Prediction of low-risk breast cancer using quantitative DCE-MRI and its pathological basis.

Yali Xu,Ting Hua,Xiaoyu Luo,Hong Xu,Lin Zhang,Guangyu Tang,Tingting Xu,Sifeng Kang

doi:10.18632/oncotarget.22267

Abstract

PurposeThis study aimed to evaluate the difference of mass in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) characteristics between low-risk and non-low-risk breast cancers and to explore the possible pathological basis.Materials and MethodsApproval from the institutional review board and informed consent were acquired for this study. The MR images of 104 patients with pathologically proven breast cancer (104 lesions) were prospectively analyzed. All of included patients were Chinese woman. The DCE-MRI morphologic findings, apparent diffusion coefficient (ADC) values, quantitative DCE-MRI parameters, and pathological biomarkers between the two subtypes of breast cancer were compared. The quantitative DCE-MRI parameters and ADC values were added to the morphologic features in multivariate models to evaluate diagnostic performance in predicting low-risk breast cancer. The values were further subjected to the receiver operating characteristic (ROC) curve analysis.ResultsLow-risk tumors showed significantly lower Ktrans and Kep values (t = 2.065, P = 0.043 and t = 3.548, P = 0.001, respectively) and higher ADC value (t = 4.713, P = 0.000) than non-low-risk breast cancers. Our results revealed no significant differences in clinic data and conventional imaging findings between the two breast cancer subtypes. Adding the quantitative DCE-MRI parameters and ADC values to conventional MRI improved the diagnostic performance of MRI: The area under the ROC improved from 0.63 to 0.91. Low-risk breast cancers showed significantly lower matrix metalloproteinase (MMP)-2 expression (P = 0.000), lower MMP-9 expression (P = 0.001), and lower microvessel density (MVD) values (P = 0.008) compared with non-low-risk breast cancers. Ktrans and Kep values were positively correlated with pathological biomarkers. The ADC value showed a significant inverse correlation with pathological biomarkers.ConclusionsThe prediction parameter using Ktrans, Kep, and ADC obtained on DCE-MRI and diffusion-weighted imaging could facilitate the identification of low-risk breast cancers. Decreased biological factors, including MVD, vascular endothelial growth factor, MMP-2, and MMP-9, may explain the possible pathological basis.

Highlights

Breast carcinoma is a heterogeneous disease that has various prognoses and treatment responses [1]
This study aimed to evaluate the difference of mass in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) characteristics between low-risk and non-low-risk breast cancers and to explore the possible pathological basis
Our results revealed no significant differences in clinic data and conventional imaging findings between the two breast cancer subtypes

Summary

Introduction

Breast carcinoma is a heterogeneous disease that has various prognoses and treatment responses [1]. Four factors, namely the estrogen receptor (ER), Human epidermal growth factor receptor 2 (HER2), as well as Ki67 are used to confirm the subtypes. These four-factors can predict long time results of hormone receptor (HR). Shin HJ et al defined ER+ tumors with low histologic grade, Ki67 lower than 15%, negative lymph node metastasis as well as HER2-negetive as low-risk breast cancer [4]. Low risk breast cancers are considered to be at low risk for recurrence, have good prognosis. Non-low-risk breast cancers are associated with aggressive histological features, poor prognosis, a high risk for recurrence, and an increased risk of death, which will benefit from adjuvant RT [6]. A personalized approach to make a precise subtype diagnosis in breast cancer before operation would be significantly valuable for the pretreatment planning and prognosis of patients

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