Deconvolution-based Dynamic Contrast-enhanced MR Imaging of Breast Tumors: Correlation of Tumor Blood Flow with Human Epidermal Growth Factor Receptor 2 Status and Clinicopathologic Findings—Preliminary Results

Suk

Magnetic Resonance Imaging

et al. 2009

159

Purpose:To evaluate the role of diffusion-weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors. Materials and Methods:Sixty-seven women with invasive cancer underwent breast MRI. Histological specimens were analyzed for tumor size and grade, and expression of estrogen receptors (ER), progesterone receptors, c-erbB-2, p53, Ki-67, and epidermal growth factor receptors. The computed mean ADC values of breast cancer and normal breast parenchyma were compared. Relationships between the ADC values and prognostic factors were determined using Wilcoxon signed rank test and Kruskal-Wallis test.Results: DWI detected breast cancer as a hyperintense area in 62 patients (92.5 %). A statistically significant difference in the mean ADC values of breast cancer (1.09 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) and normal parenchyma (1.59 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) was detected (P Ͻ 0.0001). There were no correlations between the ADC value and prognostic factors. However, the median ADC value was lower in the ER-positive group than the ER negative group, and this difference was marginally significant (1.09 ϫ 10 Ϫ5 mm 2 /s versus 1.15 ϫ 10 Ϫ5 mm 2 /s, P ϭ 0.053). Conclusion:The ADC value was a helpful parameter in detecting malignant breast tumors, but ADC value could not predict patient prognosis. DYNAMIC CONTRAST MATERIAL-enhanced MRI, which gives information on morphology and kinetics and has higher sensitivity, is frequently used to identify additional lesions and to determine the extent of tumor before surgery (1). In recent years, some studies have attempted to differentiate between benign and malignant tumors using diffusion-weighted imaging (DWI) (2-9). DWI is a specific modality that visualizes the microstructural characteristics of water diffusion in biological tissues. The microscopic motion includes the molecular diffusion of water and blood microcirculation in capillary networks; therefore, both diffusion and perfusion affect apparent diffusion coefficient (ADC) values (2,10). The ADC value was determined to be lower in cancer compared with normal parenchyme or benign breast tumor (2-9). Many studies have attempted to predict treatment response and prognosis in patients with breast cancer. It has been disclosed that there are traditional prognostic factors such as tumor grade and molecular markers such as estrogen receptors (ER) and progesterone receptors (PR) (11). Of these prognostic factors, the histologic grade of the tumor and the Ki-67 proliferation index reflect the cellularity (5,8,12,13), and c-erbB-2 and ER are thought to be associated with perfusion (14,15). We have speculated that these prognostic factors can affect the ADC value.To our knowledge, no studies have examined the correlation between the ADC value and prognostic factors. The objectives of the current study are to examine the clinical usefulness of DWI for the detection of invasive cancer, and to determine whether the ADC value can be a new prognostic factor for patients with...

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diffusion‐weighted imaging of breast cancer: Correlation of the apparent diffusion coefficient value with prognostic factors

Suk

Magnetic Resonance Imaging

et al. 2009

159

The British Journal of Radiology

“…Several studies of DWI of the breast have reported significantly lower ADC values in malignant tumours, compared with benign breast lesions and normal tissue [1-3, 5-11, 14]. Classic prognostic markers, including tumour size and grade, and lymph node status in patients with breast cancer, and molecular markers, including oestrogen receptor (ER), progesterone receptor (PR), index, human growth factor receptor 2 (HER2) protein and angiogenic molecular markers, have been reported [1,15,16]. Few studies have examined the correlation between ADC values and prognostic factors [1,8].…”

