Durando Manuela, Gennaro Lucas, Cho Gene Y, Giri Dilip D, Gnanasigamani Merlin M, Patil Sujata, Sutton Elizabeth J, Deasy Joseph O, Morris Elizabeth A, Thakur Sunitha B
Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza of Turin, 10126, Italy.
Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA.
Eur J Radiol. 2016 Sep;85(9):1651-8. doi: 10.1016/j.ejrad.2016.06.019. Epub 2016 Jun 28.
To assess the association between apparent diffusion coefficient (ADC), and histological prognostic parameters in malignant breast lesions. The ability of ADC to identify lesions with the presence of Lymphovascular invasion (LVI) in breast carcinoma was also examined.
This HIPAA-compliant retrospective study consisted of 212 consecutive patients with known cancers who underwent 3.0T MRI between January 2011 and 2013. In this study, a total of 126 malignant lesions in 114 women, who had undergone DWI (b-values of 0 and 1000s/mm(2)) in addition to diagnostic MRI, were included. Patients with less than 0.8cm lesions, or those who underwent neoadjuvant chemotherapy or suboptimal DW images were excluded. Classical prognostic factors [lesion size, histopathological type and grade, lymph node (LN) status and lymphovascular invasion (LVI)], molecular prognostic markers [estrogen receptor (ER), progesterone receptor (PR) and human epidermal grow factor receptor 2 (HER2)] were reviewed and recorded. A region of interest (ROI) was drawn within the lesions to measure ADC values. Statistical analyses were performed by the Wilcoxon rank sum test (statistical significance at P<0.05). Adjusted p values from multiple comparison analysis were also calculated.
This study demonstrates an inverse correlation between ADC and LVI in malignant lesions and the ability of ADC to identify aggressiveness in lesions with positive LVI. Tumor size, grade, ER, PR, HER2 and lymph node status did not impact tumor ADC value. However, tumors with LVI showed significantly lower ADC values when compared to tumors without LVI, regardless of the enhancement type, histological grade, histological type, and LN status.
Our study shows that ADC could be a potential clinical adjunct in the evaluation of prognostic factors related to malignant lesion aggressiveness such as LVI.
评估表观扩散系数（ADC）与恶性乳腺病变组织学预后参数之间的相关性。同时研究ADC鉴别乳腺癌中存在淋巴管侵犯（LVI）病变的能力。
这项符合健康保险流通与责任法案（HIPAA）的回顾性研究纳入了2011年1月至2013年期间连续212例已知患有癌症且接受了3.0T磁共振成像（MRI）检查的患者。本研究共纳入了114名女性的126个恶性病变，这些患者除了接受诊断性MRI检查外，还进行了扩散加权成像（DWI，b值为0和1000s/mm²）。排除病变小于0.8cm的患者，或接受过新辅助化疗的患者，或扩散加权图像质量欠佳的患者。回顾并记录了经典预后因素[病变大小、组织病理学类型和分级、淋巴结（LN）状态和淋巴管侵犯（LVI）]、分子预后标志物[雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2）]。在病变内绘制感兴趣区（ROI）以测量ADC值。采用Wilcoxon秩和检验进行统计分析（P<0.05具有统计学意义）。还计算了多重比较分析的校正P值。
本研究表明，恶性病变中ADC与LVI呈负相关，且ADC具有鉴别LVI阳性病变侵袭性的能力。肿瘤大小、分级、ER、PR、HER2和淋巴结状态不影响肿瘤ADC值。然而，无论增强类型、组织学分级、组织学类型和LN状态如何，有LVI的肿瘤与无LVI的肿瘤相比，ADC值显著更低。
我们的研究表明，ADC可能是评估与恶性病变侵袭性相关的预后因素（如LVI）的一种潜在临床辅助手段。
