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Diagnostic value of MRI features combined with clinicopathologic features in predicting the expression of human epidermal growth factor receptor 2 in breast cancer
SHEN Yiyuan  YOU Chao  LIN Luyi  ZHOU Jiayin  GU Yajia 

Cite this article as: SHEN Y Y, YOU C, LIN L Y, et al. Diagnostic value of MRI features combined with clinicopathologic features in predicting the expression of human epidermal growth factor receptor 2 in breast cancer[J]. Chin J Magn Reson Imaging, 2024, 15(1): 6-13. DOI:10.12015/issn.1674-8034.2024.01.002.


[Abstract] Objective To explore the value of magnetic resonance imaging (MRI) features combined with clinicopathologic features in distinguishing human epidermal growth factor receptor 2 (HER-2) expression status, especially in HER-2-low breast cancer.Materials and Methods The pre-treatment breast MRI images of 205 patients with pathologically confirmed breast cancer from January 2018 to December 2019 at Fudan University Shanghai Cancer Center were retrospectively analyzed. All patients underwent a bilateral breast scan and a dynamic contrast enhancement MRI. HER-2 status was categorized into HER-2 negative (including HER-2-zero and HER-2-low) and HER-2 positive based on immunohistochemistry and fluorescence in situ hybridization results. Clinicopathologic features and MRI features were analyzed in each group. Clinicopathologic features included age, menstrual status, estrogen receptor (ER), progesterone receptor (PR), hormone receptor (HR), molecular subtypes and Ki-67 level. MRI features included fibroglandular tissue, background parenchymal enhancement, multifocal or multicentric, intratumoral T2WI high signal, peritumoral edema, lesion type, lesion size, shape, margin and internal enhancement pattern of the mass, and distribution and internal enhancement pattern of non-mass enhancement. In the univariate analysis, for the comparison between HER-2 negative and positive groups, an independent sample t-test was used for age, a Mann-Whitney U test was used for lesion size, and a χ2 test was used for the remaining clinicopathologic and MRI features. For the comparison of HER-2 zero, low, and overexpression groups, a one-way analysis of variance was used for age, a Kruskal-Wallis H test was used for lesion size, and a χ2 test was used for the remaining clinicopathologic and MRI features. Multifactorial analysis was performed by binary logistic regression analysis, and the diagnostic efficacy of the model was evaluated by area under the curve (AUC), sensitivity and specificity of the receiver operating characteristic.Results There were 67 HER-2-positive (HER-2-overexpression), 59 HER-2-zero and 79 HER-2-low cases. Between the HER-2-negative and positive group, the difference in clinicopathologic features of ER, PR, HR, and molecular typing were statistically significant (all P<0.001), and the differences in the margin of the mass in MRI features were statistically significant (P=0.020). Further comparing the HER-2 low with HER-2-zero group or HER-2-overexpression group, the differences in clinicopathologic features were statistically significant in ER, PR, HR, molecular subtypes, and Ki-67 levels (with a cutoff value of 40% of the median) between HER-2-low and HER-2-zero or HER-2-overexpression group (ER, PR, HR, and molecular subtypes: all P<0.001; Ki-67: P<0.001, P= 0.037); among the MRI features, the differences in the intratumoral T2WI hyperintensity and mass shape were statistically significant between HER-2-low and HER-2-zero or HER-2-overexpression group (intratumoral T2WI hyperintensity: P=0.031, P=0.011; mass shape: P=0.012, P=0.025), and the difference in the mass margin was statistically significant between HER-2-zero and HER-2-low group (P=0.036). In the multifactorial analysis combining clinicopathologic and MRI features, PR status, Ki-67 and mass shape were independent predictors to distinguish HER-2-low and -zero expression, with an AUC, sensitivity, and specificity of 0.772, 79.7%, and 70.9%, respectively; and PR status and intratumoral T2WI hyperintensity were independent predictors to distinguish HER-2-low versus -overexpression, with an AUC, sensitivity, and specificity of 0.793, 69.8% and 76.1%, respectively.Conclusions MRI features have a differential diagnostic value for HER-2 expression status in breast cancer, especially in distinguishing HER-2 low-expression and HER-2-zero or -overexpression status. Combining clinicopathologic features and MRI features, PR positivity, Ki-67 lower than 40%, irregular mass shape, and intratumoral T2WI hyperintensity can indicate HER-2 low-expression breast cancer.
[Keywords] breast cancer；human epidermal growth factor receptor 2；magnetic resonance imaging；differential diagnosis；low expression；targeted therapy

SHEN Yiyuan1, 2   YOU Chao1, 2   LIN Luyi1, 2   ZHOU Jiayin1, 2   GU Yajia1, 2*  

1 Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai 200032, China

2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China

Corresponding author: GU Y J, E-mail: guyajia@126.com

Conflicts of interest   None.

Received  2023-10-07
Accepted  2023-12-29
DOI: 10.12015/issn.1674-8034.2024.01.002
Cite this article as: SHEN Y Y, YOU C, LIN L Y, et al. Diagnostic value of MRI features combined with clinicopathologic features in predicting the expression of human epidermal growth factor receptor 2 in breast cancer[J]. Chin J Magn Reson Imaging, 2024, 15(1): 6-13. DOI:10.12015/issn.1674-8034.2024.01.002.

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