Early Stage Triple-Negative Breast Cancer: Imaging and Clinical-Pathologic Factors Associated with Recurrence

Bae, Min Sun; Moon, Hyeong‐Gon; Han, Wonshik; Noh, Dong‐Young; Ryu, Han Suk; Park, In-Ae; Chang, Jung Min; Cho, Nariya; Moon, Woo Kyung

doi:10.1148/radiol.2015150089

Cited by 45 publications

(38 citation statements)

References 33 publications

(34 reference statements)

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“…L YMPHOVASCULAR INVASION (LVI), defined as the infiltration of tumor cells into lymphatic or blood vessels at the periphery of the invasive carcinoma, 1 has been widely recognized as a negative prognostic factor in invasive breast cancer. [2][3][4][5][6] Studies have revealed that LVI status facilitates the selection of an optimal therapeutic strategy for individual breast cancer patients. [7][8][9][10][11] The extent of LVI is an important factor for predicting neoadjuvant chemotherapy (NAC) efficacy.…”

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confidence: 99%

Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Liu

Bao

et al. 2019

Magnetic Resonance Imaging

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Background Lymphovascular invasion (LVI) status facilitates the selection of optimal therapeutic strategy for breast cancer patients, but in clinical practice LVI status is determined in pathological specimens after resection. Purpose To explore the use of dynamic contrast‐enhanced (DCE)‐magnetic resonance imaging (MRI)‐based radiomics for preoperative prediction of LVI in invasive breast cancer. Study Type Prospective. Population Ninety training cohort patients (22 LVI‐positive and 68 LVI‐negative) and 59 validation cohort patients (22 LVI‐positive and 37 LVI‐negative) were enrolled. Field Strength/Sequence 1.5 T and 3.0 T, T1‐weighted DCE‐MRI. Assessment Axillary lymph node (ALN) status for each patient was evaluated based on MR images (defined as MRI ALN status), and DCE semiquantitative parameters of lesions were calculated. Radiomic features were extracted from the first postcontrast DCE‐MRI. A radiomics signature was constructed in the training cohort with 10‐fold cross‐validation. The independent risk factors for LVI were identified and prediction models for LVI were developed. Their prediction performances and clinical usefulness were evaluated in the validation cohort. Statistical Tests Mann–Whitney U‐test, chi‐square test, kappa statistics, least absolute shrinkage and selection operator (LASSO) regression, logistic regression, receiver operating characteristic (ROC) analysis, DeLong test, and decision curve analysis (DCA). Results Two radiomic features were selected to construct the radiomics signature. MRI ALN status (odds ratio, 10.452; P < 0.001) and the radiomics signature (odds ratio, 2.895; P = 0.031) were identified as independent risk factors for LVI. The value of the area under the curve (AUC) for a model combining both (0.763) was higher than that for MRI ALN status alone (0.665; P = 0.029) and similar to that for the radiomics signature (0.752; P = 0.857). DCA showed that the combined model added more net benefit than either feature alone. Data Conclusion The DCE‐MRI‐based radiomics signature in combination with MRI ALN status was effective in predicting the LVI status of patients with invasive breast cancer before surgery. Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:847–857.

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Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Liu

Bao

et al. 2019

Magnetic Resonance Imaging

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“…33 Both that study and our study were limited by small numbers of patients with HER2-positive cancer. In a large cohort of 398 patients with triple-negative breast cancer, Bae et al 34 reported that the absence of pre-operative MRI was associated with an increased risk of recurrence. Further research is needed to define the role of MRI in evaluating breast cancer molecular subtypes, as these subtypes carry important treatment and prognostic implications.…”

Section: Discussionmentioning

confidence: 99%

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

He¹,

Plaxco²,

Wei³

et al. 2016

BJR

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Objective: To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer. Methods: A retrospective database search in a single institution identified 259 patients with breast cancer diagnosed from January 2011 to August 2014 who underwent mammography, BWBUS and MRI before surgery. Patient characteristics, tumour characteristics and lesions seen on each imaging modality were recorded. The sensitivity, specificity and accuracy for each modality were calculated. ICDRs according to index tumour histology and receptor status were also evaluated. The effect of additional cancer detection on surgical planning was obtained from the medical records. Results: A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p 5 0.01), while BWBUS was significantly more accurate and specific than MRI (p , 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptorpositive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients. Conclusion: MRI was more sensitive than BWBUS, while BWBUS was more accurate and specific than MRI. MRIdetected additional malignant lesions did not change surgical planning in almost half of these patients. Advances in knowledge: BWBUS may be a cost-effective and practical tool in breast cancer staging.

