The prognosis of small breast cancers and hence the potential absolute benefit from adjuvant chemotherapy is mostly determined by the degree of aggressiveness of these cancers. The foremost criterion to define this aggressiveness is the histological grade. However, a major proportion of these patients have an intermediary grade 2, which have been clinically attributed either to a low risk or high risk groups based on the degree of cellular proliferation assessed by a genomic grading index [1]. This methodology is expensive and more difficult to...

The preliminary results concerning the first 23 patients with breast cancers (age range 47-74 years; mean 51 years) included in a prospective ongoing study, are discussed here (Table 1). Patients who had tumor of at least 1.5cm dimension in all the three planes and who underwent mastectomy or wide excision after MR imaging were studied by in-vivo MR mammography protocol including MRS on a 1.5 T scanner (Philips Intera, Best Nederland). The MRS technique was a PRESS single voxel sequence (TE 270 ms, TR 2000ms)....

Among the 23 patients, 11 were grade II and 12 were grade III tumors. Ki67 could not be assessed in one grade III sample as it had extensive necrotic tissue. Strongly elevated tCho with a maximum concentration up to 2.53 mmol/kg was measured in grade III tumors. Figure 1 illustrates an example of a low Ki67 expressed malignant breast tumor where the HER-2 gene is amplified and has a tCho of 1.134 mmol/kg measured from the choline peak of the spectra There was a general...

This feasibility study indicates significant correlation of tCho determined by MRS with tumor grades and in Grade 2 tumors, a relatively weak correlation with Ki67 labeling index. This in turn offers a utilizing basis for further exploration of MRS based tCho estimation in the accurate in vivo assessment of breast tumor grades. These are preliminary results of an on-going study which will be further validated against the genomic grade index in a larger number of patients.

[1] Ignatiadis M et al. Pathobiology.2008;75:104-11. [2] Shin HJ1, et al. AJR Am J Roentgenol. 2012 198: 488-97. [3] Begley JKP et al. Breast Cancer Res. 2012 19;14:207