Breast dynamic contrast-enhanced (DCE) MRI provides detailed morphological features of breast tumors, as well as enhancement kinetics, which may reflect angiogenesis. Commercially available computer-aided diagnosis (CAD) systems provide clinicians with quantitative kinetic information regarding breast tumors on a pixel-by-pixel basis. Recent studies have suggested that survival outcomes and CAD-measured kinetic features of breast cancer as observed on preoperative MRI are associated (1, 2). However, to the best of our knowledge, there have been no studies of the associations between CAD-extracted kinetic features and distant metastasis...
Methods and materials
A review of medical records between November 2011 and November 2012 at our institution, a tertiary academic hospital, identified 345 consecutive women with newly diagnosed invasive breast cancer, all of whom had undergone preoperative breast MRI and subsequent surgery. Of these, a number of women were excluded for the following reasons: 11 had metastatic disease at presentation, 16 had received neoadjuvant chemotherapy before surgery, 16 had undergone vacuum-assisted or excisional biopsy for diagnosis, 4 had bilateral breast cancer, 15 had inadequate CAD-generated images...
Distant metastasis outcomes
Of 276 women with invasive breast cancer, 28 (10.1%) developed distant metastases (nine had additional local recurrence) at a median follow-up of 79 months and were classified as distant metastasis group. The median time to distant metastasis was 25 months (range, 6–79 months). The sites of distant metastases were as follows: bones (n = 11), lung (n = 6), liver (n = 5), brain (n = 2), and distal nodes (n = 4). The remaining 248 (89.9%) were classified as non-distant metastasis...
In summary, we quantified the kinetic heterogeneity of breast cancer on preoperative MRI through the use of kinetics automatically measured by a CAD system. Our results showed that higher values of kinetic heterogeneity and peak enhancement were associated with worse distant metastasis-free survival in women with invasive breast cancer. Our results suggest that CAD-extracted kinetic heterogeneity can be used as a quantitative imaging biomarker of intratumoral heterogeneity to assess the risk of distant metastasis-free survival in women with breast cancer. Further large-scale prospective research studies...
Personal information and conflict of interest
J. Y. Kim; Busan/KR - nothing to disclose J. J. Kim; Busan/KR - nothing to disclose
1.Kim JJ, Kim JY, Kang HJ, et al. Computer-aided diagnosis–generated kinetic features of breast cancer at preoperative MR imaging: association with disease-free survival of patients with primary operable invasive breast cancer. Radiology 2017;284(1):45-54.
2.Nam SY, Ko ES, Lim Y, et al. Preoperative dynamic breast magnetic resonance imaging kinetic features using computer-aided diagnosis: Association with survival outcome and tumor aggressiveness in patients with invasive breast cancer. PloS one 2018;13(4):e0195756.
3.Folkman J. The role of angiogenesis in tumor growth. Semin Cancer Biol 1992;3(2):65-71.
4.Rak JW, St Croix...