Breast stromal enhancement on MRI is associated with response to neoadjuvant chemotherapy
Breast stromal enhancement on MRI is associated with response to neoadjuvant chemotherapy
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DOI：
10.2214/ajr.07.2533
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发表时间：
2008-06-01
影响因子：
5
通讯作者：
Hylton, Nola
中科院分区：
文献类型：
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作者：
Hattangadi, Jona;Park, Catherine;Hylton, Nola
OBJECTIVE.组织学上正常的乳腺组织中的癌性新生血管变化已被证明会增加保乳治疗后局部复发的风险。然而，这种组织的成像特性还没有得到很好的研究。我们假设动态对比增强乳腺MRI的信号增强率可用于分析肿瘤边缘以外的乳腺间质中微血管的对比动力学，并且该信息可用于改进局部治疗方案。对42例接受新辅助化疗的浸润性乳腺癌患者在化疗前（扫描1）和化疗一个周期后（扫描2）进行动态增强MRI扫描，对非肿瘤乳腺间质进行信号增强率分析。基质信号增强比率值然后与几个临床参数和临床结果使用单变量和多变量分析。该组的中位随访时间为52.1个月。结果在单变量分析中，显著相关的因素（p < 0.05）与无病生存包括平均间质信号增强比在扫描2（风险比[HR] = 0.11，95% CI = 0.013 - 0.88，p = 0.03），治疗前肿瘤大小（HR = 1.33，95% CI = 1.07 - 1.66，p = 0.012），治疗前肿瘤体积（HR = 1.04，95% CI = 1.01 - 1.07，p = 0.006）和受累腋窝淋巴结数量（HR = 1.18，95% CI = 1.05 - 1.32，p = 0.005）。然后在多变量考克斯比例风险模型中分析这些因素。与无病生存相关的唯一因素是第2次扫描时平均间质信号增强率（HR = 0.11，95%CI = 0.012 - 0.95，p < 0.045）。这些结果表明，乳腺间质组织以外的事件肿瘤可以量化使用信号增强比分析动态增强MRI。间质信号增强比是乳腺癌患者治疗反应和总体结局的潜在指标;然而，这些结果应在前瞻性研究中得到验证。
OBJECTIVE. Cancerous neovascular changes in histologically normal-appearing breast tissue have been shown to increase risk for local recurrence after breast-conserving therapy. However, the imaging characteristics of this tissue have not been well studied. We hypothesized that signal enhancement ratios from dynamic contrast-enhanced breast MRI could be used to analyze the contrast kinetics of microvasculature in breast stroma beyond the tumor margin and that this information can be developed to improve local treatment options.MATERIALS AND METHODS. Signal enhancement ratio analysis of nontumor breast stroma was performed on dynamic contrast-enhanced MRI scans of 42 patients who received neoadjuvant chemotherapy for invasive breast cancer performed before chemotherapy (scan 1) and after one cycle of chemotherapy (scan 2). Stromal signal enhancement ratio values were then correlated to several clinical parameters and to clinical outcome using univariate and multivariate analyses. Median follow-up for the group was 52.1 months. RESULTS. On univariate analysis, factors that were significantly associated (p < 0.05) with disease-free survival included the mean stromal signal enhancement ratio at scan 2 (hazard ratio [HR] = 0.11, 95% CI = 0.013 - 0.88, p = 0.03), pretreatment tumor size (HR = 1.33, 95% CI = 1.07 - 1.66, p = 0.012), pretreatment tumor volume (HR = 1.04, 95% CI = 1.01 - 1.07, p = 0.006), and number of involved axillary lymph nodes (HR = 1.18, 95% CI = 1.05 - 1.32, p = 0.005). These factors were then analyzed in a multivariate Cox proportional hazards model. The only factor that was associated with disease-free survival was mean stromal signal enhancement ratio at scan 2 (HR = 0.11, 95% CI = 0.012 - 0.95, p < 0.045).CONCLUSION. These findings indicate that breast stroma tissue outside the incident tumor can be quantified using signal enhancement ratio analysis on dynamic contrast-enhanced MRI. Stromal signal enhancement ratio is a potential indicator for response to treatment and for overall outcome in patients with breast cancer; however, these results should be validated in a prospective study.