Tumor characteristics and metabolic quantification in carcinoma breast: An institutional experience

Integration of Longitudinal and Transverse Radiomics from Ultrasound Images with Clinical Factors for HER-2 Status Prediction in Invasive Breast Cancer Patients

OBJECTIVE

This study developed a nomogram combining longitudinal and transverse ultrasound radiomics with clinical factors to identify human epidermal growth factor receptor 2 (HER2) status in invasive breast cancer (BC).

MATERIALS AND METHODS

We analyzed 537 invasive BC patients from two hospitals: 436 in the training cohort (Hospital A) and 101 in the test cohort (Hospital B). From longitudinal and transverse ultrasound planes, 788 radiomics features were extracted, with dimensionality reduced using least absolute shrinkage and selection operator regression. A radiomics nomogram integrating clinical predictors and radiomics scores (Rad-scores) was constructed.

RESULTS

Fifteen and sixteen features from longitudinal and transverse ultrasound planes, respectively, were selected to generate Rad-scores, which differed significantly between HER2-positive and HER2-negative groups in both cohorts (p < 0.05). The combined radiomics model outperformed individual models with AUCs of 0.783 and 0.762 in the training and external test cohorts, respectively. Tumor size was an independent clinical predictor. The nomogram, incorporating Rad-scores and tumor size, achieved AUCs of 0.790 (training cohort) and 0.774 (test cohort). Decision curve analysis demonstrated its potential clinical utility.

CONCLUSION

A biplanar ultrasound radiomics nomogram effectively predicts HER2 status in invasive BC, potentially reducing the need for biopsies and supporting personalized treatment strategies.

Locally Advanced Breast Cancer: Response Evaluation to Neoadjuvant Chemotherapy by Clinico-Histopathological Parameters and Molecular Imaging

In India, breast cancer (BC) is not only the commonest cancer but also the commonest cause of cancer mortality among females. Advanced BC constitutes >70% of BC cases at initial presentation in India, among which locally advanced breast cancer (LABC) requires a multi-disciplinary approach with a combination of systemic and locoregional therapies. This descriptive hospital-based study was conducted over 1½ years after seeking approval from the institutional ethics committee. Fifty-five patients satisfying all the criteria of the study were enrolled. The data, thus, collected was pooled into Excel spreadsheet and analyzed using appropriate statistical tools. Most of the patients were postmenopausal, multiparous with breast lump being the commonest symptom. Mean baseline characteristics were age - 48 years, SUV max - 9.2, and Ki-67 - 17.8%. cT4 and cN2 were the commonest pre-NACT tumor and lymph node stage. Invasive ductal carcinoma was the commonest tumor type with the most common tumor grade being grade 3. Hormone receptor positivity and HER2 overexpression were seen in 33 and 17 patients respectively. Post-NACT 32 patients underwent breast-conserving surgery. Pathological complete response (pCR), i.e., ypT0N0, was seen in 13 patients (23.6%). There was slight alteration in hormone receptor status, HER2 expression and Ki-67 in the post-NACT resected tumor. pCR, which is a surrogate marker for improved clinical outcome (DFS and OS) in LABC patients, occurred more commonly in patients with pre-NACT grade 3 tumors, high Ki-67, hormone receptor-negative, and HER2 overexpressing BC (overall, in triple negative BC) but was statistically significant only with Ki-67. Post-NACT, SUV max with a cut off ≤1.5, and ΔSUV max of >80% correlated closely with pCR.

Correlation of 18-fluorodeoxyglucose uptake values on PET-CT scan with histological prognostic markers in breast cancer

BACKGROUND

Positron emission tomography-computed tomography (PET-CT) scan utilizes 18-fluorodeoxyglucose (18-FDG), based on the principle of higher glycolytic activity and reduced glucose-6-phosphatase levels in cancer cells. This imaging modality is usually advised in the metastatic evaluation of stage III breast cancer patients. The correlation of maximum standard uptake values of primary lesion with different pathological and molecular markers has not been studied extensively.

METHODS

Retrospective analysis of the data was performed from our prospectively maintained breast cancer database. All the patients who had undergone 18-FDG PET-CT scan at initial evaluation for staging between June 2017 and April 2020 were included in the study. One-way ANOVA test or Student's t-test as appropriate was performed to assess the difference of means in maximum standard uptake values (SUVmax) of the primary lesion and axillary nodes with clinical stage, histological grade, molecular subtype. Bonferroni post hoc test was also applied.

