PDF(Pubmed)
Abstract：
Preoperatively predicting extensive intraductal component in invasive breast cancer through imaging is crucial for informed decision-making, guiding surgical planning to mitigate risks of incomplete resection or re-operation for positive margins in breast-conserving surgery. This study aimed to characterize intra- and peri-tumor heterogeneity using high-spatial resolution ultrafast DCE-MRI to predict the extensive intraductal component in invasive breast cancer (IBC-EIC) preoperatively. A retrospective analysis included invasive breast cancer patients who underwent preoperative high-spatial resolution ultrafast DCE-MRI, categorized based on intraductal component status (IBC-EIC vs. IBC without EIC). Propensity score matching (PSM) was employed to balance clinicopathological covariates between the groups. Personalized kinetic intra-tumor heterogeneity (ITHkinetic) and peri-tumor heterogeneity (PTHkinetic) scores were quantified using clustered voxels with similar enhancement patterns. An image combined model, incorporating MRI features, ITHkinetic, and PTHkinetic scores, was developed and assessed. Of 368 patients, 26.4% (97/368) had IBC-EIC. PSM yielded well-matched pairs of 97 patients each. After PSM, ITHkinetic and PTHkinetic scores were significantly higher in the IBC-EIC group (ITHkinetic: 0.68 ± 0.23; PTHkinetic: 0.58 ± 0.19) compared to IBC without EIC (ITHkinetic: 0.32 ± 0.25; PTHkinetic: 0.42 ± 0.18; p < 0.001). Before PSM, ITHkinetic (0.71 ± 0.20 vs. 0.49 ± 0.28, p < 0.001) and PTHkinetic (0.61 ± 0.18 vs. 0.50 ± 0.20, p < 0.001) scores remained higher in the IBC-EIC group. The Image Combined Model demonstrated good predictive performance for IBC-EIC, with an AUC of 0.91 (95% CI 0.86-0.95) after PSM and 0.85 (95% CI 0.81-0.90) before PSM. Inclusion of ITHkinetic and PTHkinetic scores significantly improved prediction capability. ITHkinetic and PTHkinetic characterization from high-spatial resolution ultrafast DCE-MRI kinetic curves enhances preoperative prediction of IBC-EIC, offering valuable insights for personalized breast cancer management.
摘要：
术前通过成像预测浸润性乳腺癌中广泛的导管内成分对于做出明智的决策至关重要。指导手术计划，以减轻保乳手术切缘阳性的不完全切除或再次手术的风险。这项研究旨在使用高空间分辨率超快DCE-MRI来表征肿瘤内和肿瘤周围的异质性，以预测术前浸润性乳腺癌（IBC-EIC）中广泛的导管内成分。回顾性分析包括浸润性乳腺癌患者，这些患者接受了术前高空间分辨率超快DCE-MRI，根据导管内组件状态分类(IBC-EIC与没有EIC的IBC）。采用倾向评分匹配（PSM）来平衡组间的临床病理协变量。使用具有相似增强模式的聚类体素量化个性化动力学肿瘤内异质性(ITHkinetic)和肿瘤周围异质性(PTHkinetic)评分。图像组合模型，结合MRI特征，动力学,和PTH动力学分数，开发和评估。368名患者中,26.4%(97/368)患有IBC-EIC。PSM产生了匹配良好的对，每组97名患者。PSM之后,与不含EIC的IBC(ITH动力学:0.32±0.25;PTH动力学:0.42±0.18;p<0.001)相比,IBC-EIC组的ITH动力学和PTH动力学评分显著更高(ITH动力学:0.68±0.23;PTH动力学:0.58±0.19)。在PSM之前,动力学(0.71±0.20vs.0.49±0.28，p<0.001）和PTH动力学（0.61±0.18vs.0.50±0.20，p<0.001）评分在IBC-EIC组中仍然较高。图像组合模型对IBC-EIC表现出良好的预测性能，PSM后的AUC为0.91（95%CI0.86-0.95），PSM前的AUC为0.85（95%CI0.81-0.90）。包含ITH动力学和PTH动力学评分显着提高了预测能力。高空间分辨率超快DCE-MRI动力学曲线的ITH动力学和PTH动力学表征增强了IBC-EIC的术前预测，为个性化乳腺癌管理提供有价值的见解。
