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European Radiology

, Volume 30, Issue 1, pp 66–76 | Cite as

Diffusion-weighted MRI of estrogen receptor-positive, HER2-negative, node-negative breast cancer: association between intratumoral heterogeneity and recurrence risk

  • Jin You KimEmail author
  • Jin Joo Kim
  • Lee Hwangbo
  • Ji Won Lee
  • Nam Kyung Lee
  • Kyung Jin Nam
  • Ki Seok Choo
  • Taewoo Kang
  • Heeseung Park
  • Yohan Son
  • Robert Grimm
Breast
  • 171 Downloads

Abstract

Objectives

To investigate possible associations between quantitative apparent diffusion coefficient (ADC) metrics derived from whole-lesion histogram analysis and breast cancer recurrence risk in women with estrogen receptor (ER)–positive, human epidermal growth factor receptor 2 (HER2)–negative, node-negative breast cancer who underwent the Oncotype DX assay.

Methods

This retrospective study was conducted on 105 women (median age, 48 years) with ER-positive, HER2-negative, node-negative breast cancer who underwent the Oncotype DX test and preoperative diffusion-weighted imaging (DWI). Histogram analysis of pixel-based ADC data of whole tumors was performed, and various ADC histogram parameters (mean, 5th, 25th, 50th, 75th, and 95th percentiles of ADCs) were extracted. The ADC difference value (defined as the difference between the 5th and 95th percentiles of ADCs) was calculated to assess intratumoral heterogeneity. Associations between quantitative ADC metrics and the recurrence risk, stratified using the Oncotype DX recurrence score (RS), were evaluated.

Results

Whole-lesion histogram analysis showed that the ADC difference value was different between the low-risk recurrence (RS < 18) and the non-low-risk recurrence (RS ≥ 18; intermediate to high risk of recurrence) groups (0.600 × 10−3 mm2/s vs. 0.746 × 10−3 mm2/s, p < 0.001). Multivariate regression analysis demonstrated that a lower ADC difference value (< 0.559 × 10−3 mm2/s; odds ratio [OR] = 5.998; p = 0.007) and a small tumor size (≤ 2 cm; OR = 3.866; p = 0.012) were associated with a low risk of recurrence after adjusting for clinicopathological factors.

Conclusions

The ADC difference value derived from whole-lesion histogram analysis might serve as a quantitative DWI biomarker of the recurrence risk in women with ER-positive, HER2-negative, node-negative invasive breast cancer.

Key Points

• A lower ADC difference value and a small tumor size were associated with a low risk of recurrence of breast cancer.

• The ADC difference value could be a quantitative marker for intratumoral heterogeneity.

• Whole-lesion histogram analysis of the ADC could be helpful for discriminating the low-risk from non-low-risk recurrence groups.

Keywords

Diffusion magnetic resonance imaging Breast neoplasms, Oncotype DX Recurrence Biomarkers 

Abbreviations

ADC

Apparent diffusion coefficient

ASCO

American Society for Clinical Oncology

BRCA

Breast cancer susceptibility gene

CI

Confidence interval

DCE

Dynamic contrast-enhanced

DWI

Diffusion-weighted imaging

ER

Estrogen receptor

HER2

Human epidermal growth factor receptor 2

MRI

Magnetic resonance imaging

NCCN

National Comprehensive Cancer Network

OR

Odds ratio

PR

Progesterone receptor

ROI

Region-of-interest

RS

Recurrence score

Notes

Funding

This study was supported by Biomedical Research Institute Grant (2018B036), Pusan National University Hospital.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Jin You Kim.

Conflict of interest

This work was based on the Multiparametric Analysis works-in-progress software package provided by Siemens Healthineers.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Medical Research InstitutePusan National University HospitalBusanRepublic of Korea
  2. 2.Department of RadiologyPusan National University School of MedicineBusanRepublic of Korea
  3. 3.Department of RadiologyPusan National University Yangsan HospitalYangsanRepublic of Korea
  4. 4.Busan Cancer CenterPusan National University HospitalBusanRepublic of Korea
  5. 5.Siemens Healthineers Ltd.SeoulRepublic of Korea
  6. 6.Siemens Healthcare GmbHErlangenGermany

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