mentioning

confidence: 99%

Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer

Sy¹,

Chang²,

Hj³

et al. 2012

160

131

Objective: The aim of this study was to correlate the apparent diffusion coefficient (ADC) value of breast cancer with prognostic factors. Methods: 335 patients with invasive ductal carcinoma not otherwise specified (IDC NOS) and ductal carcinoma in situ (DCIS) who underwent breast MRI with diffusionweighted imaging were included in this study. ADC of breast cancer was calculated using two b factors (0 and 1000 s mm -2 ). Mean ADCs of IDC NOS and DCIS were compared and evaluated. Among cases of IDC NOS, mean ADCs were compared with lymph node status, size and immunochemical prognostic factors using Student's t-test. ADC was also correlated with histological grade using the Kruskal-Wallis test. Results: Mean ADC of IDC NOS was significantly lower than that of DCIS (p,0.001). However, the mean ADC of histological grade of IDC NOS was not significantly different (p50.564). Mean ADC of oestrogen receptor (ER)-positive or progesterone receptor (PR)-positive cancer was significantly lower than that of ER-negative or PRnegative cancer (p50.003 vs p50.032). Mean ADC of Ki-67 index-positive cancer was significantly lower than that of Ki-67 index-negative cancer (p50.028). Mean ADC values of cancers with increased microvascular density (MVD) were significantly lower than those of cancer with no MVD increase (p50.009). No correlations were observed between mean ADC value and human growth factor receptor 2 expression, tumour size and lymph node metastasis. Conclusion: Low ADC value was correlated with positive expression of ER, PR, increased Ki-67 index, and increased MVD of breast cancer. Breast MRI is an established supplemental technique to mammography and ultrasonography for evaluation of suspicious breast lesions. Diffusion-weighted MRI (DWI) has recently been integrated into the standard breast MRI for discrimination of benign and malignant breast lesions obtained with dynamic contrast-enhanced MRI [1][2][3][4][5][6][7][8][9][10][11][12][13]. DWI is a non-invasive technique that represents the biological character of the mainly Brownian movement of protons in bulk water molecules in vivo. Apparent diffusion coefficient (ADC) values are quantified by measurement of mean diffusivity along three orthogonal directions, which are affected by cellularity of the tissue, fluid viscosity, membrane permeability and blood flow [7,[9][10][11]. Microstructural characteristics, including water diffusion and blood microcirculations in capillary networks, were associated with ADC value. Decreased movement of molecules in highly cellular tissue showed correlation with a low ADC value [3,4]. Several studies of DWI of the breast have reported significantly lower ADC values in malignant tumours, compared with benign breast lesions and normal tissue [1-3, 5-11, 14]. Classic prognostic markers, including tumour size and grade, and lymph node status in patients with breast cancer, and molecular markers, including oestrogen receptor (ER), progesterone receptor (PR), Ki-67 index, human growth factor receptor 2 (HER2) protein and angiogenic mo...

“…Conversely, HER-2 overexpression increases the importance of VEGF in guiding angiogenesis. Makkat et al (2008) and others reported that HER-2 positivity is associated with higher tumor blood flow. Therefore, change in tumor molecules will affect instillation, which manifests as an increase in ADC values.…”

Section: Discussionmentioning

confidence: 94%

Value of diffusion weighted imaging in the differential diagnosis of benign and malignant breast lesions at 3.0T MRI

et al. 2014

ABSTRACT. The aim of this study was to investigate the correlation between apparent diffusion coefficients (ADCs), the relative apparent diffusion coefficient (rADC), and the pathological prognostic factor human epidermal growth factor receptor 2 (HER-2) in patients with breast cancer. A total of 64 women with breast cancer underwent breast diffusion-weighted imaging. HER-2 expression was detected in histological specimens. The ADC value, rADC value, and HER-2 level were determined. The ADC and rADC values of the breast cancer group were 1.1495 ± 0.1499 x 10 -3 and 0.6602 ± 0.0853, respectively. The differences in the ADC and rADC values between the two groups were statistically significant. There was no correlation between the ADC value and HER-2 expression in patients with breast cancer (r = -0.508, P = 0.043). However, the rADC value eliminated the individual differences to some extent. Therefore, compared to the ADC value, the rADC value had a better correlation with HER-2 expression.