Functional Tumor Volume by Fast Dynamic Contrast‐Enhanced MRI for Predicting Neoadjuvant Systemic Therapy Response in Triple‐Negative Breast Cancer
Background Dynamic contrast‐enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accu...
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| Published in | Journal of magnetic resonance imaging Vol. 54; no. 1; pp. 251 - 260 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken, USA
John Wiley & Sons, Inc
01.07.2021
Wiley Subscription Services, Inc |
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| Online Access | Get full text |
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| Abstract | Background
Dynamic contrast‐enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response.
Purpose
To investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple‐negative breast cancer (TNBC).
Study Type
Prospective.
Population/Subjects
Sixty patients with biopsy‐confirmed TNBC between December 2016 and September 2020.
Field Strength/Sequence
A 3.0 T/3D fast spoiled gradient echo‐based DCE MRI
Assessment
Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5‐minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing.
Statistical Tests
Tumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann–Whitney U test.
Results
About 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non‐pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1‐minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05).
Data Conclusion
FTV and TV measured at 1 minute after injection can predict response to NAST in TNBC.
Level of Evidence
1
Technical Efficacy
4 |
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| AbstractList | Dynamic contrast-enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response.BACKGROUNDDynamic contrast-enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response.To investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC).PURPOSETo investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC).Prospective.STUDY TYPEProspective.Sixty patients with biopsy-confirmed TNBC between December 2016 and September 2020.POPULATION/SUBJECTSSixty patients with biopsy-confirmed TNBC between December 2016 and September 2020.A 3.0 T/3D fast spoiled gradient echo-based DCE MRI ASSESSMENT: Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5-minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing.FIELD STRENGTH/SEQUENCEA 3.0 T/3D fast spoiled gradient echo-based DCE MRI ASSESSMENT: Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5-minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing.Tumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann-Whitney U test.STATISTICAL TESTSTumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann-Whitney U test.About 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non-pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1-minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05).RESULTSAbout 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non-pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1-minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05).FTV and TV measured at 1 minute after injection can predict response to NAST in TNBC.DATA CONCLUSIONFTV and TV measured at 1 minute after injection can predict response to NAST in TNBC.1 TECHNICAL EFFICACY: 4.LEVEL OF EVIDENCE1 TECHNICAL EFFICACY: 4. Background Dynamic contrast‐enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response. Purpose To investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple‐negative breast cancer (TNBC). Study Type Prospective. Population/Subjects Sixty patients with biopsy‐confirmed TNBC between December 2016 and September 2020. Field Strength/Sequence A 3.0 T/3D fast spoiled gradient echo‐based DCE MRI Assessment Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5‐minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing. Statistical Tests Tumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann–Whitney U test. Results About 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non‐pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1‐minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05). Data Conclusion FTV and TV measured at 1 minute after injection can predict response to NAST in TNBC. Level of Evidence 1 Technical Efficacy 4 Dynamic contrast-enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response. To investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC). Prospective. Sixty patients with biopsy-confirmed TNBC between December 2016 and September 2020. A 3.0 T/3D fast spoiled gradient echo-based DCE MRI