Schmitz A M T, Veldhuis W B, Menke-Pluijmers M B E, van der Kemp W J M, van der Velden T A, Viergever M A, Mali W P T M, Kock M C J M, Westenend P J, Klomp D W J, Gilhuijs K G A
Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
PLoS One. 2017 Sep 26;12(9):e0183855. doi: 10.1371/journal.pone.0183855. eCollection 2017.
To establish a preoperative decision model for accurate indication of systemic therapy in early-stage breast cancer using multiparametric MRI at 7-tesla field strength.
Patients eligible for breast-conserving therapy were consecutively included. Patients underwent conventional diagnostic workup and one preoperative multiparametric 7-tesla breast MRI. The postoperative (gold standard) indication for systemic therapy was established from resected tumor and lymph-node tissue, based on 10-year risk-estimates of breast cancer mortality and relapse using Adjuvant! Online. Preoperative indication was estimated using similar guidelines, but from conventional diagnostic workup. Agreement was established between preoperative and postoperative indication, and MRI-characteristics used to improve agreement. MRI-characteristics included phospomonoester/phosphodiester (PME/PDE) ratio on 31-phosphorus spectroscopy (31P-MRS), apparent diffusion coefficients on diffusion-weighted imaging, and tumor size on dynamic contrast-enhanced (DCE)-MRI. A decision model was built to estimate the postoperative indication from preoperatively available data.
We included 46 women (age: 43-74yrs) with 48 invasive carcinomas. Postoperatively, 20 patients (43%) had positive, and 26 patients (57%) negative indication for systemic therapy. Using conventional workup, positive preoperative indication agreed excellently with positive postoperative indication (N = 8/8; 100%). Negative preoperative indication was correct in only 26/38 (68%) patients. However, 31P-MRS score (p = 0.030) and tumor size (p = 0.002) were associated with the postoperative indication. The decision model shows that negative indication is correct in 21/22 (96%) patients when exempting tumors larger than 2.0cm on DCE-MRI or with PME>PDE ratios at 31P-MRS.
Preoperatively, positive indication for systemic therapy is highly accurate. Negative indication is highly accurate (96%) for tumors sized ≤2,0cm on DCE-MRI and with PME≤PDE ratios on 31P-MRS.
建立一种术前决策模型，用于利用7特斯拉场强的多参数磁共振成像（MRI）准确指示早期乳腺癌全身治疗的适应证。
连续纳入符合保乳治疗条件的患者。患者接受常规诊断检查及一次术前7特斯拉多参数乳腺MRI检查。基于使用辅助在线（Adjuvant! Online）对乳腺癌死亡率和复发的10年风险评估，从切除的肿瘤和淋巴结组织中确定术后（金标准）全身治疗的适应证。术前适应证根据类似指南，但基于常规诊断检查进行评估。确定术前和术后适应证之间的一致性，并确定用于提高一致性的MRI特征。MRI特征包括31磷谱（31P-MRS）上的磷酸单酯/磷酸二酯（PME/PDE）比值、扩散加权成像上的表观扩散系数以及动态对比增强（DCE）-MRI上的肿瘤大小。构建一个决策模型，根据术前可用数据估计术后适应证。
我们纳入了46名女性（年龄：43 - 74岁），共48例浸润性癌。术后，20例患者（43%）全身治疗适应证为阳性，26例患者（57%）为阴性。使用常规检查时，术前阳性适应证与术后阳性适应证高度一致（N = 8/8；100%）。术前阴性适应证仅在26/38（68%）的患者中正确。然而，31P-MRS评分（p = 0.030）和肿瘤大小（p = 0.002）与术后适应证相关。决策模型显示，当排除DCE-MRI上大于2.0cm或31P-MRS上PME>PDE比值的肿瘤时，阴性适应证在21/22（96%）的患者中正确。
术前，全身治疗的阳性适应证高度准确。对于DCE-MRI上大小≤2.0cm且31P-MRS上PME≤PDE比值的肿瘤，阴性适应证高度准确（96%）。
