Evaluation Of Biological Behavior Of Breast Cancer With Dynamic Contrast Enhanced MRI

partâ… Evaluation of BI-RADS category in the diagnosis of breast masses with dynamic contrast enhanced MRI.Objective:To evaluate the role of the breast imaging reporting and dada system (BI-RADS) categories developed by American College of Radiology and some parameters such as S_mak,K₁ in the diagnosis of breast masses with dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)Methods:Eighty-one patients with suspected breast mass underwent preoperative DCE-MRI of the breast.The MR images were divided into five categories according to BI-RADS criteria(categoryâ… ,negative;categoryâ…¡,benign;categoryâ…¢,probably benign; categoryâ…£,suspicious for malignancy;categoryâ…¤,highly suggestive of malignancy). The parameters such as steepest slope(S_max);wash-in slope(K₁) were calculated based on time-signal intensity curves of DCE-MRI.Results:Pathologic findings were conducted as golden standard.Of 42 breast cancers,1, 0,6,12,23 cases were assigned to categoryâ… ,categoryâ…¡,categoryâ…¢,categoryâ…£, categoryâ…¤,respectively.Of 39 benign lesions,18,6,12,3,0 cases were assigned to categoryâ… ,categoryâ…¡,categoryâ…¢,categoryâ…£,categoryâ…¤,respectively.A significant difference was found between malignant and benign breast masses(x²= 50.649,P＜0.0001).The sensitivity,specificity,accuracy rate,positive and negative predictive values of DCE-MRI according to BI-RADS(if category aboveâ…£were classified as malignant) were 83.3%,92.9%,91.4%,92.1%,84.8%,respectively.No significant difference between BI-RADS and BI-RADS combined with dynamic parameters was found in the diagnosis of breast cancer(u=0.907,P=0.330).Conclusion:BI-RADS category is a standard and objective criterion for DCE-MRI in the diagnosis of breast cancer.However,dynamic parameters such as S_max,K₁ aren't more helpful to the BI-RADS category in the differential diagnosis. Partâ…¡Correlative study of the parameters of dynamic contrast- enbanced MRI and angiogenesis in breast lesionsObjective To evaluate the relationship between dynamic contrast-enhanced MRI (DCE-MRI)-derived parameters and tumor angiogenesis in malignant and benign breast lesions.Methods Fifty-one patients with malignant and benign breast diseases underwent DCE-MRI using Philips Intera 1.5 T MR system and dedicated breast coil prospectively before operation.DCE-MRI derived parameters such as steepest slope(S_max),peak height(PH),time-to-peak(T_peak) were calculated based on time-signal intensity curve.The micro-vessel density(MVD) was counted and vascular endothelial growth factor(VEGF) expression was assessed in these patients after operation with immunohistochemical staining method.The parameters were correlated statistically with MVD counts and VEGF expression in breast cancer.The MVD counts and VEGF expression were also compared among the patients with breast cancer(29 case),with fibroadenoma(12 case),mastopathy (10 case) and the normal tissue(10 case) beside the cancer.Results The enhancement parameters S_max(r=0.807,p＜0.001),PH(r=0.697,p＜0.001) correlated positively with MVD respectively.T_peak(69±38) correlated negatively with MVD counts(r=-0.425,P＜0.05).The mean value of MVD(65.09±15.81/200 times field) in patients with breast cancer were significantly more than those with fibroadenoma,mastopathy and the normal tissue beside the cancer,respectively(p= 0.043,p=0.018,P=0.002).69%(20/29)cases of breast cancers demonstrated positive VEGF expression,which were significantly more than the cases of fibroadenoma, mastopathy and the normal tissue beside the cancer(p=0.035,p=0.007,p= 0.001),respectively.Moreover,the MVD counts(60.38±24.14) at the peripheral region of breast cancer were more than those at central region(37.64±16.52)(t=2.635,p=0.016). There was a significant difference in MVD counts between breast cancers(73.23±23.02) with metastasis to axillary lymph nodes and those without metastasis(59.34±18.03)(t= 2.303,p=0.031).Conclusion Some parameters derived from DCE-MRI correlated positively with MVD counts and VEGF expression in patients with breast cancer,which can reflect tumor angiogenesis objectively.The MVD counts and VEGF expression in patients with breast cancer were significantly more than those in patients with benign lesions. Partâ…¢Correlation of the parameters of dynamic contrast- enhanced MRI with prognostic factors in breast cancerObjective To explore the possibility of dynamic contrast-enhanced MR imaging (DCE-MRI) in predicting the prognosis of breast cancer in vivo by correlating its morphological characteristics,the kinetic MR parameters on DCE-MRI with classical and molecular prognostic factors.Methods Thirty-four patients with breast cancer underwent dynamic contrast-enhanced MR imaging before operation.The morphological characteristics on DCE-MRI,the type of time signal-intensity curve(TIC) and the kinetic enhancing parameters(enhancement ratio, E_1-6;time to peak,T_peak;the initial slope,Slope_i and the washout ratio,W_peak-6) were recorded.The correlation between them and detected biomarkers(ER,c-erbB-2,Ki-67, uPA/PAI-1),were statistically analyzed with the Spearman Rank Correlation.Results The spicular enhancing periphery of the tumor correlated positively with the the expression of uPA/PAI-1(r=0.510).The internal homogenous enhancemant correlated negatively with the expression of ER(r=-0.332).The ring-like enhancement correlated positively with the metastases to lymph node(r=0.560),the pathological grade(r=0.354), the expression of uPA/PAI-1(r=0.314) and negatively with the expression of ER(r= -0.407).The wash-out type of TIC correlated positively with the expression of uPA/PAI-1 (r=0.507).The T_peak correlated negatively with the expression of Ki-67(r=-0.542), c-erbB-2(r=-0.535) and uPA/PAI-1(r=-0.640).It also correlated positively with the expression of ER(r=0.532).Conclusion DCE-MRI play not only a important role in the differential diagnosis of breast cancer,but also is indirectly helpful in vivo both in evaluating the prognosis and in drawing up the treatment plan of the breast carcinoma.The statistical significant correlation between morphological characteristics,some kinetic enhancing parameters on DCE-MRI and detected biomarkers was found.The internal inhomogenous enhancemant, ring-like enhancement,spicular enhancing periphery of the tumor and short time to peak, washing out TIC are suggestive of unhealthy prognostic factors.