肿瘤周围区域的定量表观扩散系数可作为三阴性乳腺癌新辅助全身治疗反应的早期预测指标。

Quantitative Apparent Diffusion Coefficients From Peritumoral Regions as Early Predictors of Response to Neoadjuvant Systemic Therapy in Triple-Negative Breast Cancer.

机构信息

Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

出版信息

J Magn Reson Imaging. 2022 Dec;56(6):1901-1909. doi: 10.1002/jmri.28219. Epub 2022 May 2.

DOI:10.1002/jmri.28219

PMID:35499264

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9626398/

Abstract

BACKGROUND

Pathologic complete response (pCR) to neoadjuvant systemic therapy (NAST) in triple-negative breast cancer (TNBC) is a strong predictor of patient survival. Edema in the peritumoral region (PTR) has been reported to be a negative prognostic factor in TNBC.

PURPOSE

To determine whether quantitative apparent diffusion coefficient (ADC) features from PTRs on reduced field-of-view (rFOV) diffusion-weighted imaging (DWI) predict the response to NAST in TNBC.

STUDY TYPE

Prospective.

POPULATION/SUBJECTS: A total of 108 patients with biopsy-proven TNBC who underwent NAST and definitive surgery during 2015-2020.

FIELD STRENGTH/SEQUENCE: A 3.0 T/rFOV single-shot diffusion-weighted echo-planar imaging sequence (DWI).

ASSESSMENT

Three scans were acquired longitudinally (pretreatment, after two cycles of NAST, and after four cycles of NAST). For each scan, 11 ADC histogram features (minimum, maximum, mean, median, standard deviation, kurtosis, skewness and 10th, 25th, 75th, and 90th percentiles) were extracted from tumors and from PTRs of 5 mm, 10 mm, 15 mm, and 20 mm in thickness with inclusion and exclusion of fat-dominant pixels.

STATISTICAL TESTS

ADC features were tested for prediction of pCR, both individually using Mann-Whitney U test and area under the receiver operating characteristic curve (AUC), and in combination in multivariable models with k-fold cross-validation. A P value < 0.05 was considered statistically significant.

RESULTS

Fifty-one patients (47%) had pCR. Maximum ADC from PTR, measured after two and four cycles of NAST, was significantly higher in pCR patients (2.8 ± 0.69 vs 3.5 ± 0.94 mm /sec). The top-performing feature for prediction of pCR was the maximum ADC from the 5-mm fat-inclusive PTR after cycle 4 of NAST (AUC: 0.74; 95% confidence interval: 0.64, 0.84). Multivariable models of ADC features performed similarly for fat-inclusive and fat-exclusive PTRs, with AUCs ranging from 0.68 to 0.72 for the cycle 2 and cycle 4 scans.

DATA CONCLUSION

Quantitative ADC features from PTRs may serve as early predictors of the response to NAST in TNBC.

EVIDENCE LEVEL

1 TECHNICAL EFFICACY: Stage 4.

摘要

背景

新辅助全身治疗（NAST）后三阴性乳腺癌（TNBC）的完全病理缓解（pCR）是患者生存的有力预测因素。肿瘤周围区域（PTR）的水肿已被报道为 TNBC 的负预后因素。

目的

确定 PTR 上的定量表观扩散系数（ADC）特征是否可预测 TNBC 对 NAST 的反应。

研究类型

前瞻性。

人群/受试者：2015 年至 2020 年间共 108 例经活检证实的 TNBC 患者，均接受 NAST 和确定性手术。

场强/序列：3.0T/rFOV 单次激发扩散加权成像序列（DWI）。

评估

纵向采集 3 次扫描（治疗前、NAST 两个周期后和 NAST 四个周期后）。对于每个扫描，从肿瘤和厚度为 5mm、10mm、15mm 和 20mm 的 PTR 中提取 11 个 ADC 直方图特征（最小值、最大值、平均值、中位数、标准差、峰度、偏度和第 10、第 25、第 75 和第 90 百分位数），包括和排除脂肪优势像素。

统计检验

使用 Mann-Whitney U 检验和受试者工作特征曲线下面积（AUC），单独测试 ADC 特征对 pCR 的预测能力，以及在包含 k 折交叉验证的多变量模型中进行组合。P 值<0.05 被认为具有统计学意义。

结果

51 例患者（47%）获得 pCR。在 pCR 患者中，PTR 处的最大 ADC 在 NAST 两个和四个周期后测量值明显更高（分别为 2.8±0.69mm/s 和 3.5±0.94mm/s）。预测 pCR 的最佳特征是 NAST 四个周期后包含脂肪的 5mm PTR 处的最大 ADC（AUC：0.74；95%置信区间：0.64，0.84）。包含和不包含脂肪的 PTR 的 ADC 特征的多变量模型表现相似，第 2 周期和第 4 周期扫描的 AUC 范围为 0.68 至 0.72。