Lina Zhang1, Qingwei Song1, Lizhi Xie 2, Ailian Liu1, Yanwei Miao1, Weisheng Zhang1, Zhijin Lang1, Jianyun Kang1, Qiang Wei1, and Bin Xu1
1The 1st affiliated hospital of Dalian Medical University, Da lian, China, People's Republic of, 2GE Healthcare, MR Research China, Beijing, beijing, China, People's Republic of
Synopsis
This work has evaluated the
breast characteristics of invasive cancers on DCE-MRI and DWI assessed as
parameters in comparison with different molecular subtypes, and found that they
all could provide novel quantitative information reflecting invasive cancers
microenvironment changes, with a potential role in the differentiation of
molecular subtypes and to facilitate lesion-specific targeted therapies.
Target audience
A potential role in the
differentiation of molecular subtypes and to facilitate lesion-specific
targeted therapies.
Purpose
To evaluate the breast
characteristics of invasive cancers on dynamic contrast-enhanced MR imaging
(DCE-MRI) and diffusion-weighted MR imaging (DWI) assessed as parameters in
comparison with different molecular subtypes.
Methords
This retrospective study was
approved by the institutional review board. A total of 164 lesions in 161 women
who underwent preoperative breast imaging of both DCE-MRI and DWI((A 3.0T
system GE-Signa HDXT)) were reviewed. According to the receptor status, tumor
subtype was categorized as Basal-like, luminal A, luminal B, and Herb 2+. The
following lesion characteristics were recorded: DCE morphology and maximum
lesion size, initial phase peak enhancement, delayed phase enhancement
categorized by a single type of kinetics comprising the largest percentage of
enhancement (washout, plateau, or persistent) with CAD analysis, apparent
diffusion coefficient (ADC) values, and contrast-to-noise ratio (CNR) at DWI
with b values from 0 and 800 s/mm
2. All
the above work operated by two radiologists by using the GEAW4.5 workstation.
And then the SPSS17.0 statistical software was used for the data analysis. Kruskal-Wallis
rank sum test was performed in MRI characteristics of the four subtypes.
Discriminative abilities of models were compared by using the area under the
receiver operating characteristic curve (AUC).
RESULTS
For the tumor subtypes of 164 invasive breast cancers, 34 (20.7 %) were Basal-like, 69 (42.1 %) were Luminal A, 40(24.4 %) were Luminal B and 21 (12.8 %) were Herb2+.Compared with other three subtypes, Basal-like lesions exhibited, larger maximum lesion size, while no difference in lesion type among four subtypes, more details referent to Figure.1. There were significant differences of lesion margin, internal enhancement features of mass, delayed phase of enhancement and CNR (b=800s/mm
2) values were observed among four subtypes (p<0.001, p<0.005, p=0.002, and p<0.001), while lesion shape, initial phase peak enhancement parameters, mean ADC value or CNR (b=0) values were not (p=0.789, p=0.07, p=0.099, and p=0.35), concrete values are listed in Figure.2. A multivariate model combining maximum diameter, mass margin, CNR with b values of 800 s/mm
2 and delayed phase enhancement most significantly discriminated Basal-like from other three subtypes (Figure.3 AUC=0.84).
Discussion
Breast cancer is the most
common cancers for female in China from a report of cancer incidence and
mortality in China (2010)
[1].The most common molecular classification of
Invasive cancer is Basal-like, Luminal A/B and HER2+. In our study, DCE and DWI
were used simultaneously. DCE MRI findings in our report showed Basal-like with
more circumscribed margin (72.4%), rim enhancement (69%) than other three
subtypes. Regarding enhancement kinetics, delayed phase of enhancement of CAD
analysis was more helpful in differentiating four subtypes, 62.1 % of
Basal-like showed a washout enhancement pattern in our study, while the percent
was slower than the present study in the literature (95%)
[2-3]. DWI can yield
novel quantitative and qualitative information reflecting cellular changes that
can provide unique insights into tumor cellularity
[4]. To our knowledge, this
is the first study of CNR characteristics of different molecular subtypes of
breast cancer. While there was no significant difference among four subtypes in
the assessment mean ADC value. In our study, a multivariate model combining
maximum diameter, mass margin, higher CNR with b values of 800 s/mm2 and delayed phase enhancement
could be useful in differentiating Basal-like from luminal A, luminal B, and
Herb 2+.
Conclusion
In addition to the
morphological features, DCE-MRI and DWI could provide novel quantitative
information reflecting invasive cancers microenvironment changes, with a
potential role in the differentiation of molecular subtypes and to facilitate
lesion-specific targeted therapies.
Acknowledgements
No acknowledgement found.References
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