Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland.
Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
PLoS One. 2020 Jun 25;15(6):e0235278. doi: 10.1371/journal.pone.0235278. eCollection 2020.
The apparent diffusion coefficient (ADC) is increasingly used to characterize breast cancer. The peritumor/tumor ADC ratio is suggested to be a reliable and generally applicable index. However, its overall prognostication value remains unclear. We aimed to evaluate the associations between the peritumor/tumor ADC ratio and histopathological biomarkers and published prognostic tools in patients with invasive breast cancer.
This prospective study included 88 lesions (five bilateral) in 83 patients with primary invasive breast cancer who underwent preoperative 3.0-T magnetic resonance imaging. The lowest intratumoral mean ADC value on the slice with the largest tumor cross-sectional area was designated the tumor ADC, and the highest mean ADC value on the peritumoral breast parenchymal tissue adjacent to the tumor border was designated the peritumor ADC. The peritumor/tumor ADC ratio was then calculated. The tumor and peritumor ADC values and peritumor/tumor ADC ratios were compared with histopathological parameters using an unpaired t test, and their correlations with published prognostic tools were evaluated with Pearson's correlation coefficient.
The peritumor/tumor ADC ratio was significantly associated with tumor size (p<0.001), histological grade (p = 0.005), Ki-67 index (p = 0.006), axillary-lymph-node metastasis (p = 0.001), and lymphovascular invasion (p = 0.006), but was not associated with estrogen receptor status (p = 0.931), progesterone receptor status (p = 0.160), or human epidermal growth factor receptor 2 status (p = 0.259). The peritumor/tumor ADC ratio showed moderate positive correlations with the Nottingham Prognostic Index (r = 0.498, p<0.001) and mortality predicted using PREDICT (r = 0.436, p<0.001).
The peritumor/tumor ADC ratio was correlated with histopathological biomarkers in patients with invasive breast cancer, showed significant correlations with published prognostic indexes, and may provide an easily applicable imaging index for the preoperative prognostic evaluation of breast cancer.
表观扩散系数（ADC）越来越多地用于乳腺癌的特征描述。肿瘤周围/肿瘤 ADC 比值被认为是一种可靠且普遍适用的指标。然而，其总体预后预测价值尚不清楚。本研究旨在评估浸润性乳腺癌患者肿瘤周围/肿瘤 ADC 比值与组织病理学标志物及已发表的预后工具之间的相关性。
本前瞻性研究纳入了 83 例原发性浸润性乳腺癌患者 88 个病灶（5 例双侧），所有患者均在术前接受了 3.0T 磁共振成像检查。肿瘤最大横截面积层面上的最低肿瘤平均 ADC 值被定义为肿瘤 ADC，肿瘤边界旁邻近肿瘤的乳房实质组织中最高的平均 ADC 值被定义为肿瘤周围 ADC。然后计算肿瘤周围/肿瘤 ADC 比值。使用独立样本 t 检验比较肿瘤和肿瘤周围 ADC 值及肿瘤周围/肿瘤 ADC 比值与组织病理学参数之间的差异，并用 Pearson 相关系数评估其与已发表的预后工具之间的相关性。
肿瘤周围/肿瘤 ADC 比值与肿瘤大小（p<0.001）、组织学分级（p = 0.005）、Ki-67 指数（p = 0.006）、腋窝淋巴结转移（p = 0.001）和脉管侵犯（p = 0.006）显著相关，但与雌激素受体状态（p = 0.931）、孕激素受体状态（p = 0.160）或人表皮生长因子受体 2 状态（p = 0.259）无关。肿瘤周围/肿瘤 ADC 比值与 Nottingham 预后指数（r = 0.498，p<0.001）和 PREDICT 预测死亡率（r = 0.436，p<0.001）之间呈中度正相关。
肿瘤周围/肿瘤 ADC 比值与浸润性乳腺癌患者的组织病理学标志物相关，与已发表的预后指标显著相关，可能为乳腺癌术前预后评估提供一种易于应用的影像学指标。
