Value of edema on T2WI before treatment in predicting the efficacy of neoadjuvant chemotherapy for breast cancer

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• Clinical Article •

ZHU Yanfang ZHU Yongqi JI Hua LÜ Jing HE Ying LIU Yun ZHU Li

Cite this article as: ZHU Y F, ZHU Y Q, JI H, et al. Value of edema on T2WI before treatment in predicting the efficacy of neoadjuvant chemotherapy for breast cancer[J]. Chin J Magn Reson Imaging, 2023, 14(4): 76-81, 88. DOI:10.12015/issn.1674-8034.2023.04.013.

Abstract

[Abstract] Objective To explore the predictive value of breast edema on T2WI before neoadjuvant chemotherapy (NAC) and breast edema's influencing factors.Materials and Methods From October 2018 to March 2022, the data of patients with breast cancer diagnosed by immunohistochemical technique and treated with NAC in General Hospital of Ningxia Medical University were retrospectively collected. According to the breast edema score (BES) on T2WI before NAC, no edema, peritumoral edema, prechest edema, and subcutaneous edema were respectively defined as BES1, BES2, BES3, and BES4. Postoperative pathological complete response (pCR) was used as the evaluation standard for the efficacy of NAC. SPSS software was used for single factor analysis of BES and its clinicopathological characteristics to predict the efficacy. The correlation between BES and tumor diameter, Ki-67, histological grade, NAC schedule, molecular typing, axillary lymph node metastasis was further evaluated.Results A total of 260 subjects were included, and the pCR rate was 40.4% (105/260). Univariate analysis showed that there were significant differences in BES, tumor diameter, Ki-67, NAC schedule and molecular typing between the pCR group and the Non-pCR group (P＜0.05). Analysis of the influencing factors of breast edema showed that BES was correlated with tumor diameter and axillary lymph node metastasis (P＜0.05), and was positively correlated with tumor diameter (rs=0.442).Conclusions BES is helpful to predict the efficacy of NAC in breast cancer patients, and it is related to tumor diameter and axillary lymph node metastasis. Tumor diameter, Ki-67, NAC schedule and molecular typing were also effective predictors of NAC response.

[Keywords] breast cancer；neoadjuvant chemotherapy；T2 weighted imaging；breast edema；magnetic resonance imaging

Contributor Information

ZHU Yanfang¹ ZHU Yongqi² JI Hua³ LÜ Jing¹ HE Ying¹ LIU Yun^4* ZHU Li⁴

¹ Clinical College, Ningxia Medical University, Yinchuan 750000, China

² Department of Radiology, Ningxia Hui Autonomous Region People's Hospital, Yinchuan 750000, China

³ Department of Radiology, Lingwu People's Hospital of Ningxia, Lingwu 751400, China

⁴ Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750000, China

Corresponding author: Liu Y, E-mail: yunliusky@163.com

Conflicts of interest None.

Publication Information

ACKNOWLEDGMENTS Ningxia Key Research and Development Project in 2022 (No. 2022BEG02025); Clinical Medicine First-Class Discipline Open Project of Clinical Medicine School of Ningxia Medical University in 2020.

Received 2022-11-19

Accepted 2023-04-11

DOI: 10.12015/issn.1674-8034.2023.04.013

Text

References

[1]

WILKINSON L, GATHANI T. Understanding breast cancer as a global health concern[J/OL]. Br J Radiol, 2022, 95(1130): 20211033 [2022-10-7]. https://pubmed.ncbi.nlm.nih.gov/PMC8822551. DOI: 10.1259/bjr.20211033.

[2]

ZUO G D, ZENG F Y, LIU M L, et al. Research progress on the efficacy of neoadjuvant chemotherapy for breast cancer[J]. Anhui Med J, 2021, 42(7): 824-827. DOI: 10.3969/j.issn.1000-0399.2021.07.031.

[3]

ABDEL-RAZEQ H, KHALIL H, ASSI H I, et al. Treatment strategies for residual disease following neoadjuvant chemotherapy in patients with early-stage breast cancer[J]. Curr Oncol, 2022, 29(8): 5810-5822. DOI: 10.3390/curroncol29080458.

