Filiz Çelebi1, Filiz Agacayak2, Alper Ozturk3, Serkan Ilgun4, Muhammed Ucuncu5, Zeynep Erdogan Iyigun6, Çetin Ordu7, Kezban Nur Pilanci8, Gul Alco9, Serap Gultekin10, Emetullah Cindil10, Gursel Soybir11, Fatma Aktepe12, Vahit Özmen13. 1. Department of Radiology, Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sk. No:8, Gayrettepe/Beşiktaş, 34349, Istanbul, Turkey. elbuken.filiz@gmail.com. 2. Department of Radiology, İstanbul Florence Nightingale Hospital, Abide-i Hürrüyet Caddesi 161, Şişli, 34384, İstanbul, Turkey. 3. Biruni University Hospital, Protokol Yolu No:45, 10.YılCd., Zeytinburnu, 34010, İstanbul, Turkey. 4. Taksim Education and Research Hospital, Karayolları Mahallesi, Osmanbey Caddesi, 621 Sokak, Gaziosmanpaşa, 34255, İstanbul, Turkey. 5. Department of General Surgery, İstanbul Florence Nightingale Hospital, Abide-i Hürrüyet Caddesi 161, Şişli, 34384, İstanbul, Turkey. 6. Physical Therapy and Rehabilitation, İstanbul Florence Nightingale Hospital, Abide-i Hürrüyet Caddesi, Şişli, 34384, İstanbul, Turkey. 7. Department of Oncology, Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sk. No:8, Gayrettepe/Beşiktaş, 34349, Istanbul, Turkey. 8. Department of Oncology, Memorial Bahcelievler Hospital, Bahcelievler Mah. Eski Londra Asf CD No:227, Bahcelievler, 34180, Istanbul, Turkey. 9. Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sk. No:8, Gayrettepe/Beşiktaş, 34349, Istanbul, Turkey. 10. Faculty of Medicine, Department of Radiology, Gazi University, Bestepe, Ankara, Turkey. 11. Department of General Surgery, Memorial Etiler Hospital, Nispetiye st. Erdolen Ishanı no:38, Etiler, Istanbul, Turkey. 12. Department of Pathology, Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sk. No:8, Gayrettepe/Beşiktaş, 34349, Istanbul, Turkey. 13. Department of General Surgery, İstanbul Florence Nightingale Hospital, Abide-i Hürrüyet Caddesi, Şişli, 34384, İstanbul, Turkey.
Abstract
OBJECTIVES: Tumor-infiltrating lymphocytes (TILs) have been determined as a new prognostic indicator of immunotherapy response in breast cancer (BC). The aim of this study is to investigate the effectiveness of imaging features in predicting the TIL levels in invasive BC patients. METHODS: A total of 158 patients with invasive BC were included in our study. All lesions were evaluated based on the BIRADS lexicon. US was performed for all the patients and 89 of them underwent MRI. The histologic stromal TIL (sTIL) levels were assessed and associations between the sTIL levels and imaging features were evaluated. RESULTS: Tumors with high sTIL levels had more circumscribed margins, round shape, heterogeneous echogenicity, and larger size on ultrasonography (p < 0.005). There was a statistically significant positive correlation between the sTIL levels and ADC value (p < 0.001). Tumors with high sTIL levels had significantly more homogeneous enhancement than the tumors with low sTIL levels (p = 0.001). Logistic regression analysis showed that the ADC was the most statistically significant parameter in predicting the sTIL levels (the odds ratio was 90.952; p = 0.002). The optimal cutoff value for ADC in predicting low and high sTIL levels was found to be 0.87 × 10-3 mm2 s-1 (AUC = 0.726, 73% specificity, and 60% sensitivity). CONCLUSIONS: Imaging findings, especially the ADC, may play an important role as an adjunct tool in cases of uncertain situations and may improve the accuracy of biopsy results. The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis. KEY POINTS: • Preoperative assessment of TILs is an important biomarker of prognosis and treatment efficacy. • ADC value can be a useful tool in distinguishing high and low sTIL levels as a non-invasive method. • The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis and an optimal treatment for the BC patients.
OBJECTIVES:Tumor-infiltrating lymphocytes (TILs) have been determined as a new prognostic indicator of immunotherapy response in breast cancer (BC). The aim of this study is to investigate the effectiveness of imaging features in predicting the TIL levels in invasive BCpatients. METHODS: A total of 158 patients with invasive BC were included in our study. All lesions were evaluated based on the BIRADS lexicon. US was performed for all the patients and 89 of them underwent MRI. The histologic stromal TIL (sTIL) levels were assessed and associations between the sTIL levels and imaging features were evaluated. RESULTS:Tumors with high sTIL levels had more circumscribed margins, round shape, heterogeneous echogenicity, and larger size on ultrasonography (p < 0.005). There was a statistically significant positive correlation between the sTIL levels and ADC value (p < 0.001). Tumors with high sTIL levels had significantly more homogeneous enhancement than the tumors with low sTIL levels (p = 0.001). Logistic regression analysis showed that the ADC was the most statistically significant parameter in predicting the sTIL levels (the odds ratio was 90.952; p = 0.002). The optimal cutoff value for ADC in predicting low and high sTIL levels was found to be 0.87 × 10-3 mm2 s-1 (AUC = 0.726, 73% specificity, and 60% sensitivity). CONCLUSIONS: Imaging findings, especially the ADC, may play an important role as an adjunct tool in cases of uncertain situations and may improve the accuracy of biopsy results. The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis. KEY POINTS: • Preoperative assessment of TILs is an important biomarker of prognosis and treatment efficacy. • ADC value can be a useful tool in distinguishing high and low sTIL levels as a non-invasive method. • The prediction of sTIL levels using imaging findings may give an opportunity to predict prognosis and an optimal treatment for the BCpatients.
Entities:
Keywords:
Breast cancer; Diffusion; Lymphocytes; Magnetic resonance imaging; Tumor
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