Abstract
ObjectivesWe aimed to evaluate the differences in peritumoral apparent diffusion coefficient (ADC) values by four different ROI selection methods and to validate the optimal method. Furthermore, we aimed to evaluate if the peritumor-tumor ADC ratios are correlated with axillary lymph node positivity and hyaluronan accumulation.MethodsAltogether, 22 breast cancer patients underwent 3.0-T breast MRI, histopathological evaluation, and hyaluronan assay. Paired t and Friedman tests were used to compare minimum, mean, and maximum values of tumoral and peritumoral ADC by four methods: (M1) band ROI, (M2) whole tumor surrounding ROI, (M3) clockwise multiple ROI, and (M4) visual assessment of ROI selection. Subsequently, peritumor/tumor ADC ratios were compared with hyaluronan levels and axillary lymph node status by the Mann-Whitney U test.ResultsNo statistically significant differences were found among the four ROI selection methods regarding minimum, mean, or maximum values of tumoral and peritumoral ADC. Visual assessment ROI measurements represented the less time-consuming evaluation method for the peritumoral area, and with sufficient accuracy. Peritumor/tumor ADC ratios obtained by all methods except the clockwise ROI (M3) showed a positive correlation with hyaluronan content (M1, p = 0.004; M2, p = 0.012; M3, p = 0.20; M4, p = 0.025) and lymph node metastasis (M1, p = 0.001; M2, p = 0.007; M3, p = 0.22; M4, p = 0.015), which are established factors for unfavorable prognosis.ConclusionsOur results suggest that the peritumor/tumor ADC ratio could be a readily applicable imaging index associated with axillary lymph node metastasis and extensive hyaluronan accumulation. It could be related to the biological aggressiveness of breast cancer and therefore might serve as an additional prognostic factor.Key Points• Out of four different ROI selection methods for peritumoral ADC evaluation, measurements based on visual assessment provided sufficient accuracy and were the less time-consuming method.• The peritumor/tumor ADC ratio can provide an easily applicable supplementary imaging index for breast cancer assessment.• A higher peritumor/tumor ADC ratio was associated with axillary lymph node metastasis and extensive hyaluronan accumulation and might serve as an additional prognostic factor.
Highlights
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related deaths in women all around the world [1]
Out of four different region of interest (ROI) selection methods for peritumoral apparent diffusion coefficient (ADC) evaluation, measurements based on visual assessment provided sufficient accuracy and were the less time-consuming method
A higher peritumor/tumor ADC ratio was associated with axillary lymph node metastasis and extensive hyaluronan accumulation and might serve as an additional prognostic factor
Summary
Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related deaths in women all around the world [1]. The role of the tumor environment is important because it is the interaction between tumor cells and the surrounding microenvironment which influences tumor evolution and progression [4]. Invasive breast cancers cause increased lymphedema and extracellular matrix remodeling in the area surrounding the tumor [5], and peritumoral edema is one of the recognized features of malignancy. The peritumoral area comprising the extracellular matrix and various cell types maintains the wound response–like process and inflammation, as well as the increased vascular density and permeability. This represents a distinct microenvironment pivotal for tumor progression and with a significant prognostic potential [6, 7]. A high concentration of HA in the pericellular stroma and carcinoma cells strongly associates with poor differentiation of tumors, axillary lymph node positivity, and an unfavorable outcome of the disease [12, 13]
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