[4]

BARRIO A V, MONTAGNA G, MAMTANI A, et al. Nodal recurrence in patients with node-positive breast cancer treated with sentinel node biopsy alone after neoadjuvant chemotherapy-a rare event[J]. JAMA Oncol, 2021, 7(12): 1851-1855. DOI: 10.1001/jamaoncol.2021.4394.

[5]

CORTAZAR P, ZHANG L J, UNTCH M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis[J]. Lancet, 2014, 384(9938): 164-172. DOI: 10.1016/S0140-6736(13)62422-8.

[6]

YAU C, OSDOIT M, VAN DER NOORDAA M, et al. Residual cancer burden after neoadjuvant chemotherapy and long-term survival outcomes in breast cancer: a multicentre pooled analysis of 5161 patients[J]. Lancet Oncol, 2022, 23(1): 149-160. DOI: 10.1016/S1470-2045(21)00589-1.

[7]

UEMATSU T. Focal breast edema associated with malignancy on T2-weighted images of breast MRI: peritumoral edema, prepectoral edema, and subcutaneous edema[J]. Breast Cancer, 2015, 22(1): 66-70. DOI: 10.1007/s12282-014-0572-9.

[8]

UEMATSU T. MRI findings of inflammatory breast cancer, locally advanced breast cancer, and acute mastitis: T2-weighted images can increase the specificity of inflammatory breast cancer[J]. Breast Cancer, 2012, 19(4): 289-294. DOI: 10.1007/s12282-012-0346-1.

[9]

CHEON H, KIM H J, KIM T H, et al. Invasive breast cancer: prognostic value of peritumoral edema identified at preoperative MR imaging[J]. Radiology, 2018, 287(1): 68-75. DOI: 10.1148/radiol.2017171157.

[10]

RENZ D M, BALTZER P A, BÖTTCHER J, et al. Inflammatory breast carcinoma in magnetic resonance imaging: a comparison with locally advanced breast cancer[J]. Acad Radiol, 2008, 15(2): 209-221. DOI: 10.1016/j.acra.2007.09.011.

[11]

HARADA T L, UEMATSU T, NAKASHIMA K, et al. Evaluation of breast edema findings at T2-weighted breast MRI is useful for diagnosing occult inflammatory breast cancer and can predict prognosis after neoadjuvant chemotherapy[J]. Radiology, 2021, 299(1): 53-62. DOI: 10.1148/radiol.2021202604.

[12]

HARADA T L, UEMATSU T, NAKASHIMA K, et al. Is the presence of edema and necrosis on T2WI pretreatment breast MRI the key to predict pCR of triple negative breast cancer?[J]. Eur Radiol, 2020, 30(6): 3363-3370. DOI: 10.1007/s00330-020-06662-7.

[13]

Chinese Anti-Cancer Association Breast Cancer Professional Committee. Guidelines and norms for diagnosis and treatment of breast cancer of China Anti-Cancer Association (2021 edition)[J]. China Oncol, 2021, 31(10): 954-1040. DOI: 10.19401/j.cnki.1007-3639.2021.10.013.

[14]

Guideline development group for estrogen and progesterone receptor immunohistochemical testing of breast cancer. Guidelines for the immunohistochemical detection of estrogen receptor and progesterone receptor in breast cancer[J]. Chin J Pathology, 2015, 44(4): 237-239. DOI: 10.3760/cma.j.issn.0529-5807.2015.04.005.

[15]

OGSTON K N, MILLER I D, PAYNE S, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival[J]. Breast, 2003, 12(5): 320-327. DOI: 10.1016/s0960-9776(03)00106-1.

[16]

HUANG Z H, TU X Z, ZHAN Z J, et al. Intramammary edema of invasive breast cancers on MRI T2-weighted fat suppression sequence: correlation with molecular subtypes and clinical-pathologic prognostic factors[J]. Clin Imaging, 2022, 83: 87-92. DOI: 10.1016/j.clinimag.2021.12.023.

