From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (V.D., T.S.M., S.V., V.F.Z., J.P., A.B., P.J.S.); and Harvard Medical School, Boston, Mass (S.G.).
Radiology. 2016 Aug;280(2):370-8. doi: 10.1148/radiol.2016151149. Epub 2016 Mar 3.
Purpose To review mammographic, ultrasonographic (US), and magnetic resonance (MR) imaging features and pathologic characteristics of estrogen receptor (ER)-positive, lymph node-negative invasive breast cancer and to determine the relationship of these characteristics to Oncotype DX (Genomic Health, Redwood City, Calif) test recurrence scores (ODRS) for breast cancer recurrence. Materials and Methods This institutional review board-approved retrospective study was performed in a single large academic medical center. The study population included patients with ER-positive, lymph node-negative invasive breast cancer who underwent genomic testing from January 1, 2009, to December 31, 2013. Imaging features of the tumor were classified according to the Breast Imaging Reporting and Data System lexicon by breast imagers who were blinded to the ODRS. Mammography was performed in 86% of patients, US was performed in 84%, and MR imaging was performed in 33%, including morphologic and kinetic evaluation. Images from each imaging modality were evaluated. Each imaging finding, progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status, and tumor grade were then individually correlated with ODRS. Analysis of variance was used to determine differences for each imaging feature. Regression analysis was used to calculate prediction of recurrence on the basis of imaging features combined with histopathologic features. Results The 319 patients had a mean age ± standard deviation of 55 years ± 8.7 (range, 31-82 years). Imaging features with a positive correlation with ODRS included a well-circumscribed oval mass (P = .024) at mammography, vascularity (P = .047) and posterior enhancement (P = .004) at US, and lobulated mass (P = .002) at MR imaging. Recurrence scores were predicted by using these features in combination with PR and HER2 status and tumor grade by using the threshold of more than 30 as a high recurrence score. With a regression tree, there was correlation (r = 0.79) with 89% sensitivity and 83% specificity. Conclusion On the basis of preliminary data, information obtained routinely for breast cancer diagnosis can reliably be used to predict the ODRS with high sensitivity and specificity. (©) RSNA, 2016.
目的 回顾雌激素受体（ER）阳性、淋巴结阴性浸润性乳腺癌的乳腺钼靶摄影、超声（US）和磁共振（MR）成像特征及病理特征，并确定这些特征与 Oncotype DX（Genomic Health，加利福尼亚州雷德伍德城）检测乳腺癌复发的复发评分（ODRS）之间的关系。
材料与方法 本研究经机构审查委员会批准，为单中心回顾性研究。该研究纳入 2009 年 1 月 1 日至 2013 年 12 月 31 日期间于单一大型学术医疗中心行基因组检测且 ER 阳性、淋巴结阴性浸润性乳腺癌患者。乳腺成像医师应用乳腺影像报告和数据系统词汇表对肿瘤的影像学特征进行分类，这些医师对 ODRS 结果不知情。86%的患者行乳腺钼靶摄影，84%的患者行 US，33%的患者行 MR 成像，包括形态学和动力学评估。评估每个成像方式的图像。然后，分别将每个影像学发现、孕激素受体（PR）和人表皮生长因子受体 2（HER2）状态以及肿瘤分级与 ODRS 进行相关性分析。采用方差分析比较每个影像学特征的差异。采用回归分析计算基于影像学特征与组织病理学特征的复发预测值。
结果 319 例患者的平均年龄±标准差为 55 岁±8.7（范围，31～82 岁）。与 ODRS 呈正相关的影像学特征包括乳腺钼靶摄影上边界清楚的卵圆形肿块（P =.024）、US 上的血管增多（P =.047）和后方增强（P =.004）以及 MR 成像上的分叶状肿块（P =.002）。采用阈值＞30 作为高复发评分，通过将这些特征与 PR 和 HER2 状态以及肿瘤分级相结合，可以预测复发评分。采用回归树，与 ODRS 具有相关性（r = 0.79），其灵敏度为 89%，特异度为 83%。
结论 基于初步数据，乳腺癌常规诊断中获得的信息可可靠地用于预测 ODRS，具有较高的灵敏度和特异度。
