inflamed cecal diverticulitis and normal appendix in all patients. Five patients underwent appendectomy and diverticulectomy. Right hemicolectomy was performed in one patient due to suspicion of malignancy. The early postoperative period was uneventful in all patients. The mean length of hospital stay was 4.5 days with a range of 2-6 days. Histopathological examination showed acute perforated diverticulitis with underlying true diverticulum in three patients, and true diverticulum with acute diverticulitis in the remaining three patients. CONCLUSION: Pre-operative diagnosis of cecal diverticulitis is challenging due to symptoms and signs that resemble acute appendicitis. Diverticulectomy and incidental appendectomy is the treatment of choice in uncomplicated cases.

Agenesis of the gallbladder diagnosed by magnetic resonance cholangiography: report of a case and review of the literature.

Gallbladder agenesis (GA) is a rare congenital anomaly of the biliary system often associated with other congenital abnormalities. Patients become symptomatic in 23% of cases (Richards et al., 1993). GA is often misinterpreted as other diseases, therefore, leading to unnecessary surgery. Many of these patients develop a typical symptomatology of cholelithiasis that leads them to operating theatre. If an operative procedure is done, it is better to remain at the level of laparoscopy because further surgical investigation may lead to detrimental biliary tract injuries (Waisberg et al., 2002). We present a case of GA, diagnosed by magnetic resonance with cholangiopancreatography.

The management of penetrating abdominal stab wounds with organ or omentum evisceration: The results of a clinical trial.

OBJECTIVE: The therapeutic approach to abdominal penetrating stab injuries has changed over the years from routine laparotomy to non-operative treatment. In case of organ or omental evisceration, although the laparotomy need is greater, non-operative treatment may be applied in selected cases. The aim of our study was to assess the follow-up and treatment outcomes of patients with organ or omental evisceration due to penetrating abdominal injuries. MATERIAL AND METHODS: Patients with organ or omental evisceration due to penetrating abdominal stab injuries were prospectively evaluated between April 2009 and July 2012. Emergent laparotomy was performed in cases that were hemodynamically unstable or had signs of organ evisceration or peritonitis, while other patients were managed conservatively. Patients' follow-up and treatment outcomes were assessed. RESULTS: A total of 18 patients with organ or omental evisceration were assessed. Six (33.3%) patients underwent emergent laparotomy, and 12 (66.7%) patients underwent conservative follow-up. Three patients in the emergent laparotomy group had signs of organ evisceration, and 3 had signs of peritonitis; five of these 6 patients underwent therapeutic laparotomy and 1 negative laparotomy. In the non-operative follow-up group, therapeutic laparotomy was carried out in a total of 7 patients, 4 being early and 3 late, due to development of peritonitis, whereas 5 (27.8%) patients were managed non-operatively. CONCLUSION: Although organ or omental eviscerations due to penetrating abdominal stab injuries have a high rate of therapeutic laparotomy, selective conservative therapy is a safe method in selected cases.

Standard laparoscopic cholecystectomy for malposition of the gallbladder caused by right-sided ligamentum teres.

Atypical localization of the gallbladder associated with right-sided ligamentum teres is a rare anomaly of the biliary system. Although the conventional nomenclature as being a left-sided gallbladder is usually used, this definition may be incomprehensive because of lacking the anatomical detail. This report describes atypical localization of the gallbladder associated with right-sided ligamentum teres and abnormal intrahepatic portal venous branching, surgically removed laparoscopically.

Robot assisted laparoscopic (RAL) gastrectomy: case series and a review of the literature.

Gastric cancer is the fourth most common cancer type and is the second leading cause of cancer deaths worldwide. The contemporary treatment is gastrectomy and lymphadenectomy, which can be accomplished by either conventional (open), or laparoscopic surgery. With the advances in technology, there is a paradigm shift from conventional laparoscopy. As a result, single incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and robot assisted laparoscopic surgery (RALS) have evolved as new treatment options for minimal invasive surgery. Herein five patients who were treated via robot assisted laparoscopic gastrectomy were reported together with review of the literature.

Gastrointestinal Stromal Tumors: Recurrence and Survival Analysis of 49 Patients.

