Meme Kanserinde ADC Değerleri ile Histopatolojik Prognostik Faktörler Arasındaki İlişkinin Değerlendirilmesi

Abstract

Amaç: Meme kanserinde difüzyon MR, lezyonun morfolojisi yanında, metabolik aktivitesi hakkında da bilgi vermektedir. Patolojik prognostik faktörler meme kanserli olgularda tedavi protokolünü ve sağ kalımı etkilemektedir. Bu çalışmada amacımız, meme kanserli olgularda ADC değerleri ile patolojik prognostik faktörler arasında ilişkinin değerlendirilmesidir. Gereç ve Yöntemler: Kliniğimizde, meme kanseri tanısı ile preoperatif olarak Meme MR tetkiki yapılan 33 olgu retrospektif olarak değerlendirildi.33 olguda toplam 44 malign kitle vardı. Tüm olguların post-operatif patoloji sonuçları elde edildi. Post-op histopatolojik spesmenlerde tümor çapı, aksiler lenf nodu durumu, histolojik grade klasik prognostik faktörler olarak ve östrojen reseptör durumu, progesteron reseptör durumu moleküler prognostik faktörler olarak değerlendirilmiştir. Difüzyon meme MR özellikleri ile klasik ve moleküler histopatolojik prognostik faktörler arasındaki ilişki Mann Whitney U test, Kruskal Wallis test and Spearman korelasyon analizi kullanılarak değerlendirildi. Bulgular: ADC değerleri, aksiller lenf nodu tutulumu 3’den az olan olgularda (N1) aksiller lenf nodu tutulumu 4 ve/veya daha fazla olan olgulara (N2-N3) göre anlamlı düzeyde yüksek bulundu (p=0,011; p=0,010; p<0,05). Sonuç: Düşük ADC değerleri lenf nodu tutulumuyla ilişkiliydi.

Keywords

• Difüzyon
• Meme Kanseri
• Manyetik Rezonans Görüntüleme

Relationship Between ADC Values and Histopathological Prognostic Factors in Breast Cancer

Abstract

Objective To evaluate the relationship between ADC values and histopthological prognostic factors in breast cancer patients. Materials and Methods A total of 33 female breast cancer patients with preoperative breast MRI image were retrospectively evaluated. There were a total of 44 malignant masses in 33 patients. In postoperative evaluation of histopathological specimens, conventional prognostic factors used were the tumor diameter , axillary lymph nodes and histological grade, and the molecular prognostic factors used were estrogen and progesterone receptor expression, C-erb-B2. In diffusion MR with a b-value of 1000s/mm² and 1500 s/mm², the relationship between apparent diffusion coefficient(ADC) and conventional and molecular histopathological prognostic factors was evaluated by using statistical methods such as Mann Whitney U test, Kruskal Wallis test and Spearman correlation analysis. Results ADC was significiantly lower in patients with 4 and/ormore axillary lymph nodes involvement (N2-N3) compared to those with <3 axillary lymph nodes involvement (p=0.011;p=0.010;p<0.05). Conclusion Lower ADC values are related with axillary lymph node involvement.

Keywords

• Breast Neoplasm
• Diffussion
• Prognosis

References

1. 1. Tuncbilek N, Karakas HM, Okten OO. Dynamic Magnetic Resonance Imaging in Determining Histopathological Prognostic Factors of Invasive Breast Cancers. Eur J Radiol. 2005 Feb;53(2):199-205. doi: 10.1016/j.ejrad.2003.11.004.
2. 2. Belli P, Costantini M, Bufi E, Giardina GG, Rinaldi P, Franceschini G et al. Diffusion Magnetic Resonance Imaging in Breast Cancer Characterisation: Correlations Between the Apparent Diffusion Coefficient and Major Prognostic Factors. Radiol Med . 2015 Mar;120(3):268-76. doi: 10.1007/s11547-014-0442-8.
3. 3. M C Segel, D D Paulus, G N Hortobagyi. Advanced Primary Breast Cancer: Assessment at Mammography of Response to Induction Chemotherapy. Radiology. 1988 Oct;169(1):49-54. doi: 10.1148/radiology.169.1.3420282.
4. 4. Kolb TM, Lichy J, Newhouse JH. Comparison of the Performance of Screening Mammography, Physical Examination, and Breast US and Evaluation of Factors That Influence Them: An Analysis of 27,825 Patient Evaluations. Radiology 2002 Oct;225(1):165-75. doi: 10.1148/radiol.2251011667.
5. 5. Lee SH, Cho N, Kim SJ, Cha JH, Cho KS, Ko ES et al. Correlation Between High Resolution Dynamic MR Features and Prognostic Factors in Breast Cancer. Korean J Radiol. 2008 Jan-Feb;9(1):10-8. doi: 10.3348/kjr.2008.9.1.10.
6. 6. Mussurakis S, Buckley DL, Horsman A. Dynamic MR Imaging of Invasive Breast Cancer: Correlation With Tumour Grade and Other Histological Factors. Br J Radiol. 1997 May;70(833):446-51. doi: 10.1259/bjr.70.833.9227224.
7. 7. Martincich L, Deantoni V, Bertotto I, Redana S, Kubatzki F, Sarotto I et al. Correlations Between Diffusion-Weighted Imaging and Breast Cancer Biomarkers. Eur Radiol. 2012 Jul;22(7):1519-28. doi: 10.1007/s00330-012-2403-8. Epub 2012 Mar 13.
8. 8. Pereira FP, Martins G, Carvalhaes de Oliveira Rde V. Diffusion Magnetic Resonance Imaging of the Breast. Magn Reson Imaging Clin N Am. 2011 Feb;19(1):95-110. doi: 10.1016/j.mric.2010.09.001.