ASSESSMENT: Patients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5-minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing. Tumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann-Whitney U test. About 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non-pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1-minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05). FTV and TV measured at 1 minute after injection can predict response to NAST in TNBC. 1 TECHNICAL EFFICACY: 4. BackgroundDynamic contrast‐enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate of contrast enhancement curves in comparison to conventional DCE MRI, potentially characterizing tumor perfusion kinetics more accurately for measurement of functional tumor volume (FTV) as a predictor of treatment response.PurposeTo investigate FTV by fast DCE MRI as a predictor of neoadjuvant systemic therapy (NAST) response in triple‐negative breast cancer (TNBC).Study TypeProspective.Population/SubjectsSixty patients with biopsy‐confirmed TNBC between December 2016 and September 2020.Field Strength/SequenceA 3.0 T/3D fast spoiled gradient echo‐based DCE MRIAssessmentPatients underwent MRI at baseline and after four cycles (C4) of NAST, followed by definitive surgery. DCE subtraction images were analyzed in consensus by two breast radiologists with 5 (A.H.A.) and 2 (H.S.M.) years of experience. Tumor volumes (TV) were measured on early and late subtractions. Tumors were segmented on 1 and 2.5‐minute early phases subtractions and FTV was determined using optimized signal enhancement thresholds. Interpolated enhancement curves from segmented voxels were used to determine optimal early phase timing.Statistical TestsTumor volumes were compared between patients who had a pathologic complete response (pCR) and those who did not using the area under the receiver operating curve (AUC) and Mann–Whitney U test.ResultsAbout 26 of 60 patients (43%) had pCR. FTV at 1 minute after injection at C4 provided the best discrimination between pCR and non‐pCR, with AUC (95% confidence interval [CI]) = 0.85 (0.74,0.95) (P < 0.05). The 1‐minute timing was optimal for FTV measurements at C4 and for the change between C4 and baseline. TV from the early phase at C4 also yielded a good AUC (95%CI) of 0.82 (0.71,0.93) (P < 0.05).Data ConclusionFTV and TV measured at 1 minute after injection can predict response to NAST in TNBC.Level of Evidence1Technical Efficacy4 |
| Author | Mohamed, Rania M.M. Thompson, Alastair M. Yang, Wei T. Pagel, Mark D. Le‐Petross, Huong Litton, Jennifer K. Boge, Medine Arribas, Elsa Musall, Benjamin C. Ravenberg, Elizabeth E. Spak, David A. Lane, Deanna L. Adrada, Beatriz E. White, Jason B. Elshafeey, Nabil A. Mahmoud, Hagar S. Moulder, Stacy L. Abdelhafez, Abeer H. Sun, Jia Candelaria, Rosalind P. Son, Jong Bum Leung, Jessica W.T. Rauch, Gaiane M. Ma, Jingfei Wei, Peng Hwang, Ken‐Pin Zhang, Shu Damodaran, Senthil |
| AuthorAffiliation | 4 Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 5 Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 6 Department of Surgery, Baylor College of Medicine, Houston, Texas, USA 2 Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 1 Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 7 Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA |
| AuthorAffiliation_xml | – name: 7 Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA – name: 3 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA – name: 2 Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA – name: 5 Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA – name: 6 Department of Surgery, Baylor College of Medicine, Houston, Texas, USA – name: 4 Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA – name: 1 Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA |
| Author_xml | – sequence: 1 givenname: Benjamin C. orcidid: 0000-0002-1896-1446 surname: Musall fullname: Musall, Benjamin C. email: bcmusall@mdanderson.org organization: The University of Texas MD Anderson Cancer Center – sequence: 2 givenname: Abeer H. surname: Abdelhafez fullname: Abdelhafez, Abeer H. organization: The University of Texas MD Anderson Cancer Center – sequence: 3 givenname: Beatriz E. surname: Adrada fullname: Adrada, Beatriz E. organization: The University of Texas MD Anderson Cancer Center – sequence: 4 givenname: Rosalind P. surname: Candelaria fullname: Candelaria, Rosalind P. organization: The University of Texas MD Anderson Cancer Center – sequence: 5 givenname: Rania M.M. surname: Mohamed fullname: Mohamed, Rania M.M. organization: The University of Texas MD Anderson