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor originating from the gastrointestinal tract and have a broad spectrum of clinicopathological features affecting disease management regarding the treatment modalities. Methods: A retrospective study of 49 patients who underwent surgery for gastrointestinal tumors between 2008 and 2016 was conducted. Clinical, pathological, and immunohistochemical features of patients with and without recurrence were statistically analyzed. Results: Twenty-nine (59.1%) patients had gastric; 16 (32.6%) had small intestinal; 3 (6.1%) had mesenteric; and 1 (2.2%) had rectal GISTs. Microscopic tumor necrosis and tumor ulceration were also significant for disease recurrence (P = 0.005, P = 0.049). High-risk patients according to Miettinen's risk classification were more likely to develop a recurrence (P < 0.001). Additionally, high-grade tumors were also a risk factor for recurrence (P < 0.001). Ki-67 levels were available in 40 patients and the mean Ki-67 level was 16.8 in patients with recurrence, which was a significant risk factor in regression analysis (HR: 1.24, 95%, CI: 1.08-1-43). Five-year disease-free survival rates of non-gastric and gastric GISTs were 62.3% and 90%, respectively (P = 0.044). Conclusion: Larger tumors and higher mitotic rates are more likely to develop recurrence. High Ki-67 levels were also associated with recurrence.

The effects of clinicopathological and imaging findings on recurrence and survival in mammary Paget's disease.

OBJECTIVE: Mammary Paget's disease (MPD) is a rare presentation type of breast cancer. The aim of this study was to evaluate the clinicopathological and imaging features affecting the invasive component, loco-regional recurrence, prognosis, and survival of MPD. METHODS: Patients who had undergone surgery due to MPD in a 10-year period were included. Parameters including mammography and magnetic resonance imaging (MRI) findings, tumor stage, molecular subtype, axillary involvement, presence of invasive carcinoma, loco-regional recurrence, overall survival (OS), and disease-free survival (DFS) were recorded and statistically analyzed. P<0.05 was determined as statistically significant. RESULTS: The study group consisted of 49 women with a mean age of 67.05±14.43 (range: 23-90) years. There was a significant association between the presence of invasive carcinoma and a mass lesion in the MRI (p=0.002). The frequency of sentinel lymph node (SLN) metastasis was significantly higher in patients with multicentric tumors (p=0.029; p<0.05). Locoregional recurrence and distant metastasis were significantly more frequent in patients with axillary involvement (p=0.0336; p<0.05). The mean DFS was 115.02±7.28 months, while the mean OS was 119.29±6.57 months. CONCLUSION: The presence of a mass lesion on MRI was determined to be significant in recognizing invasive carcinoma in MPD. The rate of SLN metastasis was higher in patients with multicentric tumors than in patients with unifocal tumors. Axillary involvement was associated with impaired DFS.

The effect of laparoscopic cholecystectomy on the development of alkaline reflux gastritis and intestinal metaplasia.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstones. The goal of this study was to investigate the effect of cholecystectomy on alkaline reflux, histopathological changes in the gastric mucosa and H. pylori colonization. METHODOLOGY: Eighty five patients who had undergone laparoscopic cholecystectomy were included in this trial (20 males; 65 females; 44.97 ± 11.22 years). All the patients had an upper gastrointestinal endoscopy before and 6 months after the surgery and biopsies in the antrum and corpus were taken to investigate the mucosal changes and assay for the presence of H. pylori. RESULTS: At 6 months post-surgery, the presence of bile in the fasting gastric fluid and an increase in the endoscopic gastritis findings were detected. While none of the patients had chemical gastritis prior to surgery, 7 patients were diagnosed with this condition after surgery. Intestinal metaplasia was detected in 6 patients prior to surgery and 20 patients after surgery. H. pylori was observed in 64 patients before surgery and 52 patients after surgery. CONCLUSIONS: An increase in duodenogastric reflux, alkaline reflux gastritis and intestinal metaplasia, and a reduction in H. pylori colonization were observed to occur post-cholecystectomy.

Laparoscopic excision of a retroperitoneal ganglioneuroma.

