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
Results
We included 81 female patients into our study,
mean age was 47.27 ± 12.13.
Sixty-three (77.8%) patients had IDC while 9 (11.1%) patients had ILC.
When we evaluated tumor grades there were 11 (14.9%) patients with Grade 1,
29 (29.2%) patients with Grade 2 and 34 (%45.9) patients with Grade 3 tumor,
while grading for 7 patients were missing.
Forty-five (55.6%) patients had DCIS component while 10 (12.3%) had LCIS component.
Twenty patients had lymphovascular invasion and 4 (4.9%) patients received neoadjuvant chemotherapy.
When we made comparisons in regard to tumor grades,
Ki-67 percentages were significantly higher in patients with Grade 3 tumor (p<0.001).
There were no significant differences between these regarding age,
ER (%) and PR (%).
Also we found that 11 of the 15 (73.3%) patients with 3 C-erb B2 score had Grade 3 tumor.
This result also found as significant (p=0.011) (Table 1).
Table 1.
Patients' Characteristics Regarding Tumor Grade
|
|
Grade 1 (n=11)
|
Grade 2 (n=29)
|
Grade 3 (n=34)
|
p
|
Age,
mean ± SD
|
48.91 ± 10.78
|
48.66 ± 12.69
|
44.68 ± 12.25
|
0.370
|
Ki-67 (%),
median (min - max)
|
8.00
(2.00 - 21.00) (a)
|
10.00
(2.00 - 80.00 ) (a)
|
40.00
(5.00 -95.00) (b)
|
<0.001**
|
ER (%),
median (min - max)
|
90.00
(0.00 - 100.00)
|
90.00
(0.00 - 100.00)
|
80.00
(0.00 - 100.00)
|
0.078
|
PR (%),
median (min - max)
|
60.00
(0.00 - 100.00)
|
80.00
(0.00 - 100.00)
|
65.00
(0.00 - 100.00)
|
0.396
|
Type,
n (%)
|
|
|
|
|
IDC
|
7 (12.3)
|
22 (38.6)
|
28 ( 49.1)
|
0.320
|
ILC
|
1 (11.1)
|
5 (55.6)
|
3 (33.3)
|
Other
|
3 (37.5)
|
2 (25.0)
|
3 (37.5)
|
C-erb-B2,
n (%)
|
|
|
|
|
0
|
10 (24.4)
|
14 (34.1)
|
17 (41.5)
|
0.011*
|
1
|
0 (0.0)
|
10 (76.9)
|
3 (23.1)
|
2
|
0 (0.0)
|
2 (40.0)
|
3 (60.0)
|
3
|
1 (6.7)
|
3 (20)
|
11 (73.3)
|
Lenfovascular Invasion,
n (%)
|
|
|
|
|
Negative
|
6 (16.2)
|
15 (40.5)
|
16 (43.2)
|
0.291
|
Positive
|
1 (5.3)
|
6 (31.6)
|
12 (63.2)
|
Neoadjuvant Chemotherapy,
n (%)
|
|
|
|
|
Absent
|
10 (14.1)
|
27 (38.0)
|
34 (47.9)
|
0.252
|
Present
|
1 (33.3)
|
2 (66.7)
|
0 (0.0)
|
Same letter denotes the lack of statistically significant difference between groups
|
We divided our patients into three groups regarding initial enhancement.
Thirty-five patients’ initial enhancement was lower than fifty percent,
while 18 patients were between fifty and one hundred percent and 28 patients higher than one hundred percent.
When we compared Ki-67,
ER and PR values we found no significant difference between our groups (Fig.1 and Fig.2).
When we evaluated tumor types,
31 (49.2%) of the patients with IDC had lower than fifty percent initial enhancement while 5 (55.6%) of the patients with ILC had between fifty and one hundred percent initial enhancement.
This result was found as significant (p=0.014) (Table 2).
Table 2.
