A new algorithm for automatic vascular mapping of DCE-MRI of the breast: Clinical application of a potential new biomarker
Section snippets
Description of purpose
Solid tumors rely on blood vessels to obtain necessary nutrient and oxygen, and new vessels also offer path way for tumor expansion. Therefore, the assessment of tumor vascularity may provide useful information to characterize underlying malignancy and monitor vascular abnormalities [1]. In the past decade, microvessel density represented the most commonly used prognostic indicator for tumor vascularization in a wide range of cancers, although its quantification remained unreliable because of
Methods
The dataset was composed by 24 patients (mean age, 46 years; range 31–61) with unilateral LABC diagnosed at mammography and/or ultrasound. For each patient, DCE-MRI was performed before NAC initiation and repeated after the last NAC cycle. Breast surgery was scheduled within 3–4 weeks after the last NAC cycle. After surgery, the histopathologic response was evaluated using a 5-point assessment scale, from grade 1 (some alterations to individual malignant cells but no reduction in overall
Results
Eight patients were classified as responders: four with grade 5 response (pCR), and four with grade 4 response. For breasts harboring the cancer, considering both responders and non-responders, the median value of the difference in vascular volume before and after neoadjuvant treatment was 1.01 cc (1st–3rd quartiles 0.27–1.47 cc), while in the contralateral breasts it was 0.09 cc (1st–3rd quartiles −0.05 to 0.46 cc).
Both vascular evaluations performed by the radiologist, with and without support of
Discussion
The added diagnostic value of local and global breast vascularity has been recently investigated [9] and preliminary results have shown that breast vascular maps obtained by DCE-MRI can be considered as a new approach to evaluate the tumor response after NAC [10]. However, all studies in this realm highlight the requirement of further improvements for a higher reproducibility of vessel analysis. This study proposed the application of a validated vessel extraction algorithm [15] as a
Conclusions
The application of a validated algorithm for automatic vessel extraction on DCE-MRI of the breast is proposed to support breast vascularity evaluation, recently investigated as a potential DCE-MRI descriptor correlated with cancer diagnosis and with the effect of NAC. In particular, the method provides a standardized vascular mapping, its quantification based on vessel volume, overcoming the low reproducibility of current approaches based on human visual assessment. Taking into account the
Conflict of interest statement
F.S. received research grants from and is on the speakers’ bureau for Bracco Imaging Group and Bayer Pharma AG; L.M. was a blinded reader for Bayer Schering Pharma, was a speaker for Bracco Imaging Group. For the remaining authors, none were declared.
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