Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Radiology, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do 58128, Republic of Korea.
AJR Am J Roentgenol. 2022 Feb;218(2):258-269. doi: 10.2214/AJR.21.26400. Epub 2021 Aug 25.
. Tumor-infiltrating lymphocytes (TILs) are associated with therapeutic outcomes and prognosis in patients with human epidermal growth factor receptor type 2 (HER2)-positive breast cancer. Identification of TIL levels is clinically relevant. . The purpose of our study was to explore associations of clinicopathologic and MRI features with TIL levels in patients with HER2-positive breast cancer. . A total of 212 consecutive women (mean age, 54.0 years) diagnosed with HER2-positive breast cancer between January 2017 and December 2019 were included in this retrospective study. Patients were divided into low-TIL (< 10%) and high-TIL (≥ 10%) groups. Three breast radiologists independently reviewed images; interreader agreement was assessed, and the first reader's findings were used for further analysis. Associations of clinicopathologic and MRI features with TIL levels were evaluated using multivariable logistic regression analysis. Subanalysis of TIL levels by hormone receptor (HR) status was also performed. . A total of 115 (54.2%) patients had low TIL levels, and 97 (45.8%) patients had high TIL levels. A high TIL level was associated (all, < .05) with histologic grade 3 (odds ratio [OR] = 3.98; frequency, 78.4% vs 52.2% in high- vs low-TIL groups, respectively), high tumor cellularity (OR = 4.59; median cellularity, 60% vs 50%), lower frequency of associated ductal carcinoma in situ (OR = 0.16; frequency, 86.6% vs 94.8%), and higher frequency of peritumoral edema on T2-weighted images (OR = 2.83; 71.1% vs 50.4%). In subgroup analysis by HR status, histologic grade 3 (OR = 5.03, = .002) was a significant independent predictor of high TIL level in the HR-positive/HER2-positive group, whereas high tumor cellularity (OR = 9.06, = .002), peritumoral edema (OR = 5.23, = .03), and low ADC (OR = 11.69, = .047) were independent predictors of high TIL level in the HR-negative/HER2-positive group. Interreader agreement for peritumoral edema was moderate among the three radiologists (к = 0.432-0.539). . Peritumoral edema on MRI and the histopathologic feature of tumor aggressiveness help predict high TIL levels in patients with HER2-positive breast cancer. . Pretreatment MRI features may serve as a useful tool for assessing TIL levels in patients with HER2-positive breast cancer and for helping to classify patients with variable clinical outcomes related to immune activity and to guide selection among neoadjuvant chemotherapy or HER2-targeted therapy or immunotherapy.
肿瘤浸润淋巴细胞（TILs）与人类表皮生长因子受体 2（HER2）阳性乳腺癌患者的治疗结果和预后相关。TIL 水平的鉴定具有临床意义。本研究旨在探讨 HER2 阳性乳腺癌患者的临床病理和 MRI 特征与 TIL 水平的相关性。
本回顾性研究共纳入 212 例 2017 年 1 月至 2019 年 12 月期间诊断为 HER2 阳性乳腺癌的连续女性患者（平均年龄 54.0 岁）。患者分为低 TIL（<10%）和高 TIL（≥10%）组。三名乳腺放射科医生独立阅片；评估了读者间的一致性，并使用第一读者的发现进行了进一步分析。使用多变量逻辑回归分析评估 TIL 水平与临床病理和 MRI 特征的相关性。还对激素受体（HR）状态的 TIL 水平进行了亚组分析。
共有 115 例（54.2%）患者 TIL 水平较低，97 例（45.8%）患者 TIL 水平较高。TIL 水平较高与组织学分级 3（比值比[OR] = 3.98；频率分别为高 TIL 组 78.4%和低 TIL 组 52.2%）、高肿瘤细胞密度（OR = 4.59；中位数细胞密度分别为 60%和 50%）、较低的伴导管原位癌频率（OR = 0.16；频率分别为 86.6%和 94.8%）和 T2 加权图像上更高的肿瘤周围水肿频率（OR = 2.83；71.1%和 50.4%）相关（均<.05）。在 HR 状态的亚组分析中，组织学分级 3（OR = 5.03， =.002）是 HR 阳性/HER2 阳性组中 TIL 水平较高的独立显著预测因子，而高肿瘤细胞密度（OR = 9.06， =.002）、肿瘤周围水肿（OR = 5.23， =.03）和低 ADC（OR = 11.69， =.047）是 HR 阴性/HER2 阳性组中 TIL 水平较高的独立预测因子。三位放射科医生对肿瘤周围水肿的读者间一致性为中度（к = 0.432-0.539）。
MRI 上的肿瘤周围水肿和肿瘤侵袭性的组织病理学特征有助于预测 HER2 阳性乳腺癌患者的高 TIL 水平。
治疗前 MRI 特征可作为评估 HER2 阳性乳腺癌患者 TIL 水平的有用工具，并有助于对与免疫活性相关的不同临床结局的患者进行分类，指导新辅助化疗、HER2 靶向治疗或免疫治疗的选择。
