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European Radiology
Published in: European Radiology 12/2015

01-12-2015 | Breast

Intratumoral metabolic heterogeneity predicts invasive components in breast ductal carcinoma in situ

Authors: Hai-Jeon Yoon, Yemi Kim, Bom Sahn Kim

Published in: European Radiology | Issue 12/2015

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Abstract

Objectives

This study investigated whether texture-based imaging parameters could identify invasive components of ductal carcinoma in situ (DCIS).

Methods

We enrolled 65 biopsy-confirmed DCIS patients (62 unilateral, 3 bilateral) who underwent 18 F-FDG PET, diffusion-weighted imaging (DWI), or breast-specific gamma imaging (BSGI). We measured SUV max and intratumoral metabolic heterogeneity by the area under the curve (AUC) of cumulative SUV histograms (CSH) on PET, tumour-to-normal ratio (TNR) and coefficient of variation (COV) as an index of heterogeneity on BSGI, minimum ADC (ADC min ) and ADC difference (ADC diff ) as an index of heterogeneity on DWI. After surgery, final pathology was categorized as pure-DCIS (DCIS-P), DCIS with microinvasion (DCIS-MI), or invasive ductal carcinoma (IDC). Clinicopathologic features of DCIS were correlated with final classification.

Results

Final pathology confirmed 44 DCIS-P, 14 DCIS-MI, and 10 IDC. The invasive component of DCIS was significantly correlated with higher SUV max (p = 0.017) and lower AUC-CSH (p < 0.001) on PET, higher TNR (p = 0.008) and COV (p = 0.035) on BSGI, lower ADC min (p = 0.016) and higher ADC diff (p = 0.009) on DWI, and larger pathologic size (p = 0.018). On multiple regression analysis, AUC-CSH was the only significant predictor of invasive components (p = 0.044).

Conclusions

The intratumoral metabolic heterogeneity of 18 F-FDG PET was the most important predictor of invasive components of DCIS.

Key Points

• Preoperative identification of invasion in DCIS is important for axillary nodal management
• Higher SUV max and lower AUC-CSH from FDG PET may indicate invasive components of DCIS
• Higher TNR and COV from BSGI may indicate invasive components of DCIS
• Lower ADC min and higher ADC diff from DWI may indicate invasive components of DCIS
• AUC-CSH, an index of metabolic heterogeneity, is an independent predictor for invasive components
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Metadata
Title
Intratumoral metabolic heterogeneity predicts invasive components in breast ductal carcinoma in situ
Authors
Hai-Jeon Yoon
Yemi Kim
Bom Sahn Kim
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3761-9

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