Breast MRI background parenchymal enhancement as an imaging bridge to molecular cancer sub-type
Breast MRI background parenchymal enhancement as an imaging bridge to molecular cancer sub-type
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DOI：
10.1016/j.ejrad.2019.02.018
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发表时间：
2019-04-01
影响因子：
3.3
通讯作者：
Moschetta, Marco
中科院分区：
文献类型：
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作者：
Dilorenzo, Giuseppe;Telegrafo, Michele;Moschetta, Marco
用途：评估MRI乳腺实质增强（BPE）在不同乳腺癌亚型中的分布，寻找免疫组化和受体模式（雌激素受体-ER，孕激素受体-PR，人表皮生长因子受体2-HER 2）方面的任何显着差异。两名放射科医生回顾性评价了所有减影MR增强图像，以分类BPE。免疫组化法检测ER、PR和HER 2的表达。使用Allred评分（阳性值：评分>= 3）评价ER和PR状态。将cerbB-2染色强度评分为0、1+、2+或3+（阳性值：>= 3+;阴性：0和1+; 2+值用银原位杂交评估）。根据癌症亚型将患者分为五类：管腔A型、管腔B型HER 2阴性、管腔B型HER 2阳性、非管腔型HER 2阳性、三阴性。采用卡方检验（chi（2）test）评估BPE类型分布到5组肿瘤亚型中的显著性以及5种乳腺癌亚型在每种BPE类型中的分布。采用多因素回归和Logistic回归分析BPE与年龄、绝经状态、病变直径等因素的相关性。使用Cohen's kappa统计来评估BPE分类的观察者间一致性。6/82例为管腔A型（7.3%），42/82管腔B样（HER 2-）（51.2%），12/82管腔B样（HER 2+）（14.6%），4/82非管腔（HER+）（4.9%），18/82三阴性（导管）（22%）。82例中轻度BPE 16例，轻度BPE 28例，中度BPE 22例，重度BPE 16例。轻度BPE模式仅在管腔B（HER-）肿瘤中比其他BPE类型显著更普遍（p= 0.0001）。在三阴性中，中度和显著的BPE优于轻微和轻度。在所有轻度BPE患者中，管腔B（HER 2-）肿瘤显著较高（p= 0.0001）。在所有具有显著BPE的患者中，三阴性亚型显著更高（p= 0.0074）。未发现BPE定性评价的显著混杂因素（p= 0.39）。评估者之间对MRI上BPE模式的评估几乎完全一致，Cohen的k= 0.83。结论：BPE可以作为乳腺癌分子亚型的影像学桥梁，在乳腺MRI和靶向筛查试验领域提供额外的风险分层。在CE-MRI检查中轻度BPE的情况下，管腔B（HER 2-）肿瘤可能占优势，而在BPE明显的患者中，TN肿瘤可能占优势。需要对更大系列的进一步研究来证实这一假设。
Purpose: To evaluate the distribution of MRI breast parenchymal enhancement (BPE) among different breast cancer subtypes searching for any significant difference in terms of immunohistochemical and receptorial patterns (Estrogen Receptor-ER, Progesterone Receptor-PR, Human Epidermal Growth Factor Receptor 2-HER2).Methods: 82 consecutive patients affected by breast cancer underwent breast DCE-MRI. Two radiologists retrospectively evaluated all subtracted MR enhanced images for classifying BPE. ER, PR and HER2 expression was assessed by immunohistochemical analysis. ER and PR status was evaluated using Allred score (positive values: score >= 3). The intensity of the cerbB-2 staining was scored as 0, 1+, 2+, or 3+ (positive values: >= 3+; negative: 0 and 1+; 2+ value assessed with silver in-situ hybridization). Patients were classified into five categories based on cancer subtypes: Luminal A, Luminal B HER2 negative, Luminal B HER2 positive, HER2 positive non luminal, triple negative. The chi(2) test was used for evaluating the significance of BPE type distribution into the five groups of tumor subtypes and the distribution of the five breast cancer subtypes among every single BPE type. The correlation of BPE with factors such as age, menopausal status and lesion diameter was investigated using multivariate regression analysis and logistic regression. Cohen's kappa statistics was used in order to assess inter-observer agreement for classifying BPE.Results: 6/82 cases were Luminal A-like (7.3%), 42/82 Luminal B-like (HER2-) (51.2%), 12/82 Luminal B-like (HER2+) (14.6%), 4/82 Non Luminal (HER+) (4.9%), 18/82 Triple Negative (ductal) (22%). 16/82 cases showed minimal BPE, 28/82 mild BPE, 22/82 moderate BPE, 16/82 marked BPE. Mild BPE pattern was significantly more prevalent (p= 0.0001) than other BPE types only in the luminal B (HER-) tumors. Moderate and marked BPE prevailed over minimal and mild, in triple negatives. Among all patients with mild BPE, luminal B (HER2-) tumors were significantly higher (p= 0.0001). Among all patients with marked BPE, triple negative subtypes were significantly higher (p= 0.0074). No significant confounder to BPE qualitative evaluation was found (p= 0.39). The inter-rater agreement in evaluating BPE patterns on MRI was almost perfect with Cohen's k= 0.83.Conclusions: BPE could play a crucial role as an imaging bridge to molecular breast cancer subtype allowing an additional risk stratification in the field of breast MRI and targeted screening tests. Luminal B (HER2-) tumors could prevail in case of mild BPE on CE-MRI examinations and TN tumors in patients with marked BPE. Further studies on larger series are needed to confirm this hypothesis.