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European Radiology
Published in: European Radiology 2/2022

01-02-2022 | Magnetic Resonance Imaging | Breast

Characterization of breast cancer subtypes based on quantitative assessment of intratumoral heterogeneity using dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging

Authors: Jin Joo Kim, Jin You Kim, Hie Bum Suh, Lee Hwangbo, Nam Kyung Lee, Suk Kim, Ji Won Lee, Ki Seok Choo, Kyung Jin Nam, Taewoo Kang, Heeseung Park

Published in: European Radiology | Issue 2/2022

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Abstract

Objective

To investigate whether intratumoral heterogeneity, assessed via dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI), reflects the molecular subtypes of invasive breast cancers.

Material and methods

We retrospectively evaluated data from 248 consecutive women (mean age ± standard deviation, 54.6 ± 12.2 years) with invasive breast cancer who underwent preoperative DCE-MRI and DWI between 2019 and 2020. To evaluate intratumoral heterogeneity, kinetic heterogeneity (a measure of heterogeneity in the proportions of tumor pixels with delayed washout, plateau, and persistent components within a tumor) was assessed with DCE-MRI using a commercially available computer-aided diagnosis system. Apparent diffusion coefficients (ADCs) were obtained using a region-of-interest technique, and ADC heterogeneity was calculated using the following formula: (ADCmax−ADCmin)/ADCmean. Possible associations between imaging-based heterogeneity values and breast cancer subtypes were analyzed.

Results

Of the 248 invasive breast cancers, 61 (24.6%) were classified as luminal A, 130 (52.4%) as luminal B, 25 (10.1%) as HER2-enriched, and 32 (12.9%) as triple-negative breast cancer (TNBC). There were significant differences in the kinetic and ADC heterogeneity values among tumor subtypes (p < 0.001 and p = 0.023, respectively). The TNBC showed higher kinetic and ADC heterogeneity values, whereas the HER2-enriched subtype showed higher kinetic heterogeneity values compared to the luminal subtypes. Multivariate linear analysis showed that the HER2-enriched (p < 0.001) and TNBC subtypes (p < 0.001) were significantly associated with higher kinetic heterogeneity values. The TNBC subtype (p = 0.042) was also significantly associated with higher ADC heterogeneity values.

Conclusions

Quantitative assessments of heterogeneity in enhancement kinetics and ADC values may provide biological clues regarding the molecular subtypes of breast cancer.

Key Points

• Higher kinetic heterogeneity was associated with HER2-enriched and triple-negative breast cancer.
• Higher ADC heterogeneity was associated with triple-negative breast cancer.
• Aggressive breast cancer subtypes exhibited higher intratumoral heterogeneity based on MRI.
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Metadata
Title
Characterization of breast cancer subtypes based on quantitative assessment of intratumoral heterogeneity using dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging
Authors
Jin Joo Kim
Jin You Kim
Hie Bum Suh
Lee Hwangbo
Nam Kyung Lee
Suk Kim
Ji Won Lee
Ki Seok Choo
Kyung Jin Nam
Taewoo Kang
Heeseung Park
Publication date
01-02-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2022
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-021-08166-4

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