Alexander Martijn Theodorus Schmitz MD, Presenter: Nothing to Disclose

Wouter B. Veldhuis MD, PhD, Abstract Co-Author: Nothing to Disclose

Marian Menke-Pluijmers, Abstract Co-Author: Nothing to Disclose

Wybe van der Kemp, Abstract Co-Author: Nothing to Disclose

Tijl A. van der Velden, Abstract Co-Author: Nothing to Disclose

Marc C.J.M. Kock MD, Abstract Co-Author: Nothing to Disclose

Pieter Westenend, Abstract Co-Author: Nothing to Disclose

Dennis W. J. Klomp, Abstract Co-Author: Nothing to Disclose

Kenneth G.A. Gilhuijs PhD, Abstract Co-Author: Nothing to Disclose

Detection of breast cancer at earlier stages has raised concern of overtreatment in subgroups of patients, while treatment failure still occurs in other. Continuing need exists for prognostic models tailored to individual patients at time of diagnosis. Preoperative core biopsy results in discordant assessment of tumor grade in up to 40% compared to postoperative assessment. Imaging features may potentially close this gap, as they provide full overview of the tumor. Aim of this study is to assess the potential of biomarkers at 7T functional Breast MRI to characterize the proliferative nature of breast tumors in-vivo.

A one-stop-shop protocol was developed at 7T MRI (Philips) including high temporal (HT; 5 s; 2,8mm³ isotropic) and high spatial (HS; 90 s; 0,7mm³-1,0mm³ isotropic) dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging, diffusion-weighted imaging (DWI), and phosphorus spectroscopy (31P-MRS) to analyze tumor metabolism. Sixteen women (age 53-70 years) with histologically proven invasive breast carcinoma on biopsy were scanned prior to surgery. DCE characteristics were assessed according to BI-RADS. ADC-values were calculated and hypointense tumor areas scored. Localized 31P-MR spectra were assessed and scored (1-5) based on degree of tumor proliferation using a newly developed lexicon. Tumor characteristics on pathology were assessed from the resection specimen and correlated to the MRI features. Explorative analyses were performed using box plots, Pearson Chi-Square and Krusal Wallis tests.

In 16 patients, 18 malignant lesions were detected on HS DCE-MRI. The mean largest tumor diameter was 22mm (range 8–58). Time to enhancement on HT DCE-MRI ranged from 12s to 29s. Shortest interval was observed in a rim-enhancing triple-negative tumor. First observations showed correlations between the 31P-MRS score and mitotic cell index (N=11; p=0,02) as well as a trend between ADC and modified Bloom-Richardson tumor grade (N=11; p=0,097).

A one-stop-shop imaging protocol for breast MRI at 7T was developed to explore prognostic and predictive tumor biomarkers in-vivo. First explorations indicate feasibility to visualize tumor grade in-vivo.

Imaging of breast cancer biomarkers in-vivo using a one-stop-shop 7T Breast MR imaging protocol allows stratification of tumor proliferation, an important predictive marker used in therapy selection.

Schmitz, A, Veldhuis, W, Menke-Pluijmers, M, van der Kemp, W, