Feasibility Study Of MAGIC Quantitative Parameters To Assess The Efficacy Of Neoadjuvant Chemotherapy For Breast Cancer

Objective: To investigate the value of quantitative MAGIC parameters in assessing the efficacy of neoadjuvant chemotherapy for breast cancer,and to explore the influence of peri-tumor area on the efficacy of neoadjuvant chemotherapy,in conjunction with solid tumor imaging,with the expectation of discovering a test that can quantitatively and early predict the efficacy of neoadjuvant chemotherapy for breast cancer.Materials and methods: According to the inclusion and exclusion criteria,84 patients with breast cancer confirmed by pathological biopsy and scheduled to receive neoadjuvant chemotherapy and surgery in our hospital from December 2021 to January 2023 were prospectively collected,among which 2 patients had lesions on both breasts,a total of 86 breast cancer lesions.Conventional MRI and synthetic MRI scans were performed before neoadjuvant chemotherapy,after 2 cycles of chemotherapy,and after full chemotherapy,respectively.Using conventional enhanced T1 WI sequences as the basis,the area with obvious enhancement was considered as tumor tumor area/intratumoral(T),and the area within 2cm near tumor was considered as peritumoral area.The peritumoral area expanded outward successively according to the distance from the tumor margin,and was divided into the borderline area of the tumor(P1),proximal stromal area(P2),intermediate stromal area(P3)and distal stromal area(P4)every 5mm.We were interested in delineating T1 and T2 values of tumor and each peritumoral area in different chemotherapy periods,and included the changes of peritumoral edema in the study.Neoadjuvant chemotherapy for breast cancer was divided into pathologic complete response(PCR)group and non-PCR group based on postoperative pathology.T1 and T2 values and their derived parameters(changes in the early stage of chemotherapy and changes in the end of chemotherapy)were calculated before,after 2 cycles of chemotherapy and after the end of chemotherapy in the two groups.T-test was used for those conforming to normal distribution,and independent sample Wilcoxon rank sum test was used for those not conforming to normal distribution.The area under the curve was calculated using the appropriate diagnostic threshold,and the diagnostic efficacy of MAGIC quantitative parameters and derived parameters was compared.Results: Eighty-four patients with breast cancer(a total of 86 breast lesions)received Neoadjuvant chemotherapy,including 24 lesions in the PCR group and 62 lesions in the non-PCR group.1.Interatumoral:(1)P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 in the PCR group and non-PCR group were 0.494,0.101,0.795 and 0.182,respectively.At the early stage of chemotherapy,the P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 were0.824,0.604,0.196 and 0.859,respectively.After chemotherapy,P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 in PCR group and non-PCR group were 0.577,0.791,0.132 and 0.577,respectively.The above P values were all greater than 0.05,and the differences were not statistically significant.2.Peritumoral:(1)P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 at baseline tumor junction were 0.118,0.988,0.080 and 0.773 in PCR group and non-PCR group,respectively;The P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 in the proximal stroma region were 0.195,0.312,0.516 and 0.765,respectively.The P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 in the middle matrix region were 0.470,0.179,0.573 and 0.321,respectively.The P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 in the distal stroma region were 0.331,0.159,0.308 and 0.591,respectively.The above P values were all greater than 0.05,and the differences were not statistically significant.(2)At the early stage of chemotherapy,P values of Pre-T2,Gd-T1,Gd-T2,Pre-T1,Pre-T2,Gd-T2 in the proximal stroma,Pre-T2,Gd-T2 in the intermediate stroma and Pre-T2 in the distal stroma were 0.013 and 0.090 in the PCR group and non-PCR group,respectively,0.013,0.013,0.030,0.042,0.009,0.044,0.045,all P values were less than 0.05,and the area under ROC curve of T2 value was larger than that of T1value(maximum AUC was 0.705 and 0.355,respectively).The P values of Pre-T1 in the borderline area,Gd-T1 in the proximal stroma area,Pre-T1 and Gd-T1 in the intermediate stroma area,and Pre-T1,Gd-T1 and Gd-T2 in the distal stroma area were 0.190,0.145,0.113,0.192,0.191,0.898,0.173 respectively,P values were all greater than 0.05,and the differences were not statistically significant.(3)At the early stage of chemotherapy,the P values of ΔPre-T2 and ΔGd-T2 at the tumor junction andΔGd-T2 at the proximal stroma were < 0.001,0.003 and 0.021 in PCR group and non-PCR group,respectively,and the P values were all less than 0.05,with statistical significance,and the maximum AUC was 0.736.The P values of ΔPre-T1 values,ΔGd-T1 values,ΔPre-T2 values,ΔGd-T1 values,proximal stroma values ΔPre-T1 values,ΔPre-T2 values,ΔGd-T2 values,intermediate stroma values ΔPre-T1 values,ΔPre-T2 values,ΔGd-T2 values,distal stroma values ΔPre-T1 values,Δpre-T2 values,ΔGd-T2 values,ΔGd-T2 values,ΔGd-T1 values and ΔGd-T2 values between the two groups were 0.373,0.988,0.754,0.098,0.617,0.620,0.131,0.654,0.603,0.706,0.714,0.908 and 0.306,respectively,the P values were all greater than 0.05.The differences were not statistically significant.3.Peritumoral edema: Among 86 breast cancer lesions,28 were accompanied by peritumoral edema,including 9 lesions in PCR group and 19 lesions in non-PCR group.(1)The P value of Pre-T1 of peritumoral edema at baseline between the PCR group and the non-PCR group was 0.034,P value less than 0.05,and the difference was statistically significant.The P values of Pre-T2,Gd-T1 and Gd-T2 of peritumoral edema at baseline were 1.000,0.115 and 0.844 between the two groups;The P values of Pre-T1,Pre-T2,Gd-T1 and Gd-T2 in peritumoral edema at the early stage of chemotherapy were 0.357,0.263,0.439 and 0.219,respectively;the P values were all greater than 0.05,and the differences were not statistically significant.(2)The P value between the PCR group and the non-PCR group at baseline was 0.725,P value was greater than 0.05,and the difference was not statistically significant.The P value between the PCR group and the non-PCR group at the early stage of chemotherapy was 0.036 and P value was less than 0.05,and the difference was statistically significant.Conclusion(s):1.The periumoral area contains information related to the efficacy of NAC in breast cancer,and the quantitative parameters and changes of MAGIC in the early stage of chemotherapy are of certain value in the evaluation of the efficacy of neoadjuvant chemotherapy.The diagnostic efficacy of T2 values and changes in T2 values in the early stage of chemotherapy is higher than that of T1 values,and the diagnostic efficacy of T2 changes in the tumor junction area in the early stage of chemotherapy is the highest.2.The absence of peritumoral edema after early chemotherapy for breast cancer with peritumoral edema and the increase of T1 value in the baseline MAGIC quantitative parameters for breast cancer with peritumoral edema have certain value for the early evaluation of the efficacy of neoadjuvant chemotherapy for breast cancer,but the diagnostic efficacy is low.