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Prvulovic Bunovic N, Sveljo O, Kozic D, Boban J. Is Elevated Choline on Magnetic Resonance Spectroscopy a Reliable Marker of Breast Lesion Malignancy? Front Oncol 2021; 11:610354. [PMID: 34567998 PMCID: PMC8462297 DOI: 10.3389/fonc.2021.610354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Background Contemporary magnetic resonance imaging (MRI) of the breast represents a powerful diagnostic modality for cancer detection, with excellent sensitivity and high specificity. Magnetic resonance spectroscopy (MRS) is being explored as an additional tool for improving specificity in breast cancer detection, using multiparametric MRI. The aim of this study was to examine the possibility of 1H-MRS to discriminate malignant from benign breast lesions, using elevated choline (Cho) peak as an imaging biomarker. Methods A total of 60 patients were included in this prospective study: 30 with malignant (average age, 55.2 years; average lesion size, 35 mm) and 30 with benign breast lesions (average age, 44.8 years; average lesion size, 20 mm), who underwent multiparametric MRI with multivoxel 3D 1H-MRS on a 1.5-T scanner in a 3-year period. Three patients with benign breast lesions were excluded from the study. All lesions were histologically verified. Peaks identified on 1H-MRS were lipid (0.9, 2.3, 2.8, and 5.2 ppm), choline (3.2 ppm), and water peaks (4.7 ppm). Sensitivity and specificity, as well as positive and negative predictive values, were defined using ROC curves. Cohen's Kappa test of inter-test reliability was performed [testing the agreement between 1H-MRS and histologic finding, and 1H-MRS and MR mammography (MRM)]. Results Choline peak was elevated in 24/30 malignant lesions and in 20/27 benign breast lesions. The sensitivity of 1H-MRS was 0.8, specificity was 0.741, positive predictive value was 0.774, and negative predictive value was 0.769. Area under ROC was 0.77 (CI 0.640-0.871). Inter-test reliability between 1H-MRS and histologic finding was 0.543 (moderate agreement) and that between 1H-MRS and MRM was 0.573 (moderate agreement). False-negative findings were most frequently observed in invasive lobular cancers, while false-positive findings were most frequently observed in adenoid fibroadenomas. Conclusion Although elevation of the choline peak has a good sensitivity and specificity in breast cancer detection, both are significantly lower than those of multiparametric MRM. Inclusion of spectra located on tumor margins as well as analysis of lipid peaks could aid both sensitivity and specificity. An important ratio of false-positive and false-negative findings in specific types of breast lesions (lobular cancer and adenoid fibroadenoma) suggests interpreting these lesions with a caveat.
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Affiliation(s)
- Natasa Prvulovic Bunovic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Center for Diagnostic Imaging, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Olivera Sveljo
- Center for Diagnostic Imaging, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.,Department for Telecommunications and Signal Processing, Faculty of Technical Sciences, University of Novi Sad, Novi Sad, Serbia
| | - Dusko Kozic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Center for Diagnostic Imaging, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Jasmina Boban
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Center for Diagnostic Imaging, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
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Enoki T, Jomoto W, Yamano T, Kotoura N. [Influences of Tumor Volume and FWHM of the Water Peak and T 2* Value of Water on the Detection Rate of the Choline Peaks in Proton MR Spectroscopy of Breast Cancer at 3.0 T-MRI]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:351-357. [PMID: 33883369 DOI: 10.6009/jjrt.2021_jsrt_77.4.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In proton magnetic resonance (MR) spectroscopy (1H-MRS) of the breast cancer, choline peak could be detected. The purpose of this study was to evaluate the influences of the tumor volume, full width at half maximum (FWHM) of the water peak (FWHM), and T2* value of water (T2* value) on the detection rate of the choline peaks at 3.0 T-MRI. We measured FWHM and T2* value in 109 cases, and we evaluated the effect of tumor volume on the detection rate of the choline peaks and the effect of FWHM and T2* value on the detection of choline peaks. In 1H-MRS of breast cancer at 3.0 T-MRI, the detection rate of the choline peaks improved as the tumor volume was larger. As a shimming environment when acquiring 1H-MRS of breast cancer, FWHM is preferably 57.4 Hz or less and T2* value should be 11 ms or more, and T2* value has a great influence on the detection rate of the choline peaks.
