Abstract
BackgroundWe investigated the radiodensity of epicardial (EAT), subcutaneous (SAT), and visceral adipose tissue (VAT) before and after treatment with anthracyclines in a population of breast cancer (BC) patients, and in controls not treated with anthracyclines, to detect a potential role of EAT density as a biomarker of changes related to chemotherapy cardiotoxicity.MethodsWe reviewed BC patients treated with anthracyclines who underwent CT before (CT-t0) and after (CT-t1) chemotherapy, and age- and sex-matched controls who underwent two CT examinations at comparable intervals. On non-contrast scans, EAT was segmented contouring the pericardium and thresholding between -190 and -30 Hounsfield units (HU), and SAT and VAT were segmented with two 15-mm diameter regions of interest thresholded between -195 and -45 HU.ResultsThirty-two female patients and 32 controls were included. There were no differences in age (p = 0.439) and follow-up duration (p = 0.162) between patients and controls. Between CT-t0 and CT-t1, EAT density decreased in BC patients (-66 HU, interquartile range [IQR] -71 to -63 HU, to -71 HU, IQR -75 to -66 HU, p = 0.003), while it did not vary in controls (p = 0.955). SAT density increased from CT-t0 to CT-t1 in BC patients (-107 HU, IQR -111 to -105 HU, to -105 HU, IQR -110 to -100 HU, p = 0.014), whereas it did not change in controls (p = 0.477). VAT density did not vary in either BC patients (p = 0.911) or controls (p = 0.627).ConclusionsEAT density appears to be influenced by anthracycline treatment for BC, well known for its cardiotoxicity, shifting towards lower values indicative of a less active metabolism.
Highlights
Breast cancer (BC) is the most common malignancy in women, with estimates indicating that women in the European Union have a 1 in 11 chance of developing breast cancer (BC) before 74 years of age [1]
The purpose of our study was to assess the computed tomography (CT) density of epicardial adipose tissue (EAT) before and after treatment with anthracyclines in a population of BC patients, and in controls who underwent CT examinations at comparable time intervals, to detect a potential role of EAT in changes related to chemotherapy cardiotoxicity
Study population We retrospectively reviewed BC patients treated with an anthracycline-based chemotherapy regimen, and who underwent at least two chest CT examinations for disease staging or re-staging at our institution between March 2012 and June 2020, one acquired before the start of chemotherapy (CT-t0), and the other following the end of treatment (CT-t1)
Summary
Breast cancer (BC) is the most common malignancy in women, with estimates indicating that women in the European Union have a 1 in 11 chance of developing BC before 74 years of age [1]. Monti et al Insights Imaging (2021) 12:161 is facing new health complications related to BC and its treatment, the most worrisome being cardiovascular disease, a leading cause of mortality in this population [3]. Many BC treatment options yield significant cardiotoxicity: anthracyclines and radiation therapy have long been linked to a dose-related development of myocardial fibrosis, whereas trastuzumab and immune checkpoint inhibitors have been associated to stochastic cardiotoxic effects [4]. Anthracyclines still represent a cornerstone of BC treatment, especially in patients with advanced disease or triple negative neoplasms [5]. We investigated the radiodensity of epicardial (EAT), subcutaneous (SAT), and visceral adipose tissue (VAT) before and after treatment with anthracyclines in a population of breast cancer (BC) patients, and in controls not treated with anthracyclines, to detect a potential role of EAT density as a biomarker of changes related to chemotherapy cardiotoxicity
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