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“…Further studies with molecular subtypes may prove more fruitful and are ongoing. In breast cancers lacking estrogen, progesterone, and HER2-neu (ERB-B2) receptors-that is, triple negative-lack of exposure to pretreatment breast MRI has been shown to independently correlate with an increased risk of recurrence at a median follow-up of 6.1 y, with a hazard ratio of 2.66 (95% confidence interval, 1.49-4.75), comparable in magnitude to dense breasts and lymphovascular invasion (29). Unlike series across all tumor types (30,31), MRI did not increase the rate of mastectomy in women with triple-negative disease (29).…”

Section: Extent Of Diseasementioning

confidence: 99%

“…In breast cancers lacking estrogen, progesterone, and HER2-neu (ERB-B2) receptors-that is, triple negative-lack of exposure to pretreatment breast MRI has been shown to independently correlate with an increased risk of recurrence at a median follow-up of 6.1 y, with a hazard ratio of 2.66 (95% confidence interval, 1.49-4.75), comparable in magnitude to dense breasts and lymphovascular invasion (29). Unlike series across all tumor types (30,31), MRI did not increase the rate of mastectomy in women with triple-negative disease (29). Reexcision rates are generally not reduced by preoperative MRI (31,32), although MRI has been shown to be beneficial in presurgical planning for invasive lobular carcinoma (ILC) (33,34).…”

Section: Extent Of Diseasementioning

confidence: 99%

Nuclear Breast Imaging: Clinical Results and Future Directions

Berg

2016

J Nucl Med

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Interest in nuclear breast imaging is increasing because of technical improvements in dedicated devices that allow the use of relatively low doses of radiotracers with high sensitivity for even small breast cancers. For women with newly diagnosed cancer, primary chemotherapy is often recommended, and improved methods of assessing treatment response are of interest. With widespread breast density notification, functional rather than anatomic methods of screening are of increasing interest as well. For a cancer imaging technology to be adopted, several criteria must be met that will be discussed: evidence of clinical benefit with minimal harm, standardized interpretive criteria, direct biopsy guidance, and acceptable cost-effectiveness. Twor adiotracers have been used widely to depict breast cancer: the g-emitting 99m Tc-sestamibi ( 99m Tc-methoxyisobutylisonitrile), 140 keV, half-life of 6 h, originally developed as a myocardial perfusion agent; and the positron-emitting glucose analog 18 F-FDG, 511 keV, half-life of 2 h. Standard lead shielding as is used in a mammography suite is sufficient when using 99m Tc-sestamibi. Using 18 F-FDG requires much more extensive shielding and may not be feasible because of workspaces above or below the planned unit. State licensing requirements for nuclear medicine must be considered; typically, a hot lab with oversight by a trained nuclear medicine technologist and a physicist is required (1).Both 99m Tc-sestamibi and 18 F-FDG were initially studied for breast cancer using whole-body scanners. Low sensitivity to invasive cancers smaller than 1 cm was observed with whole-body g-camera imaging in a prospective multicenter series at 48.2%, compared with 74.2% for larger tumors (2); detection of small cancers, particularly small invasive cancers, is a major goal of breast imaging. Similar results were observed with whole-body PET, with sensitivity to invasive tumors 2 cm or smaller of only 30 of 44 (68%) compared with 57 of 62 (92%) for larger cancers (3).Dedicated breast g-camera imaging can be performed with singledetector scintillating-crystal systems such as breast-specific g-imaging (BSGI) (Dilon Technologies) with a 20 · 15 cm field of view, 3.3-mm pixel size; or using dual-head cadmium-zinc-telluride detector systems, often referred to as molecular breast imaging (MBI) (GE Healthcare, with a 24 · 16 cm field of view and 2.5-mm pixel size; or Gamma Medica, Inc., with a 20 · 16 cm field of view and 1.6 mm pixel size). Both approaches use positioning similar to that of mammography, with the breast gently stabilized between a compression paddle and the detector (BSGI) or between 2 detectors (MBI). It is important to include mammographic technologists in the positioning of the patients, at least for a minimum number of cases (e.g., 25), to ensure full inclusion of posterior tissues for both a craniocaudal and a mediolateral oblique (MLO) acquisition. Particularly with the dualhead systems, it can be difficult to prevent skin folds or to ensure that the nipple is in profile becau...

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Early Stage Triple-Negative Breast Cancer: Imaging and Clinical-Pathologic Factors Associated with Recurrence

Cited by 45 publications

References 33 publications

Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

Nuclear Breast Imaging: Clinical Results and Future Directions

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