Vascular characterisation of triple negative breast carcinomas using dynamic MRI.
OBJECTIVE
Triple-negative (ER-/PR-/HER2-) breast carcinomas (TNBC) are aggressive tumours with underexplored imaging features. This study investigates whether their vascular characteristics as assessed by dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast-enhanced (DSC) MRI are distinct from the prognostically more favourable ER+/PR+/HER2- cancers.


METHODS
Patients with primary breast cancer underwent MRI before neoadjuvant chemotherapy and were identified as ER-/PR-/HER2- or ER+/PR+/HER2- from core biopsy specimens. MRI parameters reflecting tissue perfusion, permeability, and extracellular leakage space were measured. Values for inflow transfer constant (K(trans)), outflow rate constant (k(ep)), leakage space (v(e)), area under the gadolinium curve (IAUGC(60) ), relative blood volume (rBV) and flow (rBF), and Mean Transit Time (MTT) were compared across receptor status and with known prognostic variables.


RESULTS
Thirty seven patients were assessable in total (16 ER-/PR-/HER2-, 21 ER+/PR+/HER2-). Lower v(e) (p = 0.001), shorter MTT (p = 0.007) and higher k(ep) values (p = 0.044) were observed in TNBC. v(e) was lower across all T stages, node-negative (p = 0.004) and low-grade TNBC (p = 0.037). v(e) was the best predictor of triple negativity (ROC AUC 0.80).


CONCLUSIONS
TNBC possess characteristic features on imaging, with lower extracellular space (higher cell density) and higher contrast agent wash-out rate (higher vascular permeability) suggesting a distinctive phenotype detectable by MRI.
Academic Oncology Unit, Mount Vernon Cancer Centre, Northwood, Middlesex HA62RN, UK. soniali@gmail.com
Sonia P
SP
Li
Anwar R
AR
Padhani
N Jane
NJ
Taylor
Mark J
MJ
Beresford
Mei-Lin W
ML
Ah-See
J James
JJ
Stirling
James A
JA
d'Arcy
David J
DJ
Collins
Andreas
A
Makris
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001707:Biopsy, Needle; D001783:Blood Flow Velocity; D001810:Blood Volume; D001943:Breast Neoplasms / Q000098:blood supply* / Q000473:pathology; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D019786:Gadolinium DTPA / Q000493:pharmacokinetics; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D010641:Phenotype; D011379:Prognosis; D012372:ROC Curve; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D003287:Contrast Media; D019786:Gadolinium DTPA; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
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