Can dynamic contrast-enhanced MRI (DCE-MRI) predict tumor recurrence and lymph node status in patients with breast cancer?

Abstract

The lymph node status is regarded as one of the most important prognostic factors for the overall and disease-free survival of patients with breast cancer. While morphological features and contrast enhancement kinetics of breast cancer shown on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) have been correlated with tumor histological type, grade, and biomarkers [1][2][3][4], there were only few studies reporting the association of lesion features such as rim enhancement and kinetic feature (early maximal enhancement and washout) with node status and showed controversial results [5][6][7]. In this study, we investigated the MRI features of the primary tumor between patients who had early recurrence versus those who remained cancer free and also between node-positive and -negative patients.We analyzed 62 patients (30-83 years old, median 58) with histologically confirmed breast cancer who were enrolled into a breast MRI study during years [2000][2001][2002][2003]. A telephone survey was conducted in 2006 to follow-up all patients regarding their disease status. Of the 62 patients, six had confirmed cancer recurrence in the previously treated breast. The MRI features of these 62 patients were retrospectively reviewed and compared between the six with early recurrence versus those who were cancer free. Of these six patients with early recurrence, three had positive nodes (sentinel and/or axillary) at the time of first cancer diagnosis and three had negative nodes. Of the 56 patients who were cancer free, 28 had positive node and the other 28 had negative nodes.Breast MRI was carried out on a 1.5T MR scanner. The protocol included precontrast images and dynamic contrastenhanced imaging. The characteristics of primary tumor were analyzed. The longest and perpendicular dimension of the tumor size was measured on contrast-enhanced MRI and then converted to one-dimensional size. The morphological appearances were characterized using features described in BI-RADS MRI lexicon [8], separated into mass lesions and nonmass-like enhancements. The following enhancement kinetic parameters were analyzed: the % enhancement at 1 min (E1), 2 min (E2), 7 min (E3), and the washout slope between 7 and 2 min. Furthermore, pharmacokinetic parameters, including transfer constant (K trans ) and exchange rate constant (k ep ), were also analyzed with the Toft's twocompartmental model [9].The comparison of lesion morphology, size, and enhancement kinetic parameters in three groups was summarized in Table 1. LN(+) group had more irregular mass lesion (19/28, 68%) compared with LN(2) group (12/28, 43%), fewer round mass (4/28, 14% versus 10/28, 36%), and more nonmass-like lesions (3/28 versus 0/28). The tumor size in the LN(+) group (0.7-4.0 cm, mean 1.8 cm) was bigger letters to the editor Annals of Oncology 822 | letters to the editor Volume

Dynamic Contrast-Enhanced MRI Kinetics of Invasive Breast Cancer: A Potential Prognostic Marker for Radiation Therapy

“…However, two other studies did not find a correlation between ANS and early-phase kinetics (9, 29). Bahri et al (29) observed significant differences in delayed-phase kinetic characteristics between node-positive and node-negative patients, although our measure of delayed-phase kinetics (WE) was not correlated with ANS. Altogether, findings from previous studies examining DCE-MRI kinetic parameters with regard to nodal status have been mixed, although their techniques have varied with respect to examination protocols and definitions of kinetic parameters, making comparisons challenging.…”

Role of perfusion parameters on DCE-MRI and ADC values on DWMRI for invasive ductal carcinoma at 3.0 Tesla

“…Currently, the correlation between DCE-MRI quantitative parameters and prognosis factors of breast cancer, including enhanced morphology, tumor size, pathological grade, and lymph node status, is still in the preliminary stage, and the results of different studies are quite different [23, 24]. Koo et al investigated the correlations between parameters (Ktrans, Kep, and Ve) of 70 IDCs and tumor size [23].…”

“…Our results also showed that Ktrans has significant positive correlation with LNM, while only Ve values exhibit significant difference between subgroups of LN, which is firstly reported in this study to date. Bahri et al reported that LN(+) group has higher Kep than the LN(−) group [24]. The inconsistent results may be due to the relatively small sample size.…”

Pharmacokinetic parameters and radiomics model based on dynamic contrast enhanced MRI for the preoperative prediction of sentinel lymph node metastasis in breast cancer

“…Previous studies have demonstrated that pharmacokinetic parameters can potentially be used as prognostic or predictive biomarkers [ 13 ]. Bahri et al [ 14 ] found that the Ktrans and Ke p values of metastatic lymph nodes are higher than those of nonmetastatic lymph nodes in breast cancer. However, using combined pharmacokinetic parameters and DCE-MRI radiomics features to predict SLN metastasis has not yet been demonstrated.…”