Abstract
Abstract
Background
Lymphovascular invasion (LVI) predicts a poor outcome of breast cancer (BC), but LVI can only be postoperatively diagnosed by histopathology. We aimed to determine whether quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can preoperatively predict LVI and clinical outcome of BC patients.
Methods
A total of 189 consecutive BC patients who underwent multiparametric MRI scans were retrospectively evaluated. Quantitative (Ktrans, Ve, Kep) and semiquantitative DCE-MRI parameters (W− in, W− out, TTP), and clinicopathological features were compared between LVI-positive and LVI-negative groups. All variables were calculated by using univariate logistic regression analysis to determine the predictors for LVI. Multivariate logistic regression was used to build a combined-predicted model for LVI-positive status. Receiver operating characteristic (ROC) curves evaluated the diagnostic efficiency of the model and Kaplan-Meier curves showed the relationships with the clinical outcomes. Multivariate analyses with a Cox proportional hazard model were used to analyze the hazard ratio (HR) for recurrence-free survival (RFS) and overall survival (OS).
Results
LVI-positive patients had a higher Kep value than LVI-negative patients (0.92 ± 0.30 vs. 0.81 ± 0.23, P = 0.012). N2 stage [odds ratio (OR) = 3.75, P = 0.018], N3 stage (OR = 4.28, P = 0.044), and Kep value (OR = 5.52, P = 0.016) were associated with LVI positivity. The combined-predicted LVI model that incorporated the N stage and Kep yielded an accuracy of 0.735 and a specificity of 0.801. The median RFS was significantly different between the LVI-positive and LVI-negative groups (31.5 vs. 34.0 months, P = 0.010) and between the combined-predicted LVI-positive and LVI-negative groups (31.8 vs. 32.0 months, P = 0.007). The median OS was not significantly different between the LVI-positive and LVI-negative groups (41.5 vs. 44.0 months, P = 0.270) and between the combined-predicted LVI-positive and LVI-negative groups (42.8 vs. 43.5 months, P = 0.970). LVI status (HR = 2.40), N2 (HR = 3.35), and the combined-predicted LVI model (HR = 1.61) were independently associated with disease recurrence.
Conclusion
The quantitative parameter of Kep could predict LVI. LVI status, N stage, and the combined-predicted LVI model were predictors of a poor RFS but not OS.
Funder
National Natural Science Foundation of China
Department of Education of Guangdong Province
Medical Scientific Foundation of Guangdong Province
Publisher
Springer Science and Business Media LLC
Subject
Radiology, Nuclear Medicine and imaging,Oncology,General Medicine,Radiological and Ultrasound Technology