Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC)

Abeer H. Abdelhafez; Benjamin C. Musall; Beatriz E. Adrada; Kenneth R. Hess; Jong Bum Son; Ken Pin Hwang; Rosalind P. Candelaria; Lumarie Santiago; Gary J. Whitman; Huong T. Le-Petross; Tanya W. Moseley; Elsa Arribas; Deanna L. Lane; Marion E. Scoggins; Jessica W.T. Leung; Hagar S. Mahmoud; Jason B. White; Elizabeth E. Ravenberg; Jennifer K. Litton; Vicente Valero; Peng Wei; Alastair M. Thompson; Stacy L. Moulder; Mark D. Pagel; Jingfei Ma; Wei T. Yang; Gaiane M. Rauch

doi:10.1007/s10549-020-05917-7

Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC)

Abeer H. Abdelhafez, Benjamin C. Musall, Beatriz E. Adrada, Kenneth R. Hess, Jong Bum Son, Ken Pin Hwang, Rosalind P. Candelaria, Lumarie Santiago, Gary J. Whitman, Huong T. Le-Petross, Tanya W. Moseley, Elsa Arribas, Deanna L. Lane, Marion E. Scoggins, Jessica W.T. Leung, Hagar S. Mahmoud, Jason B. White, Elizabeth E. Ravenberg, Jennifer K. Litton, Vicente ValeroPeng Wei, Alastair M. Thompson, Stacy L. Moulder, Mark D. Pagel, Jingfei Ma, Wei T. Yang, Gaiane M. Rauch

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Abstract

Purpose: To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC. Methods: This retrospective study included 85 TNBC patients (mean age 51.8 ± 13 years) with MRI before NAST and definitive surgery during 2010–2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann–Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR. Results: Of 39 patients (46%) with necrosis, 17 had pCR and 22 did not. Necrosis was not associated with pCR (OR, 0.995; 95% confidence interval [CI] 0.4–2.3) and was not an independent prognostic factor when combined with T stage and nodal status at staging (P = 0.46). None of the imaging metrics differed significantly between pCR and non-pCR in patients with necrosis (AUC < 0.6 and P > 0.40). Conclusion: No significant association was found between necrosis by pretreatment MRI or the quantitative imaging characteristics of tumor necrosis and response to NAST in TNBC.

Original language	English (US)
Journal	Breast Cancer Research and Treatment
Volume	185
Issue number	1
DOIs	https://doi.org/10.1007/s10549-020-05917-7
State	Published - Jan 2021

Keywords

Diffusion-weighted MRI
Multiparametric MRI
Necrosis
Neoadjuvant therapy
Triple-negative breast cancer

ASJC Scopus subject areas

Oncology
Cancer Research

MD Anderson CCSG core facilities

Biostatistics Resource Group
Clinical Trials Office

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10.1007/s10549-020-05917-7

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Abdelhafez, A. H., Musall, B. C., Adrada, B. E., Hess, K. R., Son, J. B., Hwang, K. P., Candelaria, R. P., Santiago, L., Whitman, G. J., Le-Petross, H. T., Moseley, T. W., Arribas, E., Lane, D. L., Scoggins, M. E., Leung, J. W. T., Mahmoud, H. S., White, J. B., Ravenberg, E. E., Litton, J. K., ... Rauch, G. M. (2021). Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC). Breast Cancer Research and Treatment, 185(1). https://doi.org/10.1007/s10549-020-05917-7

Abdelhafez, AH, Musall, BC, Adrada, BE, Hess, KR, Son, JB, Hwang, KP , Candelaria, RP , Santiago, L , Whitman, GJ , Le-Petross, HT , Moseley, TW , Arribas, E , Lane, DL, Scoggins, ME, Leung, JWT, Mahmoud, HS, White, JB, Ravenberg, EE, Litton, JK , Valero, V , Wei, P, Thompson, AM, Moulder, SL, Pagel, MD, Ma, J , Yang, WT & Rauch, GM 2021, 'Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC)', Breast Cancer Research and Treatment, vol. 185, no. 1. https://doi.org/10.1007/s10549-020-05917-7

@article{12f3860075fd4364892d7cc8671a100b,

title = "Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC)",

abstract = "Purpose: To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC. Methods: This retrospective study included 85 TNBC patients (mean age 51.8 ± 13 years) with MRI before NAST and definitive surgery during 2010–2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann–Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR. Results: Of 39 patients (46%) with necrosis, 17 had pCR and 22 did not. Necrosis was not associated with pCR (OR, 0.995; 95% confidence interval [CI] 0.4–2.3) and was not an independent prognostic factor when combined with T stage and nodal status at staging (P = 0.46). None of the imaging metrics differed significantly between pCR and non-pCR in patients with necrosis (AUC < 0.6 and P > 0.40). Conclusion: No significant association was found between necrosis by pretreatment MRI or the quantitative imaging characteristics of tumor necrosis and response to NAST in TNBC.",

keywords = "Diffusion-weighted MRI, Multiparametric MRI, Necrosis, Neoadjuvant therapy, Triple-negative breast cancer",

