Ma Yue, Liu Aidi, O'Connell Avice M, Zhu Yueqiang, Li Haijie, Han Peng, Yin Lu, Lu Hong, Ye Zhaoxiang
Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China.
Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, 14623, USA.
Eur Radiol. 2021 Apr;31(4):2580-2589. doi: 10.1007/s00330-020-07277-8. Epub 2020 Oct 2.
To investigate the association of contrast-enhanced cone beam breast CT (CE-CBBCT) features, immunohistochemical (IHC) receptors, and molecular subtypes in breast cancer.
In this retrospective study, patients who underwent preoperative CE-CBBCT and received complete IHC results were analyzed. CE-CBBCT features were evaluated by two radiologists. Observer reproducibility and feature reliability were assessed. The association between CE-CBBCT features, IHC receptors, and molecular subtypes was analyzed using the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Multivariate logistic regression was performed to assess the ability of combined imaging features to discriminate molecular subtypes. ROC curve was used to evaluate prediction performance.
A total of 240 invasive cancers identified in 211 women were enrolled. Molecular subtypes of breast cancer were significantly associated with focality number of lesions, lesion type, tumor size, lesion density, internal enhancement pattern, degree of lesion enhancement (ΔHU), mass shape, spiculation, calcifications, calcification distribution, and increased peripheral vascularity of lesion (all p < 0.005), some of which also helped to differentiate IHC receptor status. A multivariate logistic regression model showed that tumor size (odds ratio, OR = 1.244), mass shape (OR = 0.311), spiculation (OR = 0.159), and internal enhancement pattern (OR = 0.227) were associated with differentiation between luminal and non-luminal subtypes (AUC = 0.809). Combined CE-CBBCT features, including lesion type (OR = 0.118), calcifications (OR = 0.181), and ΔHU (OR = 0.962), could be significant indicators of triple-negative versus HER-2-enriched subtypes (AUC = 0.913).
CE-CBBCT features have the potential to help predict IHC receptor status and distinguish molecular subtypes of breast cancer, which could in turn help to develop individual treatment decisions and prognosis predictions.
• A total of 11 CE-CBBCT features were associated with molecular subtypes, some of which also helped to differentiate IHC receptor status. • Tumor size, irregular mass shape, spiculation, and internal enhancement pattern could help identify luminal subtype. • Lesion type, calcification, and ΔHU could be significant indicators of HER-2- enriched versus triple-negative breast cancers.
探讨对比增强锥束乳腺CT（CE-CBBCT）特征、免疫组化（IHC）受体与乳腺癌分子亚型之间的关联。
在这项回顾性研究中，分析了接受术前CE-CBBCT检查并获得完整IHC结果的患者。由两名放射科医生评估CE-CBBCT特征。评估观察者的可重复性和特征可靠性。使用卡方检验、曼-惠特尼检验和克鲁斯卡尔-沃利斯检验分析CE-CBBCT特征、IHC受体与分子亚型之间的关联。进行多变量逻辑回归以评估联合影像特征区分分子亚型的能力。使用ROC曲线评估预测性能。
共纳入211名女性中的240例浸润性癌。乳腺癌的分子亚型与病变灶数、病变类型、肿瘤大小、病变密度、内部强化模式、病变强化程度（ΔHU）、肿块形状、毛刺征、钙化、钙化分布以及病变周边血管增多均显著相关（均p<0.005），其中一些特征也有助于区分IHC受体状态。多变量逻辑回归模型显示，肿瘤大小（比值比，OR = 1.244）、肿块形状（OR = 0.311）、毛刺征（OR = 0.159）和内部强化模式（OR = 0.227）与管腔型和非管腔型亚型的区分相关（AUC = 0.809）。联合CE-CBBCT特征，包括病变类型（OR = 0.118）、钙化（OR = 0.181）和ΔHU（OR = 0.962），可能是三阴性与HER-2富集亚型的重要指标（AUC = 0.913）。
CE-CBBCT特征有潜力帮助预测IHC受体状态并区分乳腺癌的分子亚型，进而有助于制定个体化治疗决策和预后预测。
• 共有11个CE-CBBCT特征与分子亚型相关，其中一些特征也有助于区分IHC受体状态。• 肿瘤大小、不规则肿块形状、毛刺征和内部强化模式有助于识别管腔型亚型。• 病变类型、钙化和ΔHU可能是HER-2富集型与三阴性乳腺癌的重要指标。