Patients' Characteristics Regarding Initial Enhancement
|
|
<50% (n=35)
|
50% - 100% (n=18)
|
>100% (n=28)
|
p
|
Ki-67 (%),
median (min - max)
|
35.00
(3.00 - 95.00)
|
25.00
(5.00 - 60.00)
|
20.00
(2.00 - 80.00)
|
0.069
|
ER (%),
median (min - max)
|
90.00
(0.00 - 100.00)
|
90.00
(0.00 - 100.00)
|
90.00
(0.00 - 100.00)
|
0.806
|
PR (%),
median (min - max)
|
70.00
(0.00 - 100.00)
|
50.00
(0.00 - 90.00)
|
80.00
(0.00 - 100.00)
|
0.272
|
Type,
n (%)
|
|
|
|
|
IDC
|
31 (49.2)
|
13 (20.6)
|
19 (30.2)
|
0.014*
|
ILC
|
1 (11.1)
|
5 (55.6)
|
3 (33.3)
|
Other
|
3 (33.3)
|
0 (0.0)
|
6 (66.7)
|
Tumor Grade
|
|
|
|
|
Grade 1
|
4 (36.4)
|
1 (9.1)
|
6 (54.5)
|
0.454
|
Grade 2
|
13 (44.8)
|
8 (27.6)
|
8 (27.6)
|
Grade 3
|
17 (50.0)
|
6 (17.6)
|
11 (32.4)
|
C-erb-B2,
n (%)
|
|
|
|
|
0
|
15 (33.3)
|
11 (24.4)
|
19 (42.2)
|
0.375
|
1
|
6 (46.2)
|
3 (23.1)
|
4 (30.8)
|
2
|
3 (60.0)
|
0 (0.0)
|
2 (40.0)
|
3
|
11 (61.1)
|
4 (22.2)
|
3 (16.7)
|
Lenfovascular Invasion,
n (%)
|
|
|
|
|
Negative
|
15 (37.5)
|
10 (25.0)
|
15 (37.5)
|
0.230
|
Positive
|
12 (57.1)
|
2 (9.5)
|
7 (33.3)
|
Neoadjuvant Chemotherapy,
n (%)
|
|
|
|
|
Absent
|
32 (41.6)
|
18 (23.4)
|
27 (35.1)
|
0.362
|
Present
|
3 (75.0)
|
0 (0.0)
|
1 (25.0)
|
When we evaluated dynamic types; 5 (6.2%) patients had Type 1 curve,
40 (49.4%) patients had Type 2 curve and 36 (44.4%) patients had Type 3 curve.
When we compared our variables between curve type groups we found that all of the patients with Type 1 curve had larger than one hundred percent initial enhancement and 28 of the 36 (77.8%) patients with Type 3 curve had lower than fifty percent initial enhancement (p<0.001).
There was no significant difference between our groups regarding other variables (Table 3).
Table 3.
Patients' Characteristics Regarding Dynamic Types
|
|
Type 1 (n=5)
|
Type 2 (n=40)
|
Type 3 (n=36)
|
p
|
Ki-67 (%),
median (min - max)
|
18.00
(5.00 - 40.00)
|
21.00
(2.00 - 80.00)
|
30.00
(3.00 - 95.00)
|
0.221
|
ER (%),
median (min - max)
|
90.00
(0.00 - 100.00)
|
90.00
(0.00 - 100.00)
|
90.00
(0.00 - 100.00)
|
0.702
|
PR (%),
median (min - max)
|
90.00
(0.00 - 90.00)
|
75.00
(0.00 - 100.00)
|
50.00
(0.00 - 100.00)
|
0.356
|
Initial Enhancement,
n (%)
|
|
|
|
|
<50%
|
0 (0.0)
|
7 (20.0)
|
28 (80.0)
|
<0.001**
|
50% - 100%
|
0 (0.0)
|
13 (72.2)
|
5 (27.8)
|
>100%
|
5 (17.9)
|
20 (71.4)
|
3 (10.7)
|
Type,
n (%)
|
|
|
|
|
IDC
|
3 (4.8)
|
28 (44.4)
|
32 (50.8)
|
