Correlation Between IVIM-DWI Quantitative Parameters Histogram Analysis And Breast Cancer Immunohistochemical Index And Molecular Subtypes

Objective:1.To explore the correlation between the histogram quantitative parameters of diffusion weighted imaging(DWI)single index,intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)dual index model and the expression of ER,PR,HER-2 and Ki-67 of breast cancer.2.To compare the results of DWI,IVIM-DWI quantitative parameter histogram analysis of different molecular subtypes of breast cancer,and to explore the value of quantitative parameters of histograms in predicting molecular subtypes of breast cancer.Materials and methods:88 patients with pathologically confirmed breast cancer from October 2017 to December 2019 were enrolled in the 940th Hospital of Joint Logistics Support force of Chinese People's Liberation Army,a total of 89 lesions.All the subjects were performed preoperatively with MRI examination(plain scan,multi-b value DWI and dynamic contrast-enhanced).FireVoxel software was used to manually delineate the boundary of the lesion layer by layer on the IVIM-DWI image(b=1000 s/mm2)to obtain the quantitative parameters ADC value,D value,D*value and f value,and then perform histogram analysis on each quantitative parameter to obtain mean,minimum,maximum,10th,25th,50th(median),75th,90th,skewness and kurtosis.Different groups were based on the expressions of ER,PR,HER-2 and Ki-67 that were recorded,independent sample t test or Mann-Whitney U tests were used to compare the differences between two different groups;Spearman rank correlation was used to analyze the correlation of each parameter with the expression of ER,PR,HER-2 and Ki-67 in breast cancer.The histogram quantitative parameters of different molecular classifications were compared between multiple groups using One-Way ANOVA or Kruskal-Wallis,and the Bonferroni-t or non-parametric test were used to compare the two groups.Results:By analyzing the histogram parameters of ADC value,D value,D*value and f value in different expression states of breast cancer ER,PR,HER-2 and Ki-67,the results are as follows:1.The ADC value(maximum),D values(maximum,skewness,kurtosis),D*values(minimum,maximum,10th)and f values(10th,25th)of the ER positive group were lower than those of the ER negative group(P<0.05);ADC value(kurtosis),D values(maximum,skewness,kurtosis),D*values(minimum,maximum,10th,25th)and f value(10th)were negatively correlated with ER expression(r=-0.219?-0.330,P<0.05),and D value(skewness)was the most correlated(r=-0.330,P=0.002).2.The ADC value(maximum),D value(maximum)and D*values(minimum,maximum,10th)of the PR positive group were lower than those of the PR negative group(P<0.05);ADC value(maximum),D value(maximum)and D*values(minimum,maximum,10th,25th)were negatively correlated with PR expression(r=-0.223?-0.418,P<0.05),and D*(maximum)was the most correlated(r=-0.418,P<0.001).3.The ADC values(mean,10th,25th,50th),D values(mean,10th,25th,50th)and D*value(10th)of HER-2 positive group were higher than those of HER-2 negative group(P<0.05);ADC values(10th,25th,50th)and D values(mean,10th,25th,50th)were positively correlated with HER-2 expression(r=0.223?0.350,P<0.05),and D value(25th)was the most correlated(r=0.350,P=0.001).4.The ADC values(maximum,skewness,kurtosis),D values(maximum,skewness,kurtosis)and D*values(minimum,maximum,skewness,kurtosis)of Ki-67 high expression group were higher than those of Ki-67 low expression group(P<0.05);ADC values(maximum,skewness,kurtosis),D values(maximum,skewness,kurtosis)and D*values(minimum,maximum,10th,skewness,kurtosis)were positively correlated with Ki-67 expression(r=0.228?0.446,P<0.05),and D*value was the most correlated(r=0.446,P<0.001).By comparing the histogram parameters of ADC value,D value,D*value and f value of different molecular types of breast cancer,the results are as follows:1.ADCmax and ADC skewness were statistically significant among the four molecular types(P<0.05);Comparison between groups,ADCmax was statistically significant between Luminal A and Luminal B,triple negative breast cancer(P<0.05);ADC skewness was statistically significant between Luminal A and triple negative breast cancer(P=0.043).2.Dmax,D skewness and D kurtosis were statistically significant among the four molecular types(P<0.01);Comparison between groups,Dmax was statistically significant between Luminal A and Luminal B,triple negative breast cancer(P<0.05),D skewness was statistically significant between triple negative and Luminal A,Luminal B breast cancers(P<0.01),D kurtosis was statistically significant between Luminal A and triple negative breast cancer(P=0.019).3.D*min,D*max,D*skewness and D*kurtosis were statistically significant among the four molecular types(P<0.05);Comparison between groups,D*min was statistically significant between Luminal A and Luminal B,HER-2 overexpression,triple negative breast cancer(P<0.05);D*max was statistically significant between Luminal A and Luminal B,HER-2 overexpression,triple negative breast cancer(P<0.01);D*skewness and D*kurtosis were statistically significant between Luminal A and Luminal B breast cancer(P<0.05).4.f10th,f25th and f skewness were statistically significant among the four molecular types(P<0.05);Comparison between groups,f10th was statistically significant between Luminal A and triple negative breast cancer(P=0.001);f25th was statistically significant between triple negative and Luminal A,Luminal B,HER-2 overexpression breast cancer(P<0.05);f skewness was statistically significant between Luminal B and Luminal A,HER-2 overexpression breast cancer(P<0.05).Conclusion:1.The quantitative parameter histogram analysis of the DWI single index model and the IVIM-DWI double index model can objectively evaluate the overall information inside the tumor,and have important hints for the preoperative prediction of breast cancer immunohistochemical indicators and molecular subtypes.2.Compared with ADC value,the D value of IVIM-DWI quantitative parameter had more histogram indicators related to ER,PR,HER-2 and Ki-67,and the correlation coefficient was higher than ADC value,suggesting that IVIM-DWI dual index model can reflect the structural characteristics of tumor heterogeneity more comprehensively than DWI single index model.3.Triple negative breast cancer had more characteristics than other molecular subtype breast cancer histogram parameters,especially the larger kurtosis and skewness in the histogram parameters may suggest the possibility of this type of breast cancer,which has certain guiding significance for clinical distinction between triple negative and non-triple negative breast cancer.