OBJECTIVE: Ganglioneuromas are rare benign tumors originating from ganglion cells. Ganglioneuromas are detected incidentally because they are asymptomatic. We report a case of laparoscopic excision of a retroperitoneal ganglioneuroma. CASE DESCRIPTION: A 49-y-old female was admitted to our medical center with the complaint of abdominal pain. Abdominal ultrasound showed a hypoechoic solid lesion at the level of the liver hilum, adjacent to the pancreas. Computerized tomography scan confirmed the presence of a thin walled mass 44 mm in diameter, adjacent to the pancreas and liver. Laparoscopic excision of the retroperitoneal mass was planned. The tumor was removed en bloc, and the pathologic diagnosis was ganglioneuroma. The patient was discharged from the hospital on the third postoperative day without any complications. CONCLUSION: Minimally invasive surgery has been shown to be safe and reliable in patients with retroperitoneal tumors.

Analysis of physical violence incidents against physicians in Turkey between 2008 and 2018.

BACKGROUND: Violence against physicians is a global issue that causes impaired physical and mental health, declined work quality, resignations, and even suicides. Studies regarding violence against physicians are very limited. Therefore, our aim is to investigate the physical violence incidents against physicians presented in print media between 2008 and 2018. METHODS: A total of 8612 news reports acquired in national news database via 45 keywords were assessed. Five hundred and sixty-four of the reports met the inclusion criteria and were retrospectively analyzed. RESULTS: Of 5964 news reports, 3754 (62.9%) were reprimands and protests against violence incidents. In 11 years, 560 individual incidents occurred where 647 physicians were physically assaulted, with 2267 news reports written on those incidents. The number of incidents increased over the years, and in 2012 both the number of incidents (n=91) and news reports count per incident were found highest. About 77.7% of assaulted physicians were male, and incident rate was higher in Western Turkey (42.15%). In 11 years, ten dedicated physicians have lost their lives in the line of duty. Emergency medicine (20.4%), primary care (9.89%) were the departments most exposed to physical violence. The claim of receiving inadequate medical attention was noted to be the primary allegation of the assailants. CONCLUSION: The frequency of physical violence incidents against physicians is increasing. Throughout the study period, news reports containing condemnations, critiques, and protests are also more frequently, yet not adequately, placed in print media. Thus, social and public awareness ought to be enhanced through national and global media outlets. Furthermore, extensive measures must be taken by governments in order to prevent and eliminate violence.

Radiomics Features Based on MRI-ADC Maps of Patients with Breast Cancer: Relationship with Lesion Size, Features Stability, and Model Accuracy.

Objective: To predict breast cancer molecular subtypes with neural networks based on magnetic resonance imaging apparent diffusion coefficient (ADC) radiomics and to detect the relation of lesion size with the stability of radiomics features. Methods: This retrospective study included 221 consecutive patients (224 lesions) with breast cancer imaged between January 2015 and January 2020. Three sample size configurations were identified based on tumor size (experiment 1: all cases, experiment 2: >1 cm3, and experiment 3: >2 cm3). The tumors were segmented by three observers based on diffusion-weighted imaging-registered ADC maps, and the volumetric agreement of these segmentations was evaluated using the Dice coefficient. Stability of radiomics features (n=851) was evaluated with intraclass correlation coefficient (ICC, >0.75) and coefficient of variation (CoV, <0.15). Feature selection was made with variance inflation factor (VIF, <10) and least absolute shrinkage and selection operator regression. Outcomes were identified as molecular subtypes (Luminal A, Luminal B, HER2-enriched, triple-negative). Neural network performance was presented as an area under the curve and accuracies. Results: Of the 851 radiomics features, 611 had ICC >0.75, and 37 remained stable in the first experiment, 49 in the second, and 59 in the third based on CoV and VIF analysis. High accuracy was demonstrated by the Luminal B, HER2-enriched, and triple-negative models in the first experiment (>80%), all models in the second experiment, and HER2-enriched and triple-negative models in the third experiment. Conclusions: A positive stability is indicated by an increased lesion size related to radiomics features. Neural networks may predict moleculer subtypes of breast cancers over 1 cm3 with high accuracy.