9. 9. Razek AA, Gaballa G, Denewer A, Nada N. Invasive ductal carcinoma: correlation of apparent diffusion coefficient value with pathological prognostic factors. NMR Biomed. 2010 Jul;23(6):619-23. doi: 10.1002/nbm.1503.
10. 10. Kamitani T, Matsuo Y, Yabuuchi H, Fujita N, Nagao M, Jinnouchi M et al. Correlations between apparent diffusion coefficient values and prognostic factors of breast cancer. Magn Reson Med Sci. 2013;12(3):193-9. doi: 10.2463/mrms.2012-0095. Epub 2013 Jul 12.
11. 11. Choi SY, Chang YW, Park HJ, Kim HJ, Hong SS, Seo DY. Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer.Br J Radiol. 2012 Aug;85(1016):e474-9. doi: 10.1259/bjr/79381464. Epub 2011 Nov 29.
12. 12. Woodhams R, Matsunaga K, Kan S, Hata H, Ozaki M, Iwabuchi K et al. ADC mapping of benign and malignant breast tumors. Magn Reson Med Sci. 2005 Aug ;4(1):35-42. doi: 10.2463/mrms.4.35.
13. 13. Yoshikawa MI, Ohsumi S, Sugata S, Kataoka M, Takashima S, Mochizuki T et al. Relation between cancer cellularity and apparent diffusion coefficient values using diffusion-weighted magnetic resonance imaging in breast cancer. Radiat Med. 2008 May;26(4):222-6. doi: 10.1007/s11604-007-0218-3. Epub 2008 May 29.
14. 14. Guo Y, Cai YQ, Cai ZL, Gao YG, An NY, Ma L et al. Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging.J Magn Reson Imaging. 2002 Aug;16(2):172-8. doi: 10.1002/jmri.10140.
15. 15. Park MJ, Cha ES, Kang BJ, Ihn YK, Baik JH. The role of diffusion-weighted imaging and the apparent diffusion coefficient (ADC) values for breast tumors. Korean J Radiol. 2007 Sep-Oct;8(5):390-6. doi: 10.3348/kjr.2007.8.5.390.
16. 16. Hatakenaka M, Soeda H, Yabuuchi H, Matsuo Y, Kamitani T, Oda Y et al. Apparent diffusion coefficients of breast tumors: clinical application. Magn Reson Med Sci. 2008 May;7(1):23-9. doi: 10.2463/mrms.7.23.
17. 17. Yabuuchi H, Matsuo Y, Okafuji T, Kamitani T, Soeda H, Setoguchi T et al. Enhanced mass on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images. J Magn Reson Imaging. 2008 Nov;28(5):1157-65. doi: 10.1002/jmri.21570.
18. 18. Woodhams R, Kakita S, Hata H, Iwabuchi K, Umeoka S, Mountford CE et al. Diffusion-weighted imaging of mucinous carcinoma of the breast: evaluation of apparent diffusion coefficient and signal intensity in correlation with histologic findings. AJR Am J Roentgenol. 2009 Jul;193(1):260-6. doi: 10.2214/AJR.08.1670.
19. 19. Esteva FJ, Hortobagyi GN. Prognostic molecular markers in early breast cancer. Breast Cancer Res. 2004 Mar;6(3):109-18. doi: 10.1186/bcr777. Epub 2004 Mar 11.
20. 20. Fischer U, Kopka L, Brinck U, Korabiowska M, Schauer A, Grabbe E. Prognostic value of contrast-enhanced MR mammography in patients with breast cancer. Eur Radiol. 2014 February 1997;7(7):1002-5. doi: 10.1007/s003300050240.
21. 21. Cody DD, Mahesh M. AAPM/RSNA physics tutorial for residents: Technologic advances in multidetector CT with a focus on cardiac imaging. Radiographics. 2007 Nov-Dec;27(6):1829-37. doi: 10.1148/rg.276075120.
22. 22. W A Kaiser. Dynamic Spiral MR Mammography.Radiology 2000 Jun;215(3):919-20. doi: 10.1148/radiology.215.3.r00ap45919.
23. 23. Kim SH, Cha ES, Kim HS, Kang BJ, Choi JJ, Jung JH et al. Diffusion-weighted imaging of breast cancer: correlation of the apparent diffusion coefficient value with prognostic factors.J Magn Reson Imaging. 2009 Sep;30(3):615-20. doi: 10.1002/jmri.21884.
24. 24. Woodhams R, Matsunaga K, Iwabuchi K, Kan S, Hata H, Kuranami M et al. Diffusion-weighted imaging of malignant breast tumors: the usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension. J Comput Assist Tomogr. 2005 Sep-Oct;29(5):644-9. doi: 10.1097/01.rct.0000171913.74086.1b.
