A new study published in Radiology highlights MRI findings that are indicative of survival outcomes in patients with luminal breast cancer.
Women with luminal breast cancer achieve pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) infrequently (5-10%), and those with residual invasive disease are at an increased risk of relapse. For these reasons, the authors of a new study published in Radiology expressed the need for better predictive methods for these patients and posed the question of whether imaging features in conjunction with clinical-pathologic factors could forecast prognosis.
“Imaging characteristics of the tumors, such as the complete absence of contrast enhancement in the tumor bed and concentric shrinkage pattern at MRI, may have potential prognostic value. Combining the imaging and clinical-pathologic variables might allow for a more accurate risk prediction,” corresponding author Soo-Yeon Kim, with the Department of Radiology at Seoul National University College of Medicine, and co-authors wrote.
To test their hypothesis, the researchers developed a prediction model that took both imaging (post-NAC breast MRI) and clinical-pathologic features into account. They divided women who were diagnosed with luminal breast cancer who had undergone NAC into two cohorts—a developmental one and a validation one—to develop and test the model’s predictive utility.
Of the 318 women included in the development cohort, 68 had distant metastases and 54 died. In the validation group of 165 patients, 37 had distant metastases and 14 died. Using the death and metastases rates, the researchers were able to identify several features that predicted survival outcomes post-NAC treatment.
The presence of microcalcifications observed on pre-NAC mammography and post-NAC peritumoral edema visualized on breast MRI were both associated with worse overall survival. Researchers advised that the model had good discrimination ability and was able to distinguish between those who were at low and high risk.
“Although the exact mechanism remains unclear, microcalcifications may affect the prognosis of luminal breast cancer by activating proliferative signaling pathways and upregulating the expression of inflammatory mediators,” the experts explained. “Peritumoral edema associated with aggressive tumor characteristics such as large tumor size, lymphovascular invasion, and a high Ki-67 index and possibly associated with tumor angiogenesis may predict a poor prognosis.”
The authors noted that predictive model was simple and easily applicable and could be used to guide evidence-based treatment decisions in this specific scenario. They suggested that further research should investigate whether including biologic markers could improve the model’s predictive performance.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.