Erschienen in:
01.12.2015 | Breast
Intratumoral metabolic heterogeneity predicts invasive components in breast ductal carcinoma in situ
verfasst von:
Hai-Jeon Yoon, Yemi Kim, Bom Sahn Kim
Erschienen in:
European Radiology
|
Ausgabe 12/2015
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Abstract
Objectives
This study investigated whether texture-based imaging parameters could identify invasive components of ductal carcinoma in situ (DCIS).
Methods
We enrolled 65 biopsy-confirmed DCIS patients (62 unilateral, 3 bilateral) who underwent 18 F-FDG PET, diffusion-weighted imaging (DWI), or breast-specific gamma imaging (BSGI). We measured SUV
max
and intratumoral metabolic heterogeneity by the area under the curve (AUC) of cumulative SUV histograms (CSH) on PET, tumour-to-normal ratio (TNR) and coefficient of variation (COV) as an index of heterogeneity on BSGI, minimum ADC (ADC
min
) and ADC difference (ADC
diff
) as an index of heterogeneity on DWI. After surgery, final pathology was categorized as pure-DCIS (DCIS-P), DCIS with microinvasion (DCIS-MI), or invasive ductal carcinoma (IDC). Clinicopathologic features of DCIS were correlated with final classification.
Results
Final pathology confirmed 44 DCIS-P, 14 DCIS-MI, and 10 IDC. The invasive component of DCIS was significantly correlated with higher SUV
max
(p = 0.017) and lower AUC-CSH (p < 0.001) on PET, higher TNR (p = 0.008) and COV (p = 0.035) on BSGI, lower ADC
min
(p = 0.016) and higher ADC
diff
(p = 0.009) on DWI, and larger pathologic size (p = 0.018). On multiple regression analysis, AUC-CSH was the only significant predictor of invasive components (p = 0.044).
Conclusions
The intratumoral metabolic heterogeneity of 18 F-FDG PET was the most important predictor of invasive components of DCIS.
Key Points
• Preoperative identification of invasion in DCIS is important for axillary nodal management
• Higher SUV
max
and lower AUC-CSH from FDG PET may indicate invasive components of DCIS
• Higher TNR and COV from BSGI may indicate invasive components of DCIS
• Lower ADC
min
and higher ADC
diff
from DWI may indicate invasive components of DCIS
• AUC-CSH, an index of metabolic heterogeneity, is an independent predictor for invasive components