Can diffusion-weighted imaging predict tumor grade and expression of Ki-67 in breast cancer? A multicenter analysis.
Can diffusion-weighted imaging predict tumor grade and expression of Ki-67 in breast cancer? A multicenter analysis.
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DOI：
10.1186/s13058-018-0991-1
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发表时间：
2018-06-19
期刊：
影响因子：
--
通讯作者：
Wienke A
中科院分区：
文献类型：
--
作者：
Surov A;Clauser P;Chang YW;Li L;Martincich L;Partridge SC;Kim JY;Meyer HJ;Wienke A
许多研究分析了表观扩散系数（ADC）和乳腺癌（BC）组织病理学特征（如Ki-67增殖指数）之间的相关性，结果喜忧参半。本研究的目的是进行多中心分析，以确定ADC和Ki-67表达和肿瘤分级之间的关系。本研究采集了6个中心的数据。样本包括870例患者（均为女性;平均年龄为52.6 ± 10.8岁）。在每一个病例中，进行了乳腺磁共振成像与扩散加权成像。通过Mann-Whitney U检验进行组中ADC值的比较，其中针对多重检验调整p值（Bonferroni校正）。采用斯皮尔曼等级相关系数法计算ADC值与Ki-67值的相关性。计算诊断程序的灵敏度、特异性、阴性和阳性预测值、准确度和AUC。选择ADC阈值以使约登指数最大化。总体而言，本研究采集了870例患者的数据。肿瘤的平均ADC值为0.98 ± 0.22 × 10− 3 mm 2 s− 1。ROC分析表明，使用ADC值无法区分高/中度肿瘤和1级病变。Youden指数确定的阈值ADC值为1.03，敏感性为56.2%，特异性为67.9%。阳性预测值为18.2%，阴性预测值为92.4%。Ki-67增殖指数的水平可用于845例患者。平均值为12.33 ± 21.77%。ADC值与Ki-67表达的相关性具有弱统计学显著性（p =-0.202，p < 0.001）。进行ROC分析以使用ADC值区分具有高增殖潜力的肿瘤与具有低Ki-67表达的肿瘤。Youden指数确定的阈值ADC值为0.91（敏感性64%，特异性50%，阳性预测值67.7%，阴性预测值45.0%）。ADC不能用作乳腺癌增殖活性和/或肿瘤分级的替代标志物。
Numerous studies have analyzed associations between apparent diffusion coefficient (ADC) and histopathological features such as Ki-67 proliferation index in breast cancer (BC), with mixed results. The purpose of this study was to perform a multicenter analysis to determine relationships between ADC and expression of Ki-67 and tumor grade in BC. For this study, data from six centers were acquired. The sample comprises 870 patients (all female; mean age, 52.6 ± 10.8 years). In every case, breast magnetic resonance imaging with diffusion-weighted imaging was performed. The comparison of ADC values in groups was performed by Mann-Whitney U test where the p values are adjusted for multiple testing (Bonferroni correction). The association between ADC and Ki-67 values was calculated by Spearman’s rank correlation coefficient. Sensitivity, specificity, negative and positive predictive values, accuracy, and AUC were calculated for the diagnostic procedures. ADC thresholds were chosen to maximize the Youden index. Overall, data of 870 patients were acquired for this study. The mean ADC value of the tumors was 0.98 ± 0.22 × 10− 3 mm2 s− 1. ROC analysis showed that it is impossible to differentiate high/moderate grade tumors from grade 1 lesions using ADC values. Youden index identified a threshold ADC value of 1.03 with a sensitivity of 56.2% and specificity of 67.9%. The positive predictive value was 18.2%, and the negative predictive value was 92.4%. The level of the Ki-67 proliferation index was available for 845 patients. The mean value was 12.33 ± 21.77%. ADC correlated with weak statistical significant with expression of Ki-67 (p = − 0.202, p < 0.001). ROC analysis was performed to distinguish tumors with high proliferative potential from tumors with low expression of Ki-67 using ADC values. Youden index identified a threshold ADC value of 0.91 (sensitivity 64%, specificity 50%, positive predictive value 67.7%, negative predictive value 45.0%). ADC cannot be used as a surrogate marker for proliferation activity and/or for tumor grade in breast cancer.
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