Potential of MR Mammography to Predict Tumor Grading of Invasive Breast Cancer

Zusammenfassung

Ziel: Der Differenzierungsgrad zählt zu den am häufigsten ermittelten prognostischen Faktoren des invasiven Mammakarzinoms. Diese Studie wurde durchgeführt, um das Potenzial der Magnet-Resonanz Mammografie (MRM) zur nicht invasiven Abschätzung des Differenzierungsgrads zu ermitteln. Material und Methoden: 399 invasive Mammakarzinome wurden in die Studie eingeschlossen (einheitliches klinisches Messprotokoll; Genehmigung durch Ethikkommission) und von 2 geblindeten, erfahrenen Radiologen (> 500 MRM) prospektiv im Konsensus evaluiert. Zur Gewebsdifferenzierung wurden detaillierte MRM-Deskriptoren (n = 18) herangezogen. Basierend auf diesen Analysen wurde anschließend mittels uni- und multivariater Statistik das Potenzial der MRM zur Abschätzung des Differenzierungsgrads ermittelt (X2-Tests; binär logistische Regression; area under the ROC-curve [AUC]). Ergebnisse: 8 der insgesamt 18 MRM-Deskriptoren zeigten eine Assoziation mit dem Differenzierungsgrad, z. B. „interne Struktur”, „Ödem” (p < 0,001), „Cutisverdickung” und „Zerstörung des Mamillensaums” (p < 0,05). Die multivariate Analyse ermittelte ein signifikantes Potenzial zur Prädiktion des Differenzierungsgrads mittels MRM (p < 0,001). Hierbei konnten insbesondere prognostisch günstige, „gut” differenzierte Karzinome mit hoher Treffsicherheit identifiziert werden (AUC = 0,930). Schlussfolgerung: Die Abschätzung des Differenzierungsgrads invasiver Mammakarzinoms ist anhand typischer MRM-Charakteristika in einem standardisierten klinischen Messprotokoll möglich. Da der Differenzierungsgrad m. E. als Surrogat für das Gesamtüberleben gilt, kann die MRM somit neben differenzialdiagnostischen auch initiale prognostische Informationen liefern.

Abstract

Purpose: Tumor grading (TG) is one of the most widely used prognostic factors in the case of breast cancer. This study aims to identify the potential of magnetic resonance mammography (MRM) to non-invasively assess TG. Materials and Methods: 399 invasive breast cancers were included (IRB approval; standardized clinical MRM protocols). All breast cancers were prospectively evaluated by two experienced (> 500 MRM) and blinded radiologists in consensus. In every cancer a set of 18 previously published MRM descriptors was assessed. These were assessed by univariate and multivariate analysis to identify the potential of MRM to predict TG (X2 statistics; binary logistic regression; area under the ROC curve [AUC]). Results: 8 of 18 MRM descriptors were associated with TG, e. g. internal structure, edema (p < 0.001), as well as skin thickening and destruction of the nipple line (p < 0.05). MRM was feasible to predict TG by multivariate analysis (p < 0.001). The highest potential could be identified to predict well differentiated breast cancers with good prognosis (AUC = 0.930). Conclusion: MR mammography was able to non-invasively assess tumor grading in a standard protocol. Since tumor grading is a surrogate for overall survival, these results provide further evidence to the clinical application of MR mammography as a noninvasive prognostic tool.

Key words

breast - mammography - MR imaging - contrast agents - decision analysis - gadolinium

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