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Diffusion-weighted MRI of estrogen receptor-positive, HER2-negative, node-negative breast cancer: association between intratumoral heterogeneity and recurrence risk

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Abstract

Objectives

To investigate possible associations between quantitative apparent diffusion coefficient (ADC) metrics derived from whole-lesion histogram analysis and breast cancer recurrence risk in women with estrogen receptor (ER)–positive, human epidermal growth factor receptor 2 (HER2)–negative, node-negative breast cancer who underwent the Oncotype DX assay.

Methods

This retrospective study was conducted on 105 women (median age, 48 years) with ER-positive, HER2-negative, node-negative breast cancer who underwent the Oncotype DX test and preoperative diffusion-weighted imaging (DWI). Histogram analysis of pixel-based ADC data of whole tumors was performed, and various ADC histogram parameters (mean, 5th, 25th, 50th, 75th, and 95th percentiles of ADCs) were extracted. The ADC difference value (defined as the difference between the 5th and 95th percentiles of ADCs) was calculated to assess intratumoral heterogeneity. Associations between quantitative ADC metrics and the recurrence risk, stratified using the Oncotype DX recurrence score (RS), were evaluated.

Results

Whole-lesion histogram analysis showed that the ADC difference value was different between the low-risk recurrence (RS < 18) and the non-low-risk recurrence (RS ≥ 18; intermediate to high risk of recurrence) groups (0.600 × 10−3 mm2/s vs. 0.746 × 10−3 mm2/s, p < 0.001). Multivariate regression analysis demonstrated that a lower ADC difference value (< 0.559 × 10−3 mm2/s; odds ratio [OR] = 5.998; p = 0.007) and a small tumor size (≤ 2 cm; OR = 3.866; p = 0.012) were associated with a low risk of recurrence after adjusting for clinicopathological factors.

Conclusions

The ADC difference value derived from whole-lesion histogram analysis might serve as a quantitative DWI biomarker of the recurrence risk in women with ER-positive, HER2-negative, node-negative invasive breast cancer.

Key Points

• A lower ADC difference value and a small tumor size were associated with a low risk of recurrence of breast cancer.

• The ADC difference value could be a quantitative marker for intratumoral heterogeneity.

• Whole-lesion histogram analysis of the ADC could be helpful for discriminating the low-risk from non-low-risk recurrence groups.

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Abbreviations

ADC:

Apparent diffusion coefficient

ASCO:

American Society for Clinical Oncology

BRCA:

Breast cancer susceptibility gene

CI:

Confidence interval

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

ER:

Estrogen receptor

HER2:

Human epidermal growth factor receptor 2

MRI:

Magnetic resonance imaging

NCCN:

National Comprehensive Cancer Network

OR:

Odds ratio

PR:

Progesterone receptor

ROI:

Region-of-interest

RS:

Recurrence score

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Funding

This study was supported by Biomedical Research Institute Grant (2018B036), Pusan National University Hospital.

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Authors and Affiliations

  1. Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea

    Jin You Kim, Jin Joo Kim, Lee Hwangbo, Ji Won Lee & Nam Kyung Lee

  2. Department of Radiology, Pusan National University School of Medicine, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea

    Jin You Kim

  3. Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea

    Kyung Jin Nam & Ki Seok Choo

  4. Busan Cancer Center, Pusan National University Hospital, Busan, Republic of Korea

    Taewoo Kang & Heeseung Park

  5. Siemens Healthineers Ltd., Seoul, Republic of Korea

    Yohan Son

  6. Siemens Healthcare GmbH, Erlangen, Germany

    Robert Grimm

Authors
  1. Jin You Kim
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Corresponding author

Correspondence to Jin You Kim.

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Guarantor

The scientific guarantor of this publication is Jin You Kim.

Conflict of interest

This work was based on the Multiparametric Analysis works-in-progress software package provided by Siemens Healthineers.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Kim, J.Y., Kim, J.J., Hwangbo, L. et al. Diffusion-weighted MRI of estrogen receptor-positive, HER2-negative, node-negative breast cancer: association between intratumoral heterogeneity and recurrence risk. Eur Radiol 30, 66–76 (2020). https://doi.org/10.1007/s00330-019-06383-6

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  • DOI: https://doi.org/10.1007/s00330-019-06383-6

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