The Diagnostic Value Of IVIM And DCE-MRI In Triple-negative Breast Cancer And Their Correlation With Breast Cancer Biomarkers

Objective:To explore the relevance of apparent diffusion coefficient?ADC?values and intravoxel incoherent motion?IVIM?parameters with molecular markers of invasive breast cancer by comparing the clinicopathological features,dynamic contrast-enhanced magnetic resonance imaging?DCE-MRI?characteristics,ADC and IVIM parameters of triple-negative breast cancer?TNBC?with non-triple negative breast cancer?non-TNBC?,aiming to provide clues for establishing a reasonable treatment plan and assessing the prognosis of the tumor preoperatively.Methods:133 cases?all females?diagnosed with breast cancer confirmed by operation or biopsy pathology in Affiliated Hospital of Zunyi Medical College from January to December 2017 were enrolled,including 32 cases of TNBC and 101 cases of non-TNBC.Among the 101 non-TNBC cases,there were 25 cases of Luminal A type,25 cases of Luminal B type?HER-2 negative?,23 cases of Luminal B type?HER-2 positive?and 28cases of HER-2 overexpression.All patients underwent bilateral breast MR examination?conventional plain scan,DWI,DCE-MRI,IVIM?preoperatively.Pathological specimens of estrogen receptor,progesterone receptor,human epidermal growth factor receptor-2 and Ki-67 were measured.Imaging findings were observed and analyzed for all cases,including the lesion morphology,number,location,size,margin,shape,signal features of T₂WI,enhancement features,pathological types,histopathological grade,lymph node metastasis,TIC type,ADC values and IVIM parameters.MRI features and clinicopathological features were compared between TNBC group and non-TNBC group.And the relationship between invasive breast cancer biology markers and ADC values,IVIM parameters were analyzed.P<0.05 was considered as statistically significant difference.Results:1.The pathological type of TNBC group was mainly invasive ductal carcinoma,which accounted for 93.74%,and histological grade III was common?60%?.There were significant differences in histological grade between the five groups of breast cancer with different molecular types?P<0.001?.There were significant differences between TNBC group and Luminal A type group,Luminal B?HER-2 negative?group and Luminal B?HER-2 positive?type group?P=0.001,P=0.011,P=0.001?,but no significant difference between TNBC group and HER-2 overexpression group.2.In TNBC group,the median age of onset was 47 years old,the average diameter of tumor was 32mm,and the positive rate of axillary lymph node was 53.12%.There was no statistically significant difference in age of onset,lesion morphology,size,location,number and lymph node metastasis among the five groups.3.Comparison of MRI features among the five groups revealed a statistically significant difference in margin and internal enhancement of the mass lesions.?P=0.007,P=0.003?.There were significant differences between TNBC group and Luminal A group,Luminal B?HER-2 negative?group and Luminal B?HER-2 positive?group?P=0.010,0.002;P=0.004,0.002;P=0.011,0.004?.The difference of enhancement characteristics between TNBC group and HER-2 overexpression group was statistically significant?P=0.012?,while there was no statistical difference in the lesion margin between the two groups.There was no significant difference in the shape of the lesions,TIC curves and T₂WI signals among the five groups.?P>0.05?.4.The ADC values and D values of ER-positive group were significantly lower than those of ER-negative group?P=0.008,0.029?,but the values of D^*and f had no significant difference between ER-negative group and positive group?P=0.567,0.196?.There was no statistical difference between PR negative group and PR positive group,HER-2 negative group and HER-2 positive group,and ki-67 low expression group and ki-67 high expression group in ADC,D,D^*and f?all P>0.05?.5.The ADC values were negatively correlated with ER positive expression ?r=-0.296,P=0.010?,and showed no significant correlation with PR,HER-2 and ki-67positive expression?r=-0.008,0.041,0.079,P>0.05?.The D values were negatively correlated with ER positive expression?r=-0.249,P=0.031?,and showed no significant correlation with PR,HER-2 and Ki-67 positive expression?r=-0.073,0.067,0.017,P>0.05?.There was no significant correlation between D^*values and f values with ER,PR,HER-2 and ki-67 positive expression?P>0.05?.6.The ADC values and D values of TNBC group were higher than non-TNBC group,and the difference was statistically significant.Further analysis showed that there was only significant difference between TNBC group and Luminal B?HER-2 negative?group?P=0.001,0.002?.TNBC group and Luminal A group,Luminal B?HER-2 positive?group,HER-2 overexpression group showed no significant difference?P>0.05?.There was no significant difference in D^*values and f values among different molecular types of breast cancer.Conclusion:1.The most common type of TNBC is invasive ductal carcinoma,with histological grade III mostly.2.The MRI features of TNBC are as follows:single round mass,smooth margin,rim enhancement,and TIC curves are mostly type II and type III.3.The ADC values and D values were negatively correlated with ER positive expression,that is,the lower the ADC values and D values,the higher the positive expression rate of ER,suggesting the non-invasive imaging method to predict the potential of ER expression and determine the prognosis of breast cancer.4.The ADC values and D values in TNBC group were significantly higher than non-TNBC group,and Luminal B?HER-2 negative?group has the lowest ADC values and D values,suggesting that the potential of ADC values and D values to identify different molecular subtypes of breast cancer.