Knuttel Floortje M, van der Velden Bas H M, Loo Claudette E, Elias Sjoerd G, Wesseling Jelle, van den Bosch Maurice A A J, Gilhuijs Kenneth G A
From the *Department of Radiology, and †Image Sciences Institute, University Medical Center Utrecht, Utrecht; ‡Department of Radiology, Netherlands Cancer Institute, Amsterdam; §Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht; and ∥Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Invest Radiol. 2016 Jul;51(7):462-8. doi: 10.1097/RLI.0000000000000255.
Ductal carcinoma in situ (DCIS) is a risk factor for incomplete resection of breast cancer. Especially, extensive DCIS (E-DCIS) or extensive intraductal component often results in positive resection margins. Detecting DCIS around breast cancer before treatment may therefore alter surgery. The purpose of this study was to develop a prediction model for E-DCIS around early-stage invasive breast cancer, using clinicohistopathological and dynamic contrast-enhanced magnetic resonance imaging (MRI) features.
Dynamic contrast-enhanced MRI and local excision were performed in 322 patients with 326 ductal carcinomas. Tumors were segmented from dynamic contrast-enhanced MRI, followed by 3-dimensional extension of the margins with 10 mm. Amount of fibroglandular tissue (FGT) and enhancement features in these extended margins were automatically extracted from the MRI scans. Clinicohistopathological features were also obtained. Principal component analysis and multivariable logistic regression were used to develop a prediction model for E-DCIS. Discrimination and calibration were assessed, and bootstrapping was applied for internal validation.
Extensive DCIS occurred in 48 (14.7%) of 326 tumors. Incomplete resection occurred in 56.3% of these E-DCIS-positive versus 9.0% of E-DCIS-negative tumors (P < 0.001). Five components with eigenvalue exceeding 1 were identified; 2 were significantly associated with E-DCIS. The first, positively associated, component expressed early and overall enhancement in the 10-mm tissue margin surrounding the MRI-visible tumor. The second, positively associated, component expressed human epidermal growth factor receptor 2 and amount of FGT around the MRI-visible tumor. The area under the curve value was 0.79 (0.76 after bootstrapping).
Human epidermal growth factor receptor 2 status, early and overall enhancement in the 10-mm margin around the MRI-visible tumor, and amount of FGT in the 10 mm around the MRI-visible tumor were associated with E-DCIS.
导管原位癌（DCIS）是乳腺癌切除不完全的一个危险因素。特别是，广泛导管原位癌（E-DCIS）或广泛导管内成分常导致手术切缘阳性。因此，在治疗前检测乳腺癌周围的DCIS可能会改变手术方式。本研究的目的是利用临床组织病理学和动态对比增强磁共振成像（MRI）特征，建立早期浸润性乳腺癌周围E-DCIS的预测模型。
对322例患有326例导管癌的患者进行了动态对比增强MRI和局部切除。从动态对比增强MRI中分割出肿瘤，然后将切缘三维扩展10毫米。从MRI扫描中自动提取这些扩展切缘中的纤维腺组织（FGT）量和强化特征。还获取了临床组织病理学特征。采用主成分分析和多变量逻辑回归建立E-DCIS的预测模型。评估判别力和校准情况，并应用自举法进行内部验证。
326例肿瘤中有48例（14.7%）发生了广泛DCIS。这些E-DCIS阳性肿瘤的不完全切除率为56.3%，而E-DCIS阴性肿瘤为9.0%（P<0.001）。确定了5个特征值超过1的成分；其中2个与E-DCIS显著相关。第一个正相关成分表现为MRI可见肿瘤周围10毫米组织切缘的早期和整体强化。第二个正相关成分表现为人表皮生长因子受体2以及MRI可见肿瘤周围的FGT量。曲线下面积值为0.79（自举后为0.76）。
人表皮生长因子受体2状态、MRI可见肿瘤周围10毫米切缘的早期和整体强化以及MRI可见肿瘤周围10毫米的FGT量与E-DCIS相关。