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Affiliation(s)
- Takuya Enoki
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Wataru Jomoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | - Toshiko Yamano
- Department of Radiology, Hyogo College of Medicine (Current address: Department of Radiology, Amagasaki Chuo Hospital)
| | - Noriko Kotoura
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
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Advanced approaches to imaging primary breast cancer: an update. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Durrani SR, Mukkada VA, Guilbert TW. Eosinophilic Esophagitis: an Important Comorbid Condition of Asthma? Clin Rev Allergy Immunol 2018; 55:56-64. [PMID: 29455359 DOI: 10.1007/s12016-018-8670-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Eosinophilic esophagitis and asthma are frequently found as comorbid conditions in children and adults along with other manifestations of atopic diathesis. These two conditions have similar T helper 2 responses-driven pathophysiology and share common management strategies such as using systemic corticosteroids and targeted anti-cytokine biologic therapies. Review of the literature finds that asthma is often a comorbid condition in eosinophilic esophagitis in both children and adults; however, the EoE-asthma relationship remains poorly characterized mechanistically and clinically. EoE and asthma commonly share several comorbid conditions such as allergic rhinitis and gastroesophageal reflux disease; therefore, addressing these comorbid conditions has the potential to improve and/or maintain control in both diseases. Similar to asthma, patients with EoE frequently demonstrate elevations in serum markers of atopy, including serum IgE levels, peripheral eosinophil counts, and T helper 2-related cytokines. Gastroesophageal reflux disease is thought to affect asthma through microaspirations, airway hyperresponsiveness, and increased vagal tone. The understanding of the relationship between gastroesophageal reflux and EoE is still evolving but seems to be bidirectional and interactive. In terms of treatment, similar classes of medications have been used in both EoE and asthma. In both children and adults, EoE remission can be achieved by food trigger avoidance and use of corticosteroids and biologic therapies. Asthma control is mostly achieved through inhaled corticosteroids, and long but biologic therapies are increasingly used in severe subsets of the disease. Significant clinical and mechanistic work needs to be accomplished to better understand the relationship between asthma, EoE, and their interaction with other allergic diseases. Understanding whether shared mechanisms exist can lead to the development of new diagnostic and therapeutic strategies. The following review examines the existing literature regarding prevalence, common comorbidities, and potential therapeutic approach and identifies gaps in knowledge and future directions.
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Affiliation(s)
- Sandy R Durrani
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Vincent A Mukkada
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Montemezzi S, Camera L, Giri MG, Pozzetto A, Caliò A, Meliadò G, Caumo F, Cavedon C. Is there a correlation between 3T multiparametric MRI and molecular subtypes of breast cancer? Eur J Radiol 2018; 108:120-127. [PMID: 30396643 DOI: 10.1016/j.ejrad.2018.09.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/20/2018] [Accepted: 09/18/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To test whether 3 T multiparametric magnetic resonance imaging (mMRI) provides information related to molecular subtypes of breast cancer. METHODS Women with mammographic or US findings of breast lesions (BI-RADS 4-5) underwent 3 T mMRI (DCE, DWI and MR spectroscopy). The histological type of breast cancer was assessed. Estrogen-receptor (ER), progesterone-receptor (PgR), Ki-67 status and HER-2 expression, assessed by immunohistochemistry (IHC), defined four molecular subtypes: Luminal-A, Luminal-B, HER2-enriched and triple-negative. Non-parametric tests (Kruskal-Wallis, k-sample equality of medians, and Mann-Whitney), logistic regression or ANOVA, and a multivariate analysis were performed to investigate correlations between the four molecular subtypes and mMRI (lesion volume, margins or distribution, enhancement pattern, ADC, type of kinetic curve, and total choline (tCho) signal-to-noise-ratio (SNR)). A ROC analysis was finally performed to test the diagnostic power of a multivariate logistic regression model. RESULTS 433 patients (453 lesions) were considered. Volume was smaller in Luminal-B and larger in triple-negative tumours compared to the other subtypes combined. Margins were significantly correlated to Luminal-A and Luminal-B. The type of curve was significantly correlated to Luminal-A. ADC values were higher in Luminal-A. tCho SNR was higher in triple-negative tumours. The ROC analysis showed that the area under the curve (AUC) significantly improved when multiple MRI features were used compared to individual parameters. CONCLUSIONS A significant correlation was found between some MRI features and molecular subtypes of breast tumours. A multiparametric approach improved the diagnostic power of MRI. However, further research is needed in order to predict the molecular subtype on the sole basis of mMRI.
