Enida Bufi1, Paolo Belli2, Melania Costantini2, Antonio Cipriani2, Marialuisa Di Matteo3, Angelo Bonatesta2, Gianluca Franceschini4, Daniela Terribile4, Antonino Mulé3, Luigia Nardone5, Lorenzo Bonomo2. 1. Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy. Electronic address: reagandus@alice.it. 2. Department of Bioimaging and Radiological Sciences, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy. 3. Department of Pathology, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy. 4. Department of Surgery, Breast Unit, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy. 5. Department of Radiotherapy, Catholic University of Sacred Heart, "Agostino Gemelli" Hospital, Rome, Italy.
Abstract
BACKGROUND: We evaluated the diagnostic performance of the baseline diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in the prediction of a complete pathologic response (pCR) to neoadjuvant chemotherapy (NAC) in patients with breast cancer stratified according to the tumor phenotype. PATIENTS AND METHODS: We retrospectively studied 225 patients with stage II, III, and IV breast cancer who had undergone contrast-enhanced magnetic resonance imaging (MRI) and DWI before and after NAC, followed by breast surgery. RESULTS: The tumor phenotypes were luminal (n = 143; 63.6%), triple-negative (TN) (n = 37; 16.4%), human epidermal growth factor receptor 2 (HER2)-enriched (n = 17; 7.6%), and hybrid (hormone receptor-positive/HER2(+); n = 28; 12.4%). After NAC, a pCR was observed in 39 patients (17.3%). No statistically significant difference was observed in the mean ADC value between a pCR and no pCR in the general population (1.132 ± 0.191 × 10(-3) mm(2)/s vs. 1.092 ± 0.189 × 10(-3) mm(2)/s, respectively; P = .23). The optimal ADC cutoff value in the general population was 0.975 × 10(-3) mm(2)/s (receiver operating characteristic [ROC] area under the curve [AUC], 0.587 for the prediction of a pCR). After splitting the population into subgroups according to tumor phenotype, we observed a significant or nearly significant difference in the mean ADC value among the responders versus the nonresponders in the TN (P = .06) and HER2(+) subgroups (P = .05). No meaningful difference was seen in the luminal and hybrid subgroups (P = .59 and P = .53, respectively). In contrast, in the TN and HER2(+) subgroups (cutoff value, 0.995 × 10(-3) mm(2)/s and 0.971 × 10(-3) mm(2)/s, respectively), we observed adequate ROC AUCs (0.766 and 0.813, respectively). CONCLUSION: The pretreatment ADC value is not capable of predicting the pCR in the overall population of patients with locally advanced breast cancer. Nonetheless, an ameliorated diagnostic performance was observed in specific phenotype subgroups (ie, TN and HER2(+) tumors).
BACKGROUND: We evaluated the diagnostic performance of the baseline diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in the prediction of a complete pathologic response (pCR) to neoadjuvant chemotherapy (NAC) in patients with breast cancer stratified according to the tumor phenotype. PATIENTS AND METHODS: We retrospectively studied 225 patients with stage II, III, and IV breast cancer who had undergone contrast-enhanced magnetic resonance imaging (MRI) and DWI before and after NAC, followed by breast surgery. RESULTS: The tumor phenotypes were luminal (n = 143; 63.6%), triple-negative (TN) (n = 37; 16.4%), human epidermal growth factor receptor 2 (HER2)-enriched (n = 17; 7.6%), and hybrid (hormone receptor-positive/HER2(+); n = 28; 12.4%). After NAC, a pCR was observed in 39 patients (17.3%). No statistically significant difference was observed in the mean ADC value between a pCR and no pCR in the general population (1.132 ± 0.191 × 10(-3) mm(2)/s vs. 1.092 ± 0.189 × 10(-3) mm(2)/s, respectively; P = .23). The optimal ADC cutoff value in the general population was 0.975 × 10(-3) mm(2)/s (receiver operating characteristic [ROC] area under the curve [AUC], 0.587 for the prediction of a pCR). After splitting the population into subgroups according to tumor phenotype, we observed a significant or nearly significant difference in the mean ADC value among the responders versus the nonresponders in the TN (P = .06) and HER2(+) subgroups (P = .05). No meaningful difference was seen in the luminal and hybrid subgroups (P = .59 and P = .53, respectively). In contrast, in the TN and HER2(+) subgroups (cutoff value, 0.995 × 10(-3) mm(2)/s and 0.971 × 10(-3) mm(2)/s, respectively), we observed adequate ROC AUCs (0.766 and 0.813, respectively). CONCLUSION: The pretreatment ADC value is not capable of predicting the pCR in the overall population of patients with locally advanced breast cancer. Nonetheless, an ameliorated diagnostic performance was observed in specific phenotype subgroups (ie, TN and HER2(+) tumors).
Authors: David C Newitt; Zheng Zhang; Jessica E Gibbs; Savannah C Partridge; Thomas L Chenevert; Mark A Rosen; Patrick J Bolan; Helga S Marques; Sheye Aliu; Wen Li; Lisa Cimino; Bonnie N Joe; Heidi Umphrey; Haydee Ojeda-Fournier; Basak Dogan; Karen Oh; Hiroyuki Abe; Jennifer Drukteinis; Laura J Esserman; Nola M Hylton Journal: J Magn Reson Imaging Date: 2018-10-22 Impact factor: 4.813
Authors: Savannah C Partridge; Zheng Zhang; David C Newitt; Jessica E Gibbs; Thomas L Chenevert; Mark A Rosen; Patrick J Bolan; Helga S Marques; Justin Romanoff; Lisa Cimino; Bonnie N Joe; Heidi R Umphrey; Haydee Ojeda-Fournier; Basak Dogan; Karen Oh; Hiroyuki Abe; Jennifer S Drukteinis; Laura J Esserman; Nola M Hylton Journal: Radiology Date: 2018-09-04 Impact factor: 29.146
Authors: Gene Y Cho; Lucas Gennaro; Elizabeth J Sutton; Emily C Zabor; Zhigang Zhang; Dilip Giri; Linda Moy; Daniel K Sodickson; Elizabeth A Morris; Eric E Sigmund; Sunitha B Thakur Journal: Eur J Radiol Open Date: 2017-08-18