Can contrast-enhanced MR imaging predict survival in breast cancer?

Abstract

Purpose: To investigate the value of pre-operative contrast-enhanced MR imaging (CE-MRI) in predicting the disease-free and overall survival in breast cancer.Material and Methods: The study population consisted of 50 consecutive patients with histopathologically verified primary breast cancer who preoperatively underwent CE-MRI examination between 1992 and 1993. A threetime point MR examination was performed where the enhancement rates (C 1 and C 2 ), signal enhancement ratio (SER ¼ C 1 /C 2 ) and washout (W ¼ C 1 -C 2 ) were calculated. The relation of these MR parameters to disease-free and overall survival was investigated. The median follow-up for surviving patients was 95 months. Univariate and multivariate statistical analyses were performed to evaluate the impact of different factors on prediction of survival.Results: Of the MR parameters examined at univariate analysis, increased C 1 (p ¼ 0.029), W (p ¼ 0.0081) and SER values (p ¼ 0.0081) were significantly associated with shorter disease-free survival, and only C 1 (p ¼ 0.016) was related significantly to overall survival. Multivariate analysis for disease-free survival showed that the SER (p ¼ 0.014) and tumor size (p ¼ 0.001) were significant and independent predictors. Age (p ¼ 0.003), lymph node status (p ¼ 0.014), tumor size (p ¼ 0.039) and proliferating cell nuclear antigen index (p ¼ 0.053) remained independently associated with overall survival at multivariate analysis. C 1 was not confirmed as an independent predictor of overall survival.Conclusion: Our findings support the presumption that CE-MRI is useful in predicting the disease-free survival in patients with breast cancer.The conventional TNM classification system for staging of breast cancer is widely used to determine treatment and provides prognostic information (1). The pre-operative staging is based on a combination of clinical and imaging findings and includes the assessment of tumor extent, multifocality and lymph node status. Mammography and breast ultrasonography, however, often underestimate the extent of the disease. MR imaging has been introduced as a complementary diagnostic tool for the detection of breast cancer. It is widely accepted that MR imaging can reveal mammographically occult breast malignancy, and has the ability to determine tumor size and exclude multifocality more accurately than standard breast imaging methods (2). Recently, MR imaging has also been suggested for pre-operative loco-regional staging, as well as for the evaluation of response to preoperative chemotherapy (8,14).Although staging is very important in the clinical management and contains information on tumor size and nodal involvement, treatment planning and prediction of prognosis cannot be made without the assessment of other postoperative morphologic variables such as histologic type and malignancy grade. Besides these classic prognostic factors, a number of biological markers have also

Metabolic and Vascular Features of Dynamic Contrast-enhanced Breast Magnetic Resonance Imaging and 15O-Water Positron Emission Tomography Blood Flow in Breast Cancer

“…SER values model the shape of the enhancement curve for each voxel with SER > 1.1 indicating washout, SER between 1.1 and 0.9 indicating plateau enhancement, and SER < 0.9 indicating persistent enhancement. SER was previously shown to reflect both micro-vessel density and tumor grade (19, 20, 24). …”

“…Changes in tumor volume following neoadjuvant therapy, as measured using DCE-MRI, are predictive of recurrence free survival (8). Measurements of tumor enhancement, including semi-quantitative parameters such as initial percent enhancement (PE) and delayed signal enhancement ratio (SER), have been shown to be helpful and accurate for tumor detection and response evaluation (19–26). Tumor enhancement likely reflects a combination of blood flow and capillary permeability (15, 27).…”

Kinetic assessment of breast tumors using high spatial resolution signal enhancement ratio (SER) imaging

“…Previous studies have utilized high spatial resolution three‐dimensional (3D) DCE‐MRI with relatively low temporal resolution, e.g., 60–90 sec/frame (12). Methods based on three‐timepoint examination consisting of one pre‐ and two postcontrast scans are commonly used in clinical studies (11, 16, 17) to evaluate morphological changes of breast lesion, using high spatial resolution 3D imaging with a typical isotropic pixel size of 1 × 1 × 1 mm covering the entire symptomatic breast or both breasts. Furthermore, our group has utilized such a three‐timepoint acquisition strategy to calculate high spatial resolution maps of a semiquantitative parameter, the signal enhancement ratio (SER), for clinical studies of breast cancer (13, 18).…”

Biallelic expression of Tbx1 protects the embryo from developmental defects caused by increased receptor tyrosine kinase signaling

“…Accordingly, preoperative staging breast MRI is recommended in various clinical scenarios by senological guidelines and is routinely performed in many institutions before surgery (10). Furthermore, there is also a rising number of trials indicating that preoperative staging breast MRI might be used not only as a diagnostic but also as a prognostic tool (11–15). This is driven by the hypothesis, that contrast enhanced imaging of breast cancer with breast MRI is able to assess tumor vasculature and neoangiogenesis induced by the neoplasm (16–18).…”

“…Data on breast MRI as a prognostic tool is mainly limited to trials addressing prognostic factors as surrogates for outcome, e.g., (14). Only few studies defined “disease‐related death” as an endpoint (11–13, 22, 23). These studies were limited, e.g., by power due to small sample size (particularly: (12, 22)), outdated imaging protocols (11) or highly selected oncologic scenarios (12, 13, 23).…”