早期时相动力学作为乳腺肿瘤类型、分级和侵袭性替代标志物的可行性分析。
Feasibility analysis of early temporal kinetics as a surrogate marker for breast tumor type, grade, and aggressiveness.
机构信息
Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.
Center for Advanced Imaging Innovation and Research (CAI2 R), New York University School of Medicine, New York, New York, USA.
出版信息
J Magn Reson Imaging. 2018 Jun;47(6):1692-1700. doi: 10.1002/jmri.25897. Epub 2017 Nov 27.
BACKGROUND
Screening breast MRI has been shown to preferentially detect high-grade ductal carcinoma in situ (DCIS) and invasive carcinoma, likely due to increased angiogenesis resulting in early initial uptake of contrast. As interest grows in abbreviated screening breast MRI (AB-MRI), markers of early contrast washin that can predict tumor grade and potential aggressiveness are of clinical interest.
PURPOSE
To evaluate the feasibility of using the initial enhancement ratio (IER) as a surrogate marker for tumor grade, hormone receptor status, and prognostic markers, as an initial step to being incorporated into AB-MRI.
STUDY TYPE
Retrospective.
SUBJECTS
In all, 162 women (mean 55.0 years, range 32.8-87.7 years) with 187 malignancies imaged January 2012-November 2015.
FIELD STRENGTH/SEQUENCE: Images were acquired at 3.0T with a T -weighted gradient echo fat-suppressed-volume interpolated breath-hold sequence.
ASSESSMENT
Subjects underwent dynamic contrast-enhanced breast MRI with a 7-channel breast coil. IER (% signal increase over baseline at the first postcontrast acquisition) was assessed and correlated with background parenchymal enhancement, washout curves, stage, and final pathology.
STATISTICAL TESTS
Chi-square test, Spearman rank correlation, Mann-Whitney U-tests, Bland-Altman analysis, and receiver operating characteristic curve analysis.
RESULTS
IER was higher for invasive cancer than for DCIS (R1/R2, P < 0.001). IER increased with tumor grade (R1: r = 0.56, P < 0.001, R2: r = 0.50, P < 0.001), as ki-67 increased (R1: r = 0.35, P < 0.001; R2 r = 0.35, P < 0.001), and for node-positive disease (R1/R2, P = 0.001). IER was higher for human epidermal growth factor receptor two-positive and triple negative cancers than for estrogen receptor-positive / progesterone receptor-positive tumors (R1 P < 0.001-0.002; R2 P = 0.0.001-0.011). IER had higher sensitivity (80.6% vs. 75.5%) and specificity (55.8% vs. 48.1%) than washout curves for positive nodes, higher specificity (48.1% vs. 36.5%) and positive predictive value (70.2% vs. 66.7%) for high ki-67, and excellent interobserver agreement (intraclass correlation coefficient = 0.82).
DATA CONCLUSION
IER, a measurement of early contrast washin, is associated with higher-grade malignancies and tumor aggressiveness and might be potentially incorporated into an AB-MRI protocol.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1692-1700.
背景
乳腺 MRI 筛查已被证明可优先检测高级别导管原位癌（DCIS）和浸润性癌，这可能是由于增加了血管生成，导致对比剂早期初始摄取增加。随着对缩短乳腺 MRI 筛查（AB-MRI）的兴趣增加，能够预测肿瘤分级和潜在侵袭性的早期对比洗脱标志物具有临床意义。
目的
评估初始强化率（IER）作为肿瘤分级、激素受体状态和预后标志物的替代标志物的可行性，作为纳入 AB-MRI 的初步步骤。
研究类型
回顾性研究。
受试者
共 162 名女性（平均年龄 55.0 岁，范围 32.8-87.7 岁），187 名恶性肿瘤患者，于 2012 年 1 月至 2015 年 11 月接受检查。
场强/序列：在 3.0T 上使用 T1 加权梯度回波脂肪抑制容积屏气序列进行图像采集。
评估
受试者使用 7 通道乳腺线圈进行动态对比增强乳腺 MRI 检查。评估了 IER（在第一次对比后采集时相对于基线的信号增加百分比），并与背景实质强化、洗脱曲线、分期和最终病理相关联。
统计学检验
卡方检验、斯皮尔曼等级相关、曼-惠特尼 U 检验、Bland-Altman 分析和受试者工作特征曲线分析。
结果
与 DCIS 相比，IER 在浸润性癌中更高（R1/R2，P < 0.001）。IER 随肿瘤分级而增加（R1：r = 0.56，P < 0.001，R2：r = 0.50，P < 0.001），与 ki-67 增加相关（R1：r = 0.35，P < 0.001；R2 r = 0.35，P < 0.001），与淋巴结阳性疾病相关（R1/R2，P = 0.001）。HER2 阳性和三阴性癌症的 IER 高于雌激素受体阳性/孕激素受体阳性肿瘤（R1 P < 0.001-0.002；R2 P = 0.001-0.011）。与洗脱曲线相比，IER 对阳性淋巴结的敏感性（80.6%对 75.5%）和特异性（55.8%对 48.1%）更高，对高 ki-67 的特异性（48.1%对 36.5%）和阳性预测值（70.2%对 66.7%）更高，观察者间一致性良好（组内相关系数= 0.82）。
数据结论
IER 是一种早期对比洗脱的测量指标，与高级别恶性肿瘤和肿瘤侵袭性相关，可能被纳入 AB-MRI 方案。
证据水平
3 技术功效：2 级 J. Magn. Reson. Imaging 2018;47:1692-1700.
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