Cancer Center – sequence: 6 givenname: Medine surname: Boge fullname: Boge, Medine organization: The University of Texas MD Anderson Cancer Center – sequence: 7 givenname: Huong surname: Le‐Petross fullname: Le‐Petross, Huong organization: The University of Texas MD Anderson Cancer Center – sequence: 8 givenname: Elsa surname: Arribas fullname: Arribas, Elsa organization: The University of Texas MD Anderson Cancer Center – sequence: 9 givenname: Deanna L. surname: Lane fullname: Lane, Deanna L. organization: The University of Texas MD Anderson Cancer Center – sequence: 10 givenname: David A. surname: Spak fullname: Spak, David A. organization: The University of Texas MD Anderson Cancer Center – sequence: 11 givenname: Jessica W.T. surname: Leung fullname: Leung, Jessica W.T. organization: The University of Texas MD Anderson Cancer Center – sequence: 12 givenname: Ken‐Pin surname: Hwang fullname: Hwang, Ken‐Pin organization: The University of Texas MD Anderson Cancer Center – sequence: 13 givenname: Jong Bum orcidid: 0000-0003-2548-5895 surname: Son fullname: Son, Jong Bum organization: The University of Texas MD Anderson Cancer Center – sequence: 14 givenname: Nabil A. surname: Elshafeey fullname: Elshafeey, Nabil A. organization: The University of Texas MD Anderson Cancer Center – sequence: 15 givenname: Hagar S. surname: Mahmoud fullname: Mahmoud, Hagar S. organization: The University of Texas MD Anderson Cancer Center – sequence: 16 givenname: Peng surname: Wei fullname: Wei, Peng organization: The University of Texas MD Anderson Cancer Center – sequence: 17 givenname: Jia surname: Sun fullname: Sun, Jia organization: The University of Texas MD Anderson Cancer Center – sequence: 18 givenname: Shu surname: Zhang fullname: Zhang, Shu organization: The University of Texas MD Anderson Cancer Center – sequence: 19 givenname: Jason B. surname: White fullname: White, Jason B. organization: The University of Texas MD Anderson Cancer Center – sequence: 20 givenname: Elizabeth E. surname: Ravenberg fullname: Ravenberg, Elizabeth E. organization: The University of Texas MD Anderson Cancer Center – sequence: 21 givenname: Jennifer K. surname: Litton fullname: Litton, Jennifer K. organization: The University of Texas MD Anderson Cancer Center – sequence: 22 givenname: Senthil surname: Damodaran fullname: Damodaran, Senthil organization: The University of Texas MD Anderson Cancer Center – sequence: 23 givenname: Alastair M. surname: Thompson fullname: Thompson, Alastair M. organization: Baylor College of Medicine – sequence: 24 givenname: Stacy L. surname: Moulder fullname: Moulder, Stacy L. organization: The University of Texas MD Anderson Cancer Center – sequence: 25 givenname: Wei T. surname: Yang fullname: Yang, Wei T. organization: The University of Texas MD Anderson Cancer Center – sequence: 26 givenname: Mark D. surname: Pagel fullname: Pagel, Mark D. organization: The University of Texas MD Anderson Cancer Center – sequence: 27 givenname: Gaiane M. surname: Rauch fullname: Rauch, Gaiane M. organization: The University of Texas MD Anderson Cancer Center – sequence: 28 givenname: Jingfei surname: Ma fullname: Ma, Jingfei organization: The University of Texas MD Anderson Cancer Center |
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| Keywords | breast MRI DCE MRI functional tumor volume treatment response Triple-negative breast cancer |
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Dynamic contrast‐enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher... Dynamic contrast-enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher sampling rate... BackgroundDynamic contrast‐enhanced (DCE) MRI is useful for diagnosis and assessment of treatment response in breast cancer. Fast DCE MRI offers a higher... |
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| SubjectTerms | Auditory discrimination Biopsy Breast cancer breast MRI Breast Neoplasms - diagnostic imaging Breast Neoplasms - drug therapy Confidence intervals Contrast Media DCE MRI Female Field strength functional tumor volume Humans Injection Magnetic Resonance Imaging Neoadjuvant Therapy Patients Perfusion Population studies Prospective Studies Statistical analysis Statistical tests Surgery treatment response Triple Negative Breast Neoplasms - diagnostic imaging Triple Negative Breast Neoplasms - drug therapy Triple‐negative breast cancer Tumor Burden Tumors |
| Title | Functional Tumor Volume by Fast Dynamic Contrast‐Enhanced MRI for Predicting Neoadjuvant Systemic Therapy Response in Triple‐Negative Breast Cancer |
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