[17]

KAWASHIMA H, KOBAYASHI-YOSHIDA M, MATSUI O, et al. Peripheral hyperintense pattern on T2-weighted magnetic resonance imaging (MRI) in breast carcinoma: correlation with early peripheral enhancement on dynamic MRI and histopathologic findings[J]. J Magn Reson Imaging, 2010, 32(5): 1117-1123. DOI: 10.1002/jmri.22279.

[18]

LEE H J, LEE J E, JEONG W G, et al. HER2-positive breast cancer: association of MRI and clinicopathologic features with tumor-infiltrating lymphocytes[J]. AJR Am J Roentgenol, 2022, 218(2): 258-269. DOI: 10.2214/AJR.21.26400.

[19]

PANZIRONI G, MOFFA G, GALATI F, et al. Peritumoral edema as a biomarker of the aggressiveness of breast cancer: results of a retrospective study on a 3 T scanner[J]. Breast Cancer Res Treat, 2020, 181(1): 53-60. DOI: 10.1007/s10549-020-05592-8.

[20]

UEMATSU T, KASAMI M, WATANABE J. Is evaluation of the presence of prepectoral edema on T2-weighted with fat-suppression 3 T breast MRI a simple and readily available noninvasive technique for estimation of prognosis in patients with breast cancer?[J]. Breast Cancer, 2014, 21(6): 684-692. DOI: 10.1007/s12282-013-0440-z.

[21]

VANDORPE T, SMEETS A, VAN CALSTER B, et al. Lobular and non-lobular breast cancers differ regarding axillary lymph node metastasis: a cross-sectional study on 4, 292 consecutive patients[J]. Breast Cancer Res Treat, 2011, 128(2): 429-435. DOI: 10.1007/s10549-011-1565-4.

[22]

XU Z Y, DING Y Y, ZHAO K, et al. MRI characteristics of breast edema for assessing axillary lymph node burden in early-stage breast cancer: a retrospective bicentric study[J]. Eur Radiol, 2022, 32(12): 8213-8225. DOI: 10.1007/s00330-022-08896-z.

[23]

SANTUCCI D, FAIELLA E, CORDELLI E, et al. The impact of tumor edema on T2-weighted 3T-MRI invasive breast cancer histological characterization: a pilot radiomics study[J/OL]. Cancers, 2021, 13(18): 4635 [2022-11-18]. https://pubmed.ncbi.nlm.nih.gov/34572862/. DOI: 10.3390/cancers13184635.

[24]

MBERU V, MCFARLANE J, MACASKILL E J, et al. A retrospective review of MRI features associated with metastasis-free survival in women with breast cancer: focusing on skin thickening and skin enhancement[J/OL]. Br J Radiol, 2021, 94(1128): 20210472 [2022-11-18]. https://pubmed.ncbi.nlm.nih.gov/34591686/. DOI: 10.1259/bjr.20210472.

[25]

UEMATSU T, KASAMI M, YUEN S. Neoadjuvant chemotherapy for breast cancer: correlation between the baseline MR imaging findings and responses to therapy[J]. Eur Radiol, 2010, 20(10): 2315-2322. DOI: 10.1007/s00330-010-1813-8.

[26]

BALTZER P A, YANG F, DIETZEL M, et al. Sensitivity and specificity of unilateral edema on T2w-TSE sequences in MR-Mammography considering 974 histologically verified lesions[J]. Breast J, 2010, 16(3): 233-239. DOI: 10.1111/j.1524-4741.2010.00915.x.

[27]

BAE, SHIN S U, RYU H S, et al. Pretreatment MR imaging features of triple-negative breast cancer: association with response to neoadjuvant chemotherapy and recurrence-free survival[J]. Radiology, 2016, 281(2): 392-400. DOI: 10.1148/radiol.2016152331.

[28]

LIEDTKE C, MAZOUNI C, HESS K R, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer[J]. J Clin Oncol, 2023, 41(10): 1809-1815. DOI: 10.1200/JCO.22.02572.

