| ObjectiveTo investigate the correlation between apparent diffusion coefficient(ADC)value and the five molecular subtypes of non-specific type invasive breast carcinomas[Luminal A,Luminal B(HER-2 negative),Luminal B(HER-2 positive),HER-2 enriched,Basal-like subtype]and its biological prognostic factors[estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor 2(HER-2),Ki-67 labelling index]to provide the theory basis for identifying the different molecular subtypes and evaluating prognosis of breast cancer.Materials and Methods1.Patients information:This study retrospectively analyzed breast cancer patients diagnosed and treated in liaoning cancer hospital from January 2015 to December 2018.Finally,199 female patients were enrolled,with a total of 202 lesions(3 patients had bilateral breast lesions),and all of them met the requirements for enrollment.The enrolled patients in this study were 25 to 76 years old,with an average age of 52.1±9.9 years.Tumor volume range is about 9 mm×14 mm×15 mm～65 mm×25 mm×35 mm.2.Criterions for its biological prognostic factors and molecular subtypes:Combined with the immunohistochemical testing guidelines issued by the American society of clinical oncology/College of American pathologists(ASCO/CAP)and Chinese pathologists,the criteria for its biological prognostic factors(ER,PR,HER-2,Ki-67)were determined.According to the expert consensus reached at the 2013 St.Gallen international breast cancer conference,five molecular subtypes of non-specific invasive breast cancer were determined by taking pathological diagnosis and immunohistochemical results as the gold standard:Luminal A,Luminal B(HER-2 negative),Luminal B(HER-2 positive),HER-2 enriched,Basal-like subtype.3.MR protocols and Image Post-processing:GE Signa Excite HD 1.5T MR scanner and 8-channel phased-array surface coil was used.After conventional three-plane positioning scan,the plain scan adopted the sagittal plane rapid spin echo of bilateral mammary glands to T2WI.Secondly,Cross-sectional DWI scanning was performed.The scanning parameters were as follows:b values=0 s/mm2,800 s/mm2,TR 5000ms,TE 63.2ms,layer thickness 4mm,layer spacing 1mm,matrix 160x112,excitation times 4,FOV 20cmx20cm.All DWI sequences were fat-inhibited.The final VIBRANT was multitemporal dynamic contrast enhanced MRI(DCE MRI).Image processing were performed on GE ADW 4.5.3 workstation.The region of interest(ROI)was delimited on the ADC map after diffusion-weighted image processing with the Functool software on the workstation,referring to the T2WI and DCE-MRI images,by using the double-blind method.ROI should be located at the level of the largest lesion or both,avoiding visible areas of hemorrhage,liquefaction,necrosis and cystic change as much as possible,with an area of 25mm2～40mm2.Each lesion was measured 3 times,and the values were recorded respectively.Finally,the average ADC value was taken as the final measurement value of the lesion.4.Statistical Analysis:SPSS 25.0 software was used for statistical analysis in this study.The mean ADC values of ER,PR,HER-2 and Ki-67 were compared by independent-samples t test.The one-way analysis of variance(ANOVA)was used for the comparison of mean ADC values among molecular subtypes,and the pairwise comparison was performed by the least significant difference method(LSD-t).The correlation between ER,PR,HER-2,Ki-67 and the mean ADC values of non-specific invasive cancers was analyzed by using Spearman rank correlation analysis.Test significance level a=0.05,P<0.05 means the difference is statistically significant.Results1.By the independent-samples t test and Spearman rank correlation analysis:(1)the mean ADC values of ER-positive and PR-positive group was lower thanthat in ER-negative,PR negative group(0.880±0.152 VS 0.943±0.129,0.880±0.153 VS 0.930±0.134),the difference was statistically significant(P<0.01,P<0.05).There was a negative correlation between the mean ADC values and ER/PR positive(r=-0.177,P=0.012;r=-0.154,P=0.029).(2)The mean ADC values of Ki-67 high expression group was lower than that in Ki-67 low expression group(0.893±0.158 VS 0.928±0.067),the difference was statistically significant(P<0.05).(3)The mean ADC value of HER-2 positive group is significantly higher than that in HER-2 group negative(0.992±0.135 VS 0.866±0.139).There was a positive correlation between the mean ADC values and HER-2 positive(r=0.342,P<0.001).2.By one-way analysis of variance(ANOVA),in the multiple comparison of mean ADC values:(1)The mean ADC values of Luminal A group was higher than Luminal B(HER-2 negative)group,and lower than HER-2 enriched group(P=0.017,P=0.020).(2)The mean ADC values of Luminal B(HER-2 negative)group was lower than Luminal B(HER-2 positive)group and HER-2 enriched group(P=0.001,P<0.001).(3)The mean ADC values of Luminal B(HER-2 positive)group was higher than Basal-like subtype group(P=0.024).(4)The mean ADC values of HER-2 enriched group was higher than Basal-like subtype group(P<0.001).Conclusion1.The mean ADC value of biological factor in non-specific invasive breast cancer is different.There was a negative correlation between the mean ADC values and ER/PR positive,but was a positive correlation between the mean ADC values and HER-2 positive.It indirectly reflect the prognosis of breast cancer and achieve the purpose of using preoperative magnetic resonance imaging technology to predict the expression state of biological factors.2.There are significant differences in the mean ADC values among molecular subtypes of non-specific invasive breast cancer,revealing the heterogeneity of breast cancer and providing a new perspective for MRI imaging technology to predict heterogeneity of breast cancer.To sum up,the prediction of biological factors and molecular typing of breast cancer based on diffusion-weighted imaging technology can determine the intrinsic biological characteristics of tumor lesions preoperatively and provide help for the development of individualized treatment programs for breast cancer patients. |
PDF Full Text Request