Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, P.O. Box 1627, FI 70211, Kuopio, Finland.
Department of Oncology, Cancer Center, Kuopio University Hospital, P.O. Box 100, FI 70029, Kuopio, Finland.
Eur Radiol. 2020 Jan;30(1):38-46. doi: 10.1007/s00330-019-06361-y. Epub 2019 Jul 29.
We aimed to evaluate the differences in peritumoral apparent diffusion coefficient (ADC) values by four different ROI selection methods and to validate the optimal method. Furthermore, we aimed to evaluate if the peritumor-tumor ADC ratios are correlated with axillary lymph node positivity and hyaluronan accumulation.
Altogether, 22 breast cancer patients underwent 3.0-T breast MRI, histopathological evaluation, and hyaluronan assay. Paired t and Friedman tests were used to compare minimum, mean, and maximum values of tumoral and peritumoral ADC by four methods: (M1) band ROI, (M2) whole tumor surrounding ROI, (M3) clockwise multiple ROI, and (M4) visual assessment of ROI selection. Subsequently, peritumor/tumor ADC ratios were compared with hyaluronan levels and axillary lymph node status by the Mann-Whitney U test.
No statistically significant differences were found among the four ROI selection methods regarding minimum, mean, or maximum values of tumoral and peritumoral ADC. Visual assessment ROI measurements represented the less time-consuming evaluation method for the peritumoral area, and with sufficient accuracy. Peritumor/tumor ADC ratios obtained by all methods except the clockwise ROI (M3) showed a positive correlation with hyaluronan content (M1, p = 0.004; M2, p = 0.012; M3, p = 0.20; M4, p = 0.025) and lymph node metastasis (M1, p = 0.001; M2, p = 0.007; M3, p = 0.22; M4, p = 0.015), which are established factors for unfavorable prognosis.
Our results suggest that the peritumor/tumor ADC ratio could be a readily applicable imaging index associated with axillary lymph node metastasis and extensive hyaluronan accumulation. It could be related to the biological aggressiveness of breast cancer and therefore might serve as an additional prognostic factor.
• Out of four different ROI selection methods for peritumoral ADC evaluation, measurements based on visual assessment provided sufficient accuracy and were the less time-consuming method. • The peritumor/tumor ADC ratio can provide an easily applicable supplementary imaging index for breast cancer assessment. • A higher peritumor/tumor ADC ratio was associated with axillary lymph node metastasis and extensive hyaluronan accumulation and might serve as an additional prognostic factor.
我们旨在评估四种不同 ROI 选择方法在肿瘤周围表观扩散系数（ADC）值方面的差异，并验证最佳方法。此外，我们旨在评估肿瘤-肿瘤周围 ADC 比值是否与腋窝淋巴结阳性和透明质酸积累相关。
共 22 例乳腺癌患者接受了 3.0T 乳腺 MRI、组织病理学评估和透明质酸检测。使用配对 t 检验和 Friedman 检验比较了四种方法（M1）带 ROI、（M2）肿瘤周围全环绕 ROI、（M3）顺时针多个 ROI 和（M4）ROI 选择的视觉评估对肿瘤和肿瘤周围 ADC 的最小、平均和最大值的影响。随后，通过 Mann-Whitney U 检验比较了肿瘤周围/肿瘤 ADC 比值与透明质酸水平和腋窝淋巴结状态。
在肿瘤和肿瘤周围 ADC 的最小、平均或最大值方面，四种 ROI 选择方法之间没有统计学上的显著差异。视觉评估 ROI 测量代表了一种耗时较少的肿瘤周围区域评估方法，且具有足够的准确性。除顺时针 ROI（M3）外，所有方法获得的肿瘤周围/肿瘤 ADC 比值与透明质酸含量（M1，p=0.004；M2，p=0.012；M3，p=0.20；M4，p=0.025）和淋巴结转移（M1，p=0.001；M2，p=0.007；M3，p=0.22；M4，p=0.015）呈正相关，这些都是不良预后的既定因素。
我们的结果表明，肿瘤周围/肿瘤 ADC 比值可能是一种与腋窝淋巴结转移和广泛透明质酸积累相关的易于应用的成像指标。它可能与乳腺癌的生物学侵袭性有关，因此可能成为额外的预后因素。
在评估肿瘤周围 ADC 的四种不同 ROI 选择方法中，基于视觉评估的测量方法提供了足够的准确性，且耗时较少。
肿瘤周围/肿瘤 ADC 比值可为乳腺癌评估提供一种易于应用的补充成像指标。
较高的肿瘤周围/肿瘤 ADC 比值与腋窝淋巴结转移和广泛透明质酸积累相关，可能成为额外的预后因素。