author = "Abdelhafez, {Abeer H.} and Musall, {Benjamin C.} and Adrada, {Beatriz E.} and Hess, {Kenneth R.} and Son, {Jong Bum} and Hwang, {Ken Pin} and Candelaria, {Rosalind P.} and Lumarie Santiago and Whitman, {Gary J.} and Le-Petross, {Huong T.} and Moseley, {Tanya W.} and Elsa Arribas and Lane, {Deanna L.} and Scoggins, {Marion E.} and Leung, {Jessica W.T.} and Mahmoud, {Hagar S.} and White, {Jason B.} and Ravenberg, {Elizabeth E.} and Litton, {Jennifer K.} and Vicente Valero and Peng Wei and Thompson, {Alastair M.} and Moulder, {Stacy L.} and Pagel, {Mark D.} and Jingfei Ma and Yang, {Wei T.} and Rauch, {Gaiane M.}",

note = "Funding Information: This study has received funding by the National Institutes of Health/National Cancer Institute (Cancer Center Support Grant P30 CA016672); specifically resources from the Biostatistics Resource Group were used. Acknowledgements Publisher Copyright: {\textcopyright} 2020, Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2021",

month = jan,

doi = "10.1007/s10549-020-05917-7",

language = "English (US)",

volume = "185",

journal = "Breast Cancer Research and Treatment",

issn = "0167-6806",

publisher = "Springer New York",

number = "1",

}

TY - JOUR

T1 - Tumor necrosis by pretreatment breast MRI

T2 - association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC)

AU - Abdelhafez, Abeer H.

AU - Musall, Benjamin C.

AU - Adrada, Beatriz E.

AU - Hess, Kenneth R.

AU - Son, Jong Bum

AU - Hwang, Ken Pin

AU - Candelaria, Rosalind P.

AU - Santiago, Lumarie

AU - Whitman, Gary J.

AU - Le-Petross, Huong T.

AU - Moseley, Tanya W.

AU - Arribas, Elsa

AU - Lane, Deanna L.

AU - Scoggins, Marion E.

AU - Leung, Jessica W.T.

AU - Mahmoud, Hagar S.

AU - White, Jason B.

AU - Ravenberg, Elizabeth E.

AU - Litton, Jennifer K.

AU - Valero, Vicente

AU - Wei, Peng

AU - Thompson, Alastair M.

AU - Moulder, Stacy L.

AU - Pagel, Mark D.

AU - Ma, Jingfei

AU - Yang, Wei T.

AU - Rauch, Gaiane M.

N1 - Funding Information: This study has received funding by the National Institutes of Health/National Cancer Institute (Cancer Center Support Grant P30 CA016672); specifically resources from the Biostatistics Resource Group were used. Acknowledgements Publisher Copyright: © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2021/1

Y1 - 2021/1

N2 - Purpose: To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC. Methods: This retrospective study included 85 TNBC patients (mean age 51.8 ± 13 years) with MRI before NAST and definitive surgery during 2010–2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann–Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR. Results: Of 39 patients (46%) with necrosis, 17 had pCR and 22 did not. Necrosis was not associated with pCR (OR, 0.995; 95% confidence interval [CI] 0.4–2.3) and was not an independent prognostic factor when combined with T stage and nodal status at staging (P = 0.46). None of the imaging metrics differed significantly between pCR and non-pCR in patients with necrosis (AUC < 0.6 and P > 0.40). Conclusion: No significant association was found between necrosis by pretreatment MRI or the quantitative imaging characteristics of tumor necrosis and response to NAST in TNBC.

AB - Purpose: To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC. Methods: This retrospective study included 85 TNBC patients (mean age 51.8 ± 13 years) with MRI before NAST and definitive surgery during 2010–2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann–Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR. Results: Of 39 patients (46%) with necrosis, 17 had pCR and 22 did not. Necrosis was not associated with pCR (OR, 0.995; 95% confidence interval [CI] 0.4–2.3) and was not an independent prognostic factor when combined with T stage and nodal status at staging (P = 0.46). None of the imaging metrics differed significantly between pCR and non-pCR in patients with necrosis (AUC < 0.6 and P > 0.40). Conclusion: No significant association was found between necrosis by pretreatment MRI or the quantitative imaging characteristics of tumor necrosis and response to NAST in TNBC.

KW - Diffusion-weighted MRI

KW - Multiparametric MRI

KW - Necrosis

KW - Neoadjuvant therapy

KW - Triple-negative breast cancer

UR - http://www.scopus.com/inward/record.url?scp=85090942837&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85090942837&partnerID=8YFLogxK

U2 - 10.1007/s10549-020-05917-7

DO - 10.1007/s10549-020-05917-7

M3 - Review article

C2 - 32920733

AN - SCOPUS:85090942837

SN - 0167-6806

VL - 185

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

IS - 1

ER -

Tumor necrosis by pretreatment breast MRI: association with neoadjuvant systemic therapy (NAST) response in triple-negative breast cancer (TNBC)

Abstract

Keywords

ASJC Scopus subject areas

MD Anderson CCSG core facilities

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