Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients?
The potential of total choline (tCho), apparent diffusion coefficient (ADC) and tumor volume, both individually and in combination of all these three parameters (multi-parametric approach), was evaluated in predicting both pathological and clinical responses in 42 patients with locally advanced brea...
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| Language: | English |
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Frontiers Media S.A.
2018-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2018.00319/full |
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| author | Uma Sharma Khushbu Agarwal Rani G. Sah Rajinder Parshad Vurthaluru Seenu Sandeep Mathur Siddhartha D. Gupta Naranamangalam R. Jagannathan |
| author_facet | Uma Sharma Khushbu Agarwal Rani G. Sah Rajinder Parshad Vurthaluru Seenu Sandeep Mathur Siddhartha D. Gupta Naranamangalam R. Jagannathan |
| author_sort | Uma Sharma |
| collection | DOAJ |
| description | The potential of total choline (tCho), apparent diffusion coefficient (ADC) and tumor volume, both individually and in combination of all these three parameters (multi-parametric approach), was evaluated in predicting both pathological and clinical responses in 42 patients with locally advanced breast cancer (LABC) enrolled for neoadjuvant chemotherapy (NACT). Patients were sequentially examined by conventional MRI; diffusion weighted imaging and in vivo proton MR spectroscopy at 4 time points (pre-therapy, after I, II, and III NACT) at 1.5 T. Miller Payne grading system was used for pathological assessment of response. Of the 42 patients, 24 were pathological responders (pR) while 18 were pathological non-responders (pNR). Clinical response determination classified 26 patients as responders (cR) while 16 as non-responders (cNR). tCho and ADC showed significant changes after I NACT, however, MR measured tumor volume showed reduction only after II NACT both in pR and cR. After III NACT, the sensitivity to detect responders was highest for MR volume (83.3% for pR and 96.2% for cR) while the specificity was highest for ADC (76.5% for pR and 100% for cR). Combination of all three parameters exhibited lower sensitivity (66.7%) than MR volume for pR prediction, however, a moderate improvement was seen in specificity (58.8%). For the prediction of clinical response, multi-parametric approach showed 84.6% sensitivity with 100% specificity compared to MR volume (sensitivity 96.2%; specificity 80%). Kappa statistics demonstrated substantial agreement of clinical response with MR volume (k = 0.78) and with multi-parametric approach (k = 0.80) while moderate agreement was seen for tCho (k = 0.48) and ADC (k = 0.46). The values of k for tCho, MR volume and ADC were 0.31, 0.38, and 0.18 indicating fair, moderate, and slight agreement, respectively with pathological response. Moderate agreement (k = 0.44) was observed between clinical and pathological responses. Our study demonstrated that both tCho and ADC are strong predictors of assessment of early pathological and clinical responses. Multi-parametric approach yielded 100% specificity in predicting clinical response. Following III NACT, MR volume emerged as highly suitable predictor for both clinical and pathological assessments. PCA demonstrated separate clusters of pR vs. pNR and cR vs. cNR at post-therapy while with some overlap at pre-therapy. |
| first_indexed | 2024-12-15T00:04:36Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-15T00:04:36Z |
| publishDate | 2018-08-01 |
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| spelling | doaj.art-0df612453c834147b3baea094bea78db2022-12-21T22:42:46ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2018-08-01810.3389/fonc.2018.00319402526Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients?Uma Sharma0Khushbu Agarwal1Rani G. Sah2Rajinder Parshad3Vurthaluru Seenu4Sandeep Mathur5Siddhartha D. Gupta6Naranamangalam R. Jagannathan7Department of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Pathology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Pathology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of NMR and MRI Facility, All India Institute of Medical Sciences, New Delhi, IndiaThe potential of total choline (tCho), apparent diffusion coefficient (ADC) and tumor volume, both individually and in combination of all these three parameters (multi-parametric approach), was evaluated in predicting both pathological and clinical responses in 42 patients with locally advanced breast cancer (LABC) enrolled for neoadjuvant chemotherapy (NACT). Patients were sequentially examined by conventional MRI; diffusion weighted imaging and in vivo proton MR spectroscopy at 4 time points (pre-therapy, after I, II, and III NACT) at 1.5 T. Miller Payne grading system was used for pathological assessment of response. Of the 42 patients, 24 were pathological responders (pR) while 18 were pathological non-responders (pNR). Clinical response determination classified 26 patients as responders (cR) while 16 as non-responders (cNR). tCho and ADC showed significant changes after I NACT, however, MR measured tumor volume showed reduction only after II NACT both in pR and cR. After III NACT, the sensitivity to detect responders was highest for MR volume (83.3% for pR and 96.2% for cR) while the specificity was highest for ADC (76.5% for pR and 100% for cR). Combination of all three parameters exhibited lower sensitivity (66.7%) than MR volume for pR prediction, however, a moderate improvement was seen in specificity (58.8%). For the prediction of clinical response, multi-parametric approach showed 84.6% sensitivity with 100% specificity compared to MR volume (sensitivity 96.2%; specificity 80%). Kappa statistics demonstrated substantial agreement of clinical response with MR volume (k = 0.78) and with multi-parametric approach (k = 0.80) while moderate agreement was seen for tCho (k = 0.48) and ADC (k = 0.46). The values of k for tCho, MR volume and ADC were 0.31, 0.38, and 0.18 indicating fair, moderate, and slight agreement, respectively with pathological response. Moderate agreement (k = 0.44) was observed between clinical and pathological responses. Our study demonstrated that both tCho and ADC are strong predictors of assessment of early pathological and clinical responses. Multi-parametric approach yielded 100% specificity in predicting clinical response. Following III NACT, MR volume emerged as highly suitable predictor for both clinical and pathological assessments. PCA demonstrated separate clusters of pR vs. pNR and cR vs. cNR at post-therapy while with some overlap at pre-therapy.https://www.frontiersin.org/article/10.3389/fonc.2018.00319/fullbreast cancerneoadjuvant chemotherapymagnetic resonance spectroscopytotal cholineapparent diffusion coefficienttumor volume |
| spellingShingle | Uma Sharma Khushbu Agarwal Rani G. Sah Rajinder Parshad Vurthaluru Seenu Sandeep Mathur Siddhartha D. Gupta Naranamangalam R. Jagannathan Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients? Frontiers in Oncology breast cancer neoadjuvant chemotherapy magnetic resonance spectroscopy total choline apparent diffusion coefficient tumor volume |
| title | Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients? |
| title_full | Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients? |
| title_fullStr | Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients? |
| title_full_unstemmed | Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients? |
| title_short | Can Multi-Parametric MR Based Approach Improve the Predictive Value of Pathological and Clinical Therapeutic Response in Breast Cancer Patients? |
| title_sort | can multi parametric mr based approach improve the predictive value of pathological and clinical therapeutic response in breast cancer patients |
| topic | breast cancer neoadjuvant chemotherapy magnetic resonance spectroscopy total choline apparent diffusion coefficient tumor volume |
| url | https://www.frontiersin.org/article/10.3389/fonc.2018.00319/full |
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