[29]

SHEIKH F, NAZIR A, YASMEEN S, et al. Pathologic complete response in HER2-positive breast cancer patients receiving trastuzumab in neoadjuvant setting[J]. J Coll Physicians Surg Pak, 2019, 29(2): 159-163. DOI: 10.29271/jcpsp.2019.02.159.

[30]

SIKOV W M, BERRY D A, PEROU C M, et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage Ⅱ to Ⅲ triple-negative breast cancer: CALGB 40603 (Alliance)[J]. J Clin Oncol, 2015, 33(1): 13-21. DOI: 10.1200/JCO.2014.57.0572.

[31]

SCHNEEWEISS A, MÖBUS V, TESCH H, et al. Intense dose-dense epirubicin, paclitaxel, cyclophosphamide versus weekly paclitaxel, liposomal doxorubicin (plus carboplatin in triple-negative breast cancer) for neoadjuvant treatment of high-risk early breast cancer (GeparOcto-GBG 84): a randomised phase Ⅲ trial[J]. Eur J Cancer, 2019, 106: 181-192. DOI: 10.1016/j.ejca.2018.10.015.

[32]

BROWN J R, DIGIOVANNA M P, KILLELEA B, et al. Quantitative assessment Ki-67 score for prediction of response to neoadjuvant chemotherapy in breast cancer[J]. Lab Invest, 2014, 94(1): 98-106. DOI: 10.1038/labinvest.2013.128.

[33]

COATES A S, WINER E P, GOLDHIRSCH A, et al. Tailoring therapies: improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015[J]. Ann Oncol, 2015, 26(8): 1533-1546. DOI: 10.1093/annonc/mdv221.

[34]

MYERS S P, AHRENDT G M, LEE J S, et al. Association of tumor molecular subtype and stage with breast and axillary pathologic complete response after neoadjuvant chemotherapy for breast cancer[J]. Ann Surg Oncol, 2021, 28(13): 8636-8642. DOI: 10.1245/s10434-021-10195-8.

[35]

ZHANG W, LAI M L, YANG S H, et al. Neoadjuvant chemotherapy effect and influencing factors on Luminal B breast cancer[J]. Guangdong Med J, 2017, 38(22): 3426-3429, 3432. DOI: 10.13820/j.cnki.gdyx.20171117.002.

[36]

DENKERT C, LOIBL S, MÜLLER B M, et al. Ki67 levels as predictive and prognostic parameters in pretherapeutic breast cancer core biopsies: a translational investigation in the neoadjuvant GeparTrio trial[J]. Ann Oncol, 2013, 24(11): 2786-2793. DOI: 10.1093/annonc/mdt350.

[37]

CHEN X Y, HE C, HAN D D, et al. The predictive value of Ki-67 before neoadjuvant chemotherapy for breast cancer: a systematic review and meta-analysis[J]. Future Oncol, 2017, 13(9): 843-857. DOI: 10.2217/fon-2016-0420.

[38]

DENG D M, YE X, WEN R Y, et al. Correlation between ER, PR and Ki-67 status and the efficacy of neoadjuvant chemotherapy for breast cancer[J]. J Mol Diagn Ther, 2021, 13(1): 83-86, 90. DOI: 10.19930/j.cnki.jmdt.2021.01.021.

[39]

PLICHTA J K, REN Y, THOMAS S M, et al. Implications for breast cancer restaging based on the 8th edition AJCC staging manual[J]. Ann Surg, 2020, 271(1): 169-176. DOI: 10.1097/SLA.0000000000003071.

[40]

CAUDLE A S, GONZALEZ-ANGULO A M, HUNT K K, et al. Predictors of tumor progression during neoadjuvant chemotherapy in breast cancer[J]. J Clin Oncol, 2010, 28(11): 1821-1828. DOI: 10.1200/JCO.2009.25.3286.

[41]

SHI H, WANG X H, GU J W, et al. Study on the relevant influencing factors of neoadjuvant chemotherapy for breast cancer[J]. Chin J New Clin Med, 2019, 12(12): 1311-1315. DOI: 10.3969/j.issn.1674-3806.2019.12.14.

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