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Affiliation(s)
- Stefania Montemezzi
- Department of Pathology and Diagnostics - Radiology Unit, University Hospital of Verona, Verona, Italy.
| | - Lucia Camera
- Department of Pathology and Diagnostics - Radiology Unit, University Hospital of Verona, Verona, Italy
| | - Maria Grazia Giri
- Department of Pathology and Diagnostics - Medical Physics Unit, University Hospital of Verona, Verona, Italy
| | - Alice Pozzetto
- Department of Pathology and Diagnostics - Radiology Unit, University Hospital of Verona, Verona, Italy
| | - Anna Caliò
- Department of Pathology and Diagnostics - Pathology Unit, University Hospital of Verona, Verona, Italy
| | - Gabriele Meliadò
- Department of Pathology and Diagnostics - Medical Physics Unit, University Hospital of Verona, Verona, Italy
| | - Francesca Caumo
- Radiology Department, Istituto Oncologico Veneto, Padova, Italy
| | - Carlo Cavedon
- Department of Pathology and Diagnostics - Medical Physics Unit, University Hospital of Verona, Verona, Italy
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Montemezzi S, Cavedon C, Camera L, Meliadò G, Caumo F, Baglio I, Sardanelli F. 1H-MR spectroscopy of suspicious breast mass lesions at 3T: a clinical experience. Radiol Med 2016; 122:161-170. [DOI: 10.1007/s11547-016-0713-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/27/2016] [Indexed: 12/24/2022]
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Ramazan A, Demircioglu O, Ugurlu U, Kaya H, Aribal E. Efficacy of single voxel 1H MR spectroscopic imaging at 3T for the differentiation of benign and malign breast lesions. Clin Imaging 2016; 40:831-6. [PMID: 27179154 DOI: 10.1016/j.clinimag.2016.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/18/2016] [Accepted: 03/10/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of our study was to evaluate the effect of 1H Magnetic Resonance Spectroscopy (MRS) in differentiating breast lesions. MATERIALS AND METHODS Single voxel 1H Magnetic Resonance Spectroscopy (1H-MRS) was performed with 3T magnet in 45 women. The choline cut off point was set semi-quantitavely. Sensitivity, specificity and accuracy of MRS were calculated. RESULTS Twenty-four of 25 (96%) malignant and 9 of 26 (35%) benign lesions had choline peak. With the use cutoff value of 19,5 MRS provided a 96% sensitivity, 65% specificity and 80% accuracy. CONCLUSION MRS has a high diagnostic accuracy in differentiating breast lesions.
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Affiliation(s)
- Abdullah Ramazan
- Marmara University Pendik Education and Research Hospital, Department of Radiology, Istanbul.
| | - Ozlem Demircioglu
- Marmara University Pendik Education and Research Hospital, Department of Radiology, Istanbul.
| | - Umit Ugurlu
- Marmara University Pendik Education and Research Hospital, Department of General Surgery, Istanbul.
| | - Handan Kaya
- Marmara University Pendik Education and Research Hospital, Department of Pathology, Istanbul.
| | - Erkin Aribal
- Marmara University Pendik Education and Research Hospital, Department of Radiology, Istanbul.
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Abstract
In view of the trend towards personalized treatment strategies for (cancer) patients, there is an increasing need to noninvasively determine individual patient characteristics. Such information enables physicians to administer to patients accurate therapy with appropriate timing. For the noninvasive visualization of disease-related features, imaging biomarkers are expected to play a crucial role. Next to the chemical development of imaging probes, this requires preclinical studies in animal tumour models. These studies provide proof-of-concept of imaging biomarkers and help determine the pharmacokinetics and target specificity of relevant imaging probes, features that provide the fundamentals for translation to the clinic. In this review we describe biological processes derived from the “hallmarks of cancer” that may serve as imaging biomarkers for diagnostic, prognostic and treatment response monitoring that are currently being studied in the preclinical setting. A number of these biomarkers are also being used for the initial preclinical assessment of new intervention strategies. Uniquely, noninvasive imaging approaches allow longitudinal assessment of changes in biological processes, providing information on the safety, pharmacokinetic profiles and target specificity of new drugs, and on the antitumour effectiveness of therapeutic interventions. Preclinical biomarker imaging can help guide translation to optimize clinical biomarker imaging and personalize (combination) therapies.
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Correlation between Choline Peak at MR Spectroscopy and Calcium-Sensing Receptor Expression Level in Breast Cancer: A Preliminary Clinical Study. Mol Imaging Biol 2015; 17:548-56. [DOI: 10.1007/s11307-015-0823-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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