Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY 10016.
Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY 10016.
Acad Radiol. 2020 May;27(5):e87-e93. doi: 10.1016/j.acra.2019.07.011. Epub 2019 Aug 20.
Pathologic complete response (pCR) in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer after HER2-targeted therapy correlates increased disease-free survival and decreased mastectomy rates. The aim of this study was to explore tumor shrinkage patterns and initial tumor enhancement with pCR in HER2-positive breast cancer.
This was an institutional review board-approved retrospective analysis of 51 HER2 positive breast cancer patients with breast MRI both pre- and post-HER2-targeted therapy. Initial enhancement ratio (IER, initial enhancement percentage over baseline at first postcontrast imaging), pattern of tumor shrinkage, and Dynamic contrast enhanced (DCE)-MRI imaging features were assessed. Wilcoxon rank, Spearman correlation, Fisher's exact, and Mann-Whitney tests were used to correlate MRI imaging features with pCR. IER reader agreement was evaluated by intraclass correlation. Binary logistic regression was used to evaluate multivariate associations with pCR.
56.9% (29/51) of patients had pCR at surgery. Concentric tumor shrinkage pattern was associated with pCR (p = 0.001, Area under the curve (AUC) 0.778): accuracy 80.4%, specificity 96.6%, and sensitivity of 59.1%. There was no association with pCR and imaging response as defined by RECIST criteria (p = 0.169), pretreatment IER (Reader 1 (R1) p = 0.665, Reader 2 (R2) p = 0.766), or lesion size (p = 0.69). IER was associated with axillary metastases (R1 p = 0.016, R2 < 0.001) and ki-67 (R1 r = 0.52, p = 0.008, R2 r = -0.44, p = 0.028).
The shrinkage pattern of HER2-positive tumors after targeted therapy may be associated with pCR. There was no association between IER and pCR. Future studies evaluating the correlation of shrinkage patterns to texture radiomics are of interest.
曲妥珠单抗靶向治疗后 HER2 阳性乳腺癌患者的病理完全缓解（pCR）与无病生存期延长和乳房切除术率降低相关。本研究旨在探讨 HER2 阳性乳腺癌患者 pCR 与肿瘤退缩模式和初始肿瘤增强之间的关系。
这是一项经机构审查委员会批准的回顾性分析，纳入了 51 例 HER2 阳性乳腺癌患者，这些患者在接受曲妥珠单抗靶向治疗前后均接受了乳腺 MRI 检查。评估了初始强化率（IER，初次强化百分比相对于第一次对比后成像的基线）、肿瘤退缩模式和动态对比增强（DCE）MRI 成像特征。采用 Wilcoxon 秩和检验、Spearman 相关分析、Fisher 确切检验和 Mann-Whitney 检验来评估 MRI 成像特征与 pCR 的相关性。采用组内相关系数评估 IER 观察者间的一致性。采用二元逻辑回归分析评估与 pCR 的多变量相关性。
56.9%（29/51）的患者在手术时达到了 pCR。同心型肿瘤退缩模式与 pCR 相关（p = 0.001，AUC 为 0.778）：准确性为 80.4%，特异性为 96.6%，敏感性为 59.1%。与 pCR 无相关性的因素包括 RECIST 标准定义的影像学反应（p = 0.169）、治疗前 IER（观察者 1（R1）p = 0.665，观察者 2（R2）p = 0.766）或病变大小（p = 0.69）。IER 与腋窝转移（R1 p = 0.016，R2 < 0.001）和 ki-67 相关（R1 r = 0.52，p = 0.008，R2 r = -0.44，p = 0.028）。
曲妥珠单抗靶向治疗后 HER2 阳性肿瘤的退缩模式可能与 pCR 相关。IER 与 pCR 无相关性。未来评估退缩模式与纹理放射组学相关性的研究具有一定意义。
