Abstract
.Although the role of cancer-activated stroma in malignant progression has been well investigated, the influence of an activated stroma in therapy response is not well understood. Using retrospective pilot cohorts, we previously observed that MRI detected stromal contrast enhancement was associated with proximity to the tumor and was predictive for relapse-free survival in patients with breast cancer receiving neoadjuvant chemotherapy. Here, to evaluate the association of stromal contrast enhancement to therapy, we applied an advanced tissue mapping technique to evaluate stromal enhancement patterns within 71 patients enrolled in the I-SPY 1 neoadjuvant breast cancer trial. We correlated MR stromal measurements with stromal protein levels involved in tumor progression processes. We found that stromal percent enhancement values decrease with distance from the tumor edge with the estimated mean change ranging to () for time points T2 through T4. While not statistically significant, we found a decreasing trend in global stromal signal enhancement ratio values with the use of chemotherapy. There were no statistically significant differences between MR enhancement measurements and stromal protein levels. Findings from this study indicate that stromal features characterized by MRI are impacted by chemotherapy and may have predictive value in a larger study.
Highlights
Much like the wound healing process, cancer stroma comprises neovasculature, inflammatory cells, and extracellular matrix components that work cooperatively to support malignant progression.[1]
We previously showed that the stroma surrounding breast primary tumors was distinguishable by detectable enhancement patterns using contrast-enhanced breast magnetic resonance imaging (MRI).[3,4]
We developed the tumor proximity technique to map the stromal enhancement at incremental distances from the primary tumor edge as visualized on MRI
Summary
Much like the wound healing process, cancer stroma comprises neovasculature, inflammatory cells, and extracellular matrix components that work cooperatively to support malignant progression.[1] Through active angiogenesis, stimulated cell proliferation, and the synthesis of connective-tissue, cancer stroma transforms into a highly cellular vascularized tissue. Cancer stroma has been commonly referred to as activated or reactive stroma.[2] While its similarity to wound healing is well understood, the clinically relevant features of activated stroma in treatment and prognosis are unclear. To investigate properties of activated stroma that may play a role in cancer therapy or prognosis, better tools and assessment techniques are necessary. We previously showed that the stroma surrounding breast primary tumors was distinguishable by detectable enhancement patterns using contrast-enhanced breast magnetic resonance imaging (MRI).[3,4] Using a tumor proximity mapping technique, stromal enhancement could be related to Journal of Medical Imaging
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