25. 25. Kinoshita T, Yashiro N, Ihara N, Funatu H, Fukuma E, Narita M. Diffusion-weighted half-Fourier single-shot turbo spin echo imaging in breast tumors: differentiation of invasive ductal carcinoma from fibroadenoma. J Comput Assist Tomogr. 2002 Nov-Dec;26(6):1042-6. doi: 10.1097/00004728-200211000-00033.
26. 26. Pereira FP, Martins G, Figueiredo E, Domingues MN, Domingues RC, da Fonseca LM et al. Assessment of breast lesions with diffusion-weighted MRI: comparing the use of different b values. AJR Am J Roentgenol. 2009 Oct;193(4):1030-5. doi: 10.2214/AJR.09.2522.
27. 27. Pereira FP, Martins G, Figueiredo E, Domingues MN, Domingues RC, da Fonseca LM et al. Assessment of breast lesions with diffusion-weighted MRI: comparing the use of different b values. AJR Am J Roentgenol. 2009 Oct;193(4):1030-5. doi: 10.2214/AJR.09.2522.
28. 28. Costantini M, Belli P, Rinaldi P, Bufi E, Giardina G, Franceschini G et al. Diffusion-weighted imaging in breast cancer: relationship between apparent diffusion coefficient and tumour aggressiveness.Clin Radiol. 2010 Dec;65(12):1005-12. doi: 10.1016/j.crad.2010.07.008. Epub 2010 Sep 24.
29. 29. Marini C, Iacconi C, Giannelli M, Cilotti A, Moretti M, Bartolozzi C. Quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesion. Eur Radiol. 2007 Oct;17(10):2646-55. doi: 10.1007/s00330-007-0621-2. Epub 2007 Mar 14.
30. 30. Buadu LD, Murakami J, Murayama S, Hashiguchi N, Sakai S, Masuda K et al. Breast lesions: correlation of contrast medium enhancement patterns on MR images with histopathologic findings and tumor angiogenesis. Radiology. 1996 Sep;200(3):639-49. doi: 10.1148/radiology.200.3.8756909.
31. 31. Guo Y, Cai YQ, Cai ZL, Gao YG, An NY, Ma L et al. Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging. J Magn Reson Imaging. 2002 Aug;16(2):172-8. doi: 10.1002/jmri.10140.
32. 32. Partridge SC, Mullins CD, Kurland BF, Allain MD, DeMartini WB, Eby PR et al. Apparent diffusion coefficient values for discriminating benign and malignant breast MRI lesions: effects of lesion type and size. AJR Am J Roentgenol. 2010 Jun;194(6):1664-73. doi: 10.2214/AJR.09.3534.
33. 33. Rubesova E, Grell AS, De Maertelaer V, Metens T, Chao SL, Lemort M. Quantitative diffusion imaging in breast cancer: a clinical prospective study. J Magn Reson Imaging. 2006 Aug;24(2):319-24. doi: 10.1002/jmri.20643.
34. 34. Sinha S, Lucas-Quesada FA, Sinha U, DeBruhl N, Bassett LW. In vivo diffusion-weighted MRI of the breast: potential for lesion characterization. J Magn Reson Imaging. 2002 Jun;15(6):693-704. doi: 10.1002/jmri.10116.
35. 35. Yabuuchi H, Matsuo Y, Okafuji T, Kamitani T, Soeda H, Setoguchi et al. Enhanced mass on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images. J Magn Reson Imaging. 2008 Nov;28(5):1157-65. doi: 10.1002/jmri.21570.
36. 36. Szabó BK, Aspelin P, Kristoffersen Wiberg M, Tot T, Boné B. Invasive breast cancer: correlation of dynamic MR features with prognostic factors.Eur Radiol. 2003 Nov;13(11):2425-35. doi: 10.1007/s00330-003-2000-y. Epub 2003 Jul 26.
37. 37. Montemurro F, Martincich L, Sarotto I, Bertotto I, Ponzone R, Cellini L et al. Relationship between DCE-MRI morphological and functional features and histopathological characteristics of breast cancer. Eur Radiol. 2007 Jun;17(6):1490-7. doi: 10.1007/s00330-006-0505-x. Epub 2006 Dec 6.
38. 38. Narisada H, Aoki T, Sasaguri T, Hashimoto H, Konishi T, Morita M et al. Correlation between numeric gadolinium-enhanced dynamic MRI ratios and prognostic factors and histologic type of breast carcinoma. AJR Am J Roentgenol. 2006 Aug;187(2):297-306. doi: 10.2214/AJR.05.0696.
39. 39. Iacconi C. Diffusion and perfusion of the breast. Eur J Radiol. 2010 Dec;76(3):386-90. doi: 10.1016/j.ejrad.2010.03.009. Epub 2010 Apr 21