Apparent diffusion coefficient in estrogen receptor-positive and lymph node-negative invasive breast cancers at 3.0T DW-MRI: A potential predictor for an oncotype Dx test recurrence score

Sunitha B Thakur ¹, Manuela Durando ², Soledad Milans ², Gene Y Cho ², Lucas Gennaro ², Elizabeth J Sutton ², Dilip Giri ³, Elizabeth A Morris ²

Affiliations

¹ Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
² Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
³ Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

PMID: 28640531
29 References
8 citations

Abstract

Purpose: To measure the apparent diffusion coefficient (ADC) values in estrogen receptor-positive (ER+) and axillary lymph node-negative (LN-) invasive breast cancer and investigate the correlation of ADC with Oncotype Dx test recurrence scores (ODxRS).

Materials And Methods: This was a Health Insurance Portability and Accountability Act (HIPAA)-compliant single-site retrospective study. Patients underwent preoperative 3.0T MRI scans with additional diffusion-weighted imaging sequential scans (b = 0, 600 and b = 0, 1000 s/mm2 ) from January 2011 to 2013. The study population included 31 ER+/LN- invasive breast cancers, which underwent ODxRS genomic testing. ADC600 and ADC1000 parametric maps were generated, and ADC values were calculated from a user-drawn region of interest. ODxRS predicts 10-year recurrence risk in individual patients: low (RS <18), intermediate (RS: 18-30), or high (RS >30). All breast lesions, including subgroups of invasive ductal carcinoma (IDC) lesions and mass-only lesions were dichotomized by RS scores, low-risk versus intermediate/high-risk, and statistical analysis was performed using Mann-Whitney's test (statistical significance at P < 0.05) and receiver operating characteristic (ROC) curves. Multivariate analysis was also performed.

Results: Invasive breast cancers, when scored as low-risk by ODxRS, had significantly higher ADC values compared with intermediate/high-risk lesions for both ADC600 (P = 0.007) and ADC1000 (P = 0.008) mean values. This was true both when analyzing only mass-lesions (P = 0.03 and 0.01) or only IDCs (P = 0.001 and 0.009).

Conclusion: Preliminary findings suggest that lesion ADC values correlate with recurrence risk likelihood stratified using ODxRS. Hence, ADC is a potential surrogate biomarker for tumor aggressiveness.

Level Of Evidence: 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:401-409.

Keywords: apparent diffusion coefficient; breast cancer; diffusion weighted MRI; dynamic contrast enhanced MRI; recurrence scores.

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