Kirti Manohar Kulkarni MD, Presenter: Nothing to Disclose

Kirsten Gaarder MD, Abstract Co-Author: Nothing to Disclose

Lingyun Xiong MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Abe MD, Abstract Co-Author: Nothing to Disclose

Maryellen L. Giger PhD, Abstract Co-Author: Stockholder, Hologic, Inc Shareholder, Quantitative Insights, Inc Royalties, Hologic, Inc Royalties, General Electric Company Royalties, MEDIAN Technologies Royalties, Riverain Technologies, LLC Royalties, Mitsubishi Corporation Royalties, Toshiba Corporation Researcher, Koninklijke Philips Electronics NV Researcher, U-Systems, Inc

Gillian Maclaine Newstead MD, Abstract Co-Author: Medical Advisory Board, Bayer AG Consultant, Three Palm Software LLC

Charlene A. Sennett MD, Abstract Co-Author: Nothing to Disclose

Akiko Shimauchi MD, Abstract Co-Author: Nothing to Disclose

David Victor Schacht MD, Abstract Co-Author: Nothing to Disclose

Can aggressive MRI characteristics and receptor profile of invasive breast cancers be used to predict clinical outcome and metastases/recurrence rates?

54 patients (mean age 56 yo) with biopsy-proven invasive breast cancer and staging MRI (1.5T Phillips) at University of Chicago from 2002-2003 were included in a HIPAA-compliant retrospective study. Patients with prior history of invasive or in-situ breast cancer or distant metastases at time of breast cancer diagnosis were excluded. Imaging and clinical notes were reviewed to identify local recurrence or distant metastases. Average follow up time was 7.8 years. All breast cancers were measured on MRI as maximum diameter in axial dimension. Aggressive MRI morphologic features such as non-mass enhancement (NME), rim or heterogeneous enhancement and multifocality were analyzed in consensus by two board-certified fellowship-trained radiologists. Receptor profiles of all cancers were obtained from pathology reports.  

Histology yielded IDC 46/54 (85%) and ILC 8/54 (15%). 9/54 (17%) of the total patients developed distant metastases. Average time to metastases was 2.8 years, range 0.7 to 6.8 yrs. Histology of all metastatic cancers was IDC. 33% of cancers were grade 2 and 37% were grade 3. Grade 3 tumors metastasized in (6/20) 30% of cases and grade 2 in (1/18) 6%; tumor grade was not included in the pathology report in 2 cases. Cancers were categorized based on receptor profile as triple negative (9/54; 17%), Her2+ (12/54; 22%), and ER+Her2- (33/54; 61%). ER+ Her2- cancers metastasized in 9% (3/33) and all were unifocal. Her+ cancers metastasized in 25% (3/12) (1 unifocal, 2 multifocal) and triple negative cancers in 33% (3/9) (1 unifocal, 2 multifocal). Analysis of the MRI morphologic features showed that 25% of rim-enhancing tumors, 22% with NME, 18% of multifocal and 16% of unifocal cancers metastasized.    

Pilot data shows that grade 3, triple negative, NME and multifocal IDC have higher rates of metastases compared to unifocal, low grade, and ILC. Distant metastases presented as late as 6.8 yrs after diagnosis. We intend to analyze a total of 200 patients in our final study.

To determine the group of patients that can benefit from close follow up and metastatic work up to prevent or detect local recurrence/distant metastases. 

Kulkarni, K, Gaarder, K, Xiong, L, Abe, H, Giger, M, Newstead, G, Sennett, C, Shimauchi, A, Schacht, D, Invasive Breast Cancer MRI Phenotype and Receptor Status as Predictors of Clinical Outcome.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13020369.html