Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China.
Application Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China.
Eur J Radiol. 2022 May;150:110232. doi: 10.1016/j.ejrad.2022.110232. Epub 2022 Mar 2.
To investigate the feasibility of simultaneous multi-slice readout-segmented diffusion-weighted echo-planar imaging (SMS rs-EPI DWI) in predicting invasive breast cancer molecular subtypes using whole-tumor histogram and texture analyses.
In our retrospective study, 125 patients (mean age, 52.81 ± 12.01 years; range, 24-84 years) with single invasive breast cancer who underwent preoperative MRI with SMS rs-EPI DWI and surgery at our institution were included. Two radiologists independently performed whole-tumor histogram and texture analyses on the apparentdiffusioncoefficient (ADC) map of SMS rs-EPI DWI (TR, 3800.0 ms; TE 90.0 ms; field of view, 340 mm × 206 mm; in-plane matrix, 244 × 148; section thickness, 5 mm; readout segments, 5, b = 0, 800 s/mm; scan time, 3 mins; slice acceleration factor, 2). The Mann-Whitney U test or Kruskal-Wallis test were used to compare histogram and texture parameters to assess their potential in differentiating molecular subtypes of breast cancer and predicting axillary lymph node status. Receiver operating characteristic (ROC) curves were generated for parameters with significant differences, and the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
Compared to luminal A breast cancer, the HER2-positive breast cancer subtype showed higher ADC values (p = 0.016). In addition, HER2-positive breast cancer yielded significantly higher ADC (p = 0.025), ADC (p = 0.025), and ADC (p = 0.041) values than luminal B breast cancer. The ADC value was higher for triple-negative breast cancer (TNBC) than Luminal A breast cancer (p = 0.021). The difference in ADC, ADC, ADC and ADC values between the HER2-positive breast cancer and luminal types was statistically significant, with a combined AUC for these parameters of 0.762 (sensitivity 72.41%, specificity 75.00%, PPV 27.27 %, and NPV 95.45 %). The ADC value for TNBC was higher than for luminal types (p = 0.012) and yielded an AUC value of 0.688 (sensitivity 96.15%, specificity 36.78%, PPV 31.25%, and NPV 96.97 %). Additionally, significantly higher ADC and ADC values (p = 0.003, 0.002, respectively) were reported for non-luminal types than luminal types yielding a combined AUC value of 0.712 (sensitivity 92.11%, and specificity 50.23%, PPV 41.18%, and NPV 92.50%). The AUC value for ADC for axillary lymph node status prediction was 0.659 (sensitivity 65.38%, specificity of 64.86%).
The whole-tumor histogram and texture analyses parameters based on SMS rs-EPI DWI may provide biological information on aggressive molecular subtypes of breast cancer. In addition, ADC values were significantly different between lymph node-positive and lymph node-negative breast cancer.
利用全瘤体直方图和纹理分析，探讨多层面分段弥散加权回波平面成像（SMS rs-EPI DWI）在预测浸润性乳腺癌分子亚型中的可行性。
本回顾性研究纳入了在我院接受术前 MRI 检查（采用 SMS rs-EPI DWI）并接受手术治疗的 125 例单发性浸润性乳腺癌患者（平均年龄 52.81±12.01 岁，范围 24-84 岁）。两名放射科医生分别对 SMS rs-EPI DWI 的表观扩散系数（ADC）图进行全瘤体直方图和纹理分析（TR 3800.0ms；TE 90.0ms；视野 340mm×206mm；平面矩阵 244×148；层厚 5mm；读出段 5，b=0，800s/mm；扫描时间 3 分钟；切片加速因子 2）。采用 Mann-Whitney U 检验或 Kruskal-Wallis 检验比较直方图和纹理参数，以评估它们在鉴别乳腺癌分子亚型和预测腋窝淋巴结状态方面的潜在价值。对有显著差异的参数生成受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
与 luminal A 型乳腺癌相比，HER2 阳性乳腺癌亚型的 ADC 值更高（p=0.016）。此外，HER2 阳性乳腺癌的 ADC 值（p=0.025）、ADC 值（p=0.025）和 ADC 值（p=0.041）显著高于 luminal B 型乳腺癌。三阴性乳腺癌（TNBC）的 ADC 值高于 luminal A 型乳腺癌（p=0.021）。HER2 阳性乳腺癌与 luminal 型之间的 ADC、ADC、ADC 和 ADC 值差异具有统计学意义，这些参数的联合 AUC 为 0.762（敏感性 72.41%，特异性 75.00%，PPV 27.27%，NPV 95.45%）。TNBC 的 ADC 值高于 luminal 型（p=0.012），AUC 值为 0.688（敏感性 96.15%，特异性 36.78%，PPV 31.25%，NPV 96.97%）。此外，非 luminal 型的 ADC 和 ADC 值显著高于 luminal 型（p=0.003，0.002），联合 AUC 值为 0.712（敏感性 92.11%，特异性 50.23%，PPV 41.18%，NPV 92.50%）。腋窝淋巴结状态预测的 ADC 值 AUC 值为 0.659（敏感性 65.38%，特异性 64.86%）。
基于 SMS rs-EPI DWI 的全瘤体直方图和纹理分析参数可为侵袭性乳腺癌分子亚型提供生物学信息。此外，淋巴结阳性和淋巴结阴性乳腺癌之间的 ADC 值有显著差异。
