治疗前乳腺MRI显示的肿瘤坏死：与三阴性乳腺癌（TNBC）新辅助全身治疗（NAST）反应的相关性

Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC).

作者信息

Abdelhafez Abeer H, Musall Benjamin C, Adrada Beatriz E, Hess KennethR, Son Jong Bum, Hwang Ken-Pin, Candelaria Rosalind P, Santiago Lumarie, Whitman Gary J, Le-Petross Huong T, Moseley Tanya W, Arribas Elsa, Lane Deanna L, Scoggins Marion E, Leung Jessica W T, Mahmoud Hagar S, White Jason B, Ravenberg Elizabeth E, Litton Jennifer K, Valero Vicente, Wei Peng, Thompson Alastair M, Moulder Stacy L, Pagel Mark D, Ma Jingfei, Yang Wei T, Rauch Gaiane M

机构信息

Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030, USA.

Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1472, Houston, TX, 77030, USA.

出版信息

Breast Cancer Res Treat. 2021 Jan;185(1):1-12. doi: 10.1007/s10549-020-05917-7. Epub 2020 Sep 13.

DOI:10.1007/s10549-020-05917-7

PMID:32920733

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8294182/

Abstract

PURPOSE

To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC.

METHODS

This retrospective study included 85 TNBC patients (mean age 51.8 ± 13 years) with MRI before NAST and definitive surgery during 2010-2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann-Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR.

RESULTS

Of 39 patients (46%) with necrosis, 17 had pCR and 22 did not. Necrosis was not associated with pCR (OR, 0.995; 95% confidence interval [CI] 0.4-2.3) and was not an independent prognostic factor when combined with T stage and nodal status at staging (P = 0.46). None of the imaging metrics differed significantly between pCR and non-pCR in patients with necrosis (AUC < 0.6 and P > 0.40).

CONCLUSION

No significant association was found between necrosis by pretreatment MRI or the quantitative imaging characteristics of tumor necrosis and response to NAST in TNBC.

摘要

目的

确定三阴乳腺癌（TNBC）患者治疗前乳腺MRI显示的肿瘤坏死情况及其定量成像特征是否与新辅助全身治疗（NAST）的疗效相关。

方法

这项回顾性研究纳入了2010年至2018年间85例TNBC患者（平均年龄51.8±13岁），这些患者在接受NAST前进行了MRI检查，并接受了根治性手术。每次MRI检查均包括T2加权成像、扩散加权成像（DWI）和动态对比增强成像（DCE）。对于每例索引癌，在早期DCE减影图像和DWI图像上分割包括坏死灶的肿瘤总体积（TTV）、不包括坏死灶的肿瘤体积（TV）以及仅坏死灶的体积（NV）。计算NV和NV百分比。从TTV、TV和NV中提取DCE早期和晚期的增强百分比以及表观扩散系数。使用优势比（OR）评估坏死与病理完全缓解（pCR）之间的关联。采用多变量分析评估坏死与分期时的T分期和淋巴结状态的预后价值。采用曼-惠特尼U检验和曲线下面积（AUC）评估成像指标区分pCR与非pCR的性能。

结果

39例（46%）有坏死的患者中，17例达到pCR，22例未达到。坏死与pCR无关（OR，0.995；95%置信区间[CI]0.4 - 2.3），并且与分期时的T分期和淋巴结状态联合分析时不是独立的预后因素（P = 0.46）。在有坏死的患者中，pCR组和非pCR组的成像指标均无显著差异（AUC < 0.6且P > 0.40）。