Povezanost morfoloških i kinetičkih osobitosti duktalnoga invazivnoga karcinoma dojke dobivenih magnetnom rezonancijom s patohistološkim prognostičkim pokazateljima [Correlation of morphological and kinetic features at magnetic resonance imaging and pathohistological prognostic factors in invasive ductal breast cancer]

Alduk, Ana Marija (2015) Povezanost morfoloških i kinetičkih osobitosti duktalnoga invazivnoga karcinoma dojke dobivenih magnetnom rezonancijom s patohistološkim prognostičkim pokazateljima [Correlation of morphological and kinetic features at magnetic resonance imaging and pathohistological prognostic factors in invasive ductal breast cancer]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Objective. The aim of this study was to correlate magnetic resnonace imaging (MRI) features of invasive ductal carcinomas (IDC) with pathohistological prognostic factors, as well as with molecular subtypes of breast cancer. Such an association, if present, could have significant translational implications for early identification of aggressive types of breast cancer, where rapid identification can expedite tumor treatment. Methods. 114 women with IDC who underwent breast MRI within one month prior to surgery were included in this retrospective study. MRI features were analyzed and then interpreted with a Göttingen score (GS) that included morphological (shape, margins and pattern of enhancement) and kinetic characteristics (initial signal increase and post-initial behaviour of the time-signal intensity curve). Histological specimens were analyzed for tumor size, axillary lymph node status, histological grade, estrogene receptors (ER), progesterone receptors (PR), HER2, and Ki-67. Results. By multivariate analysis, a smooth margin was a significant, independent predictor of a larger tumor size (p=0.041), lymph node invasion (p=0,013), and lower expression of ER (p=0.022). High GS was significant, independent predictor of a higher histological grade (p=0.022) while round or oval shape of lesion was independent predictor of a higher PR expression (p=0,027). Conclusion. A smooth margin of breast cancer on breast MRI was able to predict positive axillary lymph nodes, larger tumor size and lower expression of ER. Except for a higher histological grade, GS was not able to predict other unfavourable prognostic factors, mainly due to the fact that smooth margins were assigned less points than spiculated margins.

Abstract in Croatian

Svrha rada. Svrha istraživanja je analizirati povezanost karakteristika duktalnoga invazivnoga karcinoma (IDC) dojke dobivenih magnetnom rezonancijom (MR) s patohistološkim prognostičkim pokazateljima te s molekularnim podtipovima karcinoma dojke. Metode. U ovo retrospektivno istraživanje je bilo uključeno 114 bolesnica s IDC-om dojke kod kojih je učinjen preoperativni MR pregled. Analizirane su morfološke i kinetičke karakteristike IDC-a, koje su potom interpretirane pomoću Göttingenskog sustava bodovanja (GS). Uvidom u konačni patohistološki nalaz utvrđena je veličina tumora, status aksilarnih limfnih čvorova, histološki gradus, limfovaskularna invazija, estrogenski receptori (ER), progesteronski receptori (PR), ekspresija HER2 i proliferacijski indeks (Ki-67). Rezultati. Multivarijatna analiza je pokazala da su glatki rubovi značajan neovisan prediktor većeg tumora (p=0.041), pozitivnih aksilarnih limfnih čvorova (p=0,013) i negativnih ER (p=0.022). Veći GS je bio značajan neovisni prediktor višeg histološkog gradusa (p=0.022), dok je okrugli ili ovalni oblik bio neovisan prediktor pozitivnih PR (p=0,027). Zaključak. Otkrivanje glatkih rubova pri MR-u je klinički bitna odrednica prognoze karcinoma dojke budući da su glatki rubovi značajan neovisan prediktor više nepovoljnih prognostičkih pokazatelja, i to veličine tumora, pozitivnih aksilarnih limfnih čvorova te negativnih ER. Osim s višim histološkim gradusom, GS nije bio značajno povezan s ostalim nepovoljnim prognostičkim pokazateljima, vjerojatno zbog činjenice da se prema ovom sustavu bodovanja glatkim rubovima dodjeljuje manje bodova nego spikuliranim rubovima.

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