0.061
|
ILC
|
2 (22.2)
|
6 (66.7)
|
1 (11.1)
|
Other
|
0 (0.0)
|
6 (66.7)
|
3 (33.3)
|
Tumor Grade
|
|
|
|
|
Grade 1
|
2 (18.2)
|
5 (45.5)
|
4 (36.4)
|
0.570
|
Grade 2
|
1 (3.4)
|
14 (48.3)
|
14 (48.3)
|
Grade 3
|
2 (5.9)
|
17 (50.0)
|
15 (44.1)
|
C-erb-B2,
n (%)
|
|
|
|
|
0
|
4 (8.9)
|
26 (57.8)
|
15 (33.3)
|
0.318
|
1
|
0 (0.0)
|
6 (46.2)
|
7 (53.8)
|
2
|
0 (0.0)
|
1 (20.0)
|
4 (80.0)
|
3
|
1 (5.6)
|
7 (38.9)
|
10 (55.6)
|
Lenfovascular Invasion,
n (%)
|
|
|
|
|
Negative
|
3 (7.5)
|
21 (52.5)
|
16 (40.0)
|
0.772
|
Positive
|
2 (9.5)
|
9 (42.9)
|
10 (47.6)
|
Neoadjuvant Chemotherapy,
n (%)
|
|
|
|
|
Absent
|
4 (5.2)
|
40 (51.9)
|
33 (42.9)
|
0.068
|
Present
|
1 (25.0)
|
0 (0.0)
|
3 (75.0)
|
Lastly,
we evaluated washout type curves specifically.
Which was done by divided the patients into two groups; (1) washout type curve (type 3) and (2) the other curve types (type 1 and 2).
This evaluation was performed because a main focus of our hypotheses was that washout type curve (type 3) may have a higher association with prognostic factors.
We found initial enhancement was significantly different between groups (as was found previously); however,
we again found no significant relationship between any prognostic factors and washout type curve (Fig.3 and Fig.4) (table 4).
Table 4.
Patients' Characteristics when Grouped as Washout and Others
|
|
Type 1 and 2 (n=45)
|
Washout (n=36)
|
p
|
Ki-67 (%),
median (min - max)
|
20.50 (2.00 - 80.00)
|
30.00 (3.00 - 95.00)
|
0.113
|
ER (%),
median (min - max)
|
90.00 (0.00 - 100.00)
|
90.00 (0.00 - 100.00)
|
0.466
|
PR (%),
median (min - max)
|
80.00 (0.00 - 100.00)
|
50.00 (0.00 - 100.00)
|
0.184
|
Initial Enhancement,
n (%)
|
|
|
|
<50%
|
7 (20.0)
|
28 (80.0)
|
<0.001**
|
50% - 100%
|
13 (72.2)
|
5 (27.8)
|
>100%
|
25 (89.3)
|
3 (10.7)
|
Type,
n (%)
|
|
|
|
IDC
|
31 (49.2)
|
32 (50.8)
|
0.063
|
ILC
|
8 (88.9)
|
1 (11.1)
|
Other
|
6 (66.7)
|
3 (33.3)
|
Tumor Grade
|
|
|
|
Grade 1
|
7 (63.6)
|
4 (36.4)
|
0.793
|
Grade 2
|
15 (51.7)
|
14 (48.3)
|
Grade 3
|
19 (55.9)
|
15 (44.1)
|
C-erb-B2,
n (%)
|
|
|
|
0
|
30 (66.7)
|
15 (33.3)
|
0.103
|
1
|
6 (46.2)
|
7 (53.8)
|
2
|
1 (20.0)
|
4 (80.0)
|
3
|
8 (44.4)
|
10 (55.6)
|
Lenfovascular Invasion,
n (%)
|
|
|
|
Negative
|
24 (60.00)
|
16 (40.0)
|
0.765
|
Positive
|
11 (52.4)
|
10 (47.6)
|
Neoadjuvant Chemotherapy,
n (%)
|
|
|
|
Absent
|
44 (51.9)
|
33 (42.9)
|
0.318
|
Present
|
1 (25.0)
|
3 (75.0)
|