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MRI Enhancement in Stromal Tissue Surrounding Breast Tumors: Association with Recurrence Free Survival following Neoadjuvant Chemotherapy

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  • Ella F Jones
  • Sumedha P Sinha
  • David C Newitt
  • Catherine Klifa
  • John Kornak
  • Catherine C Park
  • Nola M Hylton

Abstract

Rationale and Objectives: Normal-appearing stromal tissues surrounding breast tumors can harbor abnormalities that lead to increased risk of local recurrence. The objective of this study was to develop a new imaging methodology to characterize the signal patterns of stromal tissue and to investigate their association with recurrence-free survival following neoadjuvant chemotherapy. Materials and Methods: Fifty patients with locally-advanced breast cancer were imaged with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before (V1) and after one cycle (V2) of adriamycin-cytoxan therapy. Contrast enhancement in normal-appearing stroma around the tumor was characterized by the mean percent enhancement (PE) and mean signal enhancement ratio (SER) in distance bands of 5 mm from the tumor edge. Global PE and SER were calculated by averaging all stromal bands 5 to 40 mm from tumor. Proximity-dependent PE and SER were analyzed using a linear mixed effects model and Cox proportional hazards model for recurrence-free survival. Results: The mixed effects model displayed a decreasing radial trend in PE at both V1 and V2. An increasing trend was less pronounced in SER. Survival analysis showed that the hazard ratio estimates for each unit decrease in global SER was statistically significant at V1 [estimated hazard ratio = 0.058, 95% Wald CI (0.003, 1.01), likelihood ratio p = 0.03]; but was not so for V2. Conclusions: These findings show that stromal tissue outside the tumor can be quantitatively characterized by DCE-MRI, and suggest that stromal enhancement measurements may be further developed for use as a potential predictor of recurrence/disease-free survival following therapy.

Suggested Citation

  • Ella F Jones & Sumedha P Sinha & David C Newitt & Catherine Klifa & John Kornak & Catherine C Park & Nola M Hylton, 2013. "MRI Enhancement in Stromal Tissue Surrounding Breast Tumors: Association with Recurrence Free Survival following Neoadjuvant Chemotherapy," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-8, May.
    • Handle: RePEc:plo:pone00:0061969
    DOI: 10.1371/journal.pone.0061969
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    References listed on IDEAS

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    1. Lisa M. Coussens & Zena Werb, 2002. "Inflammation and cancer," Nature, Nature, vol. 420(6917), pages 860-867, December.
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    Cited by:

    1. Jeff Wang & Fumi Kato & Noriko Oyama-Manabe & Ruijiang Li & Yi Cui & Khin Khin Tha & Hiroko Yamashita & Kohsuke Kudo & Hiroki Shirato, 2015. "Identifying Triple-Negative Breast Cancer Using Background Parenchymal Enhancement Heterogeneity on Dynamic Contrast-Enhanced MRI: A Pilot Radiomics Study," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-17, November.

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