RESULTS

Out of 388 patients in the breast cancer database, 45 patients met inclusion criteria. There was a significant correlation of molecular subtype (p = 0.029) with SUVmax of the primary lesion. Higher primary SUVmax was associated with higher T stage (p = 0.01) and higher histological grade (p = 0.06). In each molecular subtype, there was an increase in mean SUVmax of the primary lesion with increasing histological grade and vice versa.

CONCLUSIONS

SUVmax of the primary lesion in breast cancer patients reflects tumor biology. Higher SUVmax can predict patients with triple-negative breast cancers and higher grades in primary tumors. However, further large-scale validatory studies are essential.

PET-CT upstaging of unilateral operable breast cancer and its correlation with molecular subtypes

Context:

Prognosis and survival rates for breast cancer vary greatly depending on the cancer stage of the patient. Instead of a step-by-step approach using multiple investigations, we can get all the information about the metastatic load of the disease in PET-CT imaging by one single investigation. There is also a correlation between prognosis, FDG uptake, and molecular subtype of breast cancer (Luminal A, Luminal B, Human epidermal growth factor receptor 2 (HER2) positive and Triple-negative). Pre-treatment baseline PET-CT scan was done in 156 unilateral early and operable breast cancer patients from November 2017 to April 2019 in our prospective observational study.

Aims:

To evaluate the utility of PET-CT in staging and upstaging of early and operable breast cancer by detection of unsuspected lymph nodes and distant organ metastases.

To determine the prognostic association between SUVmax of the primary breast lesion in the upstaged cases and the molecular subtypes.

Results:

Thus, PET-CT can serve as one-stop imaging in unilateral operable early breast cancer patients for upstaging and prognostication based on the correlation of SUVmax with molecular subtypes of breast lesions in patients who will surely benefit from whole-body imaging.

Out of 156 patients, approximately 27 patients were upstaged after pre-treatment PET CT.

Six patients were upstaged to stage IIIC and 21 patients were upstaged to IV.

Regional nodes like internal mammary and supraclavicular nodes were detected in 7 patients and 5 patients, respectively, out of 156 patients.

Non-regional distant nodes and organ metastases were detected in 11 and 18 patients out of 156 patients.

Most common molecular subtype detected in the upstaged cases in our study was Luminal A (13 patients) followed by Triple negative (6), Luminal B (3) and HER2-neu-positive subtypes (1).

Conclusions:

FDG PET-CT is a substantial modality to provide information on regional, non regional lymph nodes and distant metastases in early operable breast cancer.

It helps in evaluating the whole body metastatic burden in a single sitting, therefore, reducing the need for multiple investigations.

SUVmax association of the index lesion with molecular subtype in the FDG PET scanning can serve as a prognostication factor in operable early breast cancer patients.

Hybrid 18F-FDG-PET/MRI Measurement of Standardized Uptake Value Coupled with Yin Yang 1 Signature in Metastatic Breast Cancer. A Preliminary Study

Purpose: Detection of breast cancer (BC) metastasis at the early stage is important for the assessment of BC progression status. Image analysis represents a valuable tool for the management of oncological patients. Our preliminary study combined imaging parameters from hybrid ¹⁸F-FDG-PET/MRI and the expression level of the transcriptional factor Yin Yang 1 (YY1) for the detection of early metastases. Methods: The study enrolled suspected n = 217 BC patients that underwent ¹⁸F-FDG-PET/MRI scans. The analysis retrospectively included n = 55 subjects. n = 40 were BC patients and n = 15 imaging-negative female individuals were healthy subjects (HS). Standard radiomics parameters were extracted from PET/MRI image. RNA was obtained from peripheral blood mononuclear cells and YY1 expression level was evaluated by real time reverse transcription polymerase chain reactions (qRT-PCR). An enzyme-linked immuosorbent assay (ELISA) was used to determine the amount of YY1 serum protein. Statistical comparison between subgroups was evaluated by Mann-Whitney U and Spearman’s tests. Results: Radiomics showed a significant positive correlation between Greg-level co-occurrence matrix (GLCM) and standardized uptake value maximum (SUVmax) (r = 0.8 and r = 0.8 respectively) in BC patients. YY1 level was significant overexpressed in estrogen receptor (ER)-positive/progesteron receptor-positive/human epidermal growth factor receptor2-negative (ER+/PR+/HER2-) subtype of BC patients with synchronous metastasis (SM) at primary diagnosis compared to metachronous metastasis (MM) and HS (p < 0.001) and correlating significantly with ¹⁸F-FDG-uptake parameter (SUVmax) (r = 0.48). Conclusions: The combination of functional ¹⁸F-FDG-PET/MRI parameters and molecular determination of YY1 could represent a novel integrated approach to predict synchronous metastatic disease with more accuracy than ¹⁸F-FDG-PET/MRI alone.