Keywords:
Breast, Oncology, MR, Diagnostic procedure, Cancer
Authors:
H. AYDIN, B. GUNER, I. ESEN BOSTANCI, M. BOYACIOGLU BULUT, B. K. Arıbaş, L. DOGAN, M. A. GULCELİK, O. Unal; Ankara/TR
DOI:
10.1594/ecr2018/C-1238
Aims and objectives
The most frequently diagnosed cancer among women worldwide is breast cancer,
it is also the leader among deaths caused by cancer in women but the mortality rate of breast cancer has reduced in recent years [1].
This progress may be in part due to advancements in imaging modalities which are used in the screening and diagnosis of breast cancer.
When breast cancer diagnosis is established,
further evaluations are required to understand the extent of the disease and determine treatment path(s).
The determination of prognosis is important for informing the patient,
deciding on the options for treatment and other medical/social decisions.
Classical guidelines incorporate lymph node status and tumor size together with pathological findings such as histological type and grade of the cancer to determine prognosis [2,
3].
The determination of various biomarkers such as Ki-67,
cerbB2 (HER2 and sHER2),
aromatase,
osteopontin,
and CEASCAM6 have been found to determine prognosis at different reliability levels [4].
Steroid hormone receptor (estrogen and progesterone receptors) expression measurements are also important for prognosis due to their influence on hormone therapy efficacy [5,
6].
Magnetic resonance imaging (MRI),
as previously stated,
is one of the imaging modalities used in the diagnosis of breast cancer.
The use of contrast in dynamic MRI,
namely dynamic contrast-enhanced magnetic resonance (MR) imaging,
has emerged as a very high sensitivity modality which is effective in the detection and staging of invasive breast cancer [7].
MR imaging determines the functional characteristics of the tumor,
these characteristics were found to be an important addition to the diagnostic approach in breast cancer [8].
A significant relationship between MRI kinetic findings and prognosis may exist,
identifying this relationship would improve the approach to breast cancer and may serve as an alternative method in determining prognosis.
We hypothesized that patients with poor prognostic factors will exhibit washout type (type 3) contrast enhancement pattern.
Because,
the more aggressive a malignant lesion,
the more cell turnover it will have.
In addition,
neovascularization is increased in the mass.
Thus,
we would expect the mass to lose contrast in a fast manner in the early phase (consistent with type 3 curves).
Furthermore,
various studies associate tumor grade with tumor angiogenesis [9].
As tumor grade is one of the classical factors for breast cancer prognosis,
determining the level of angiogenesis (via contrast-enhanced dynamic MRI) in the tumor may provide important prognostic data.
Several studies have investigated the relationship between classical prognostic factors and kinetic MRI results [10,
11].
Our aim was to determine if any relationship exists between kinetic MRI features and classical prognostic factors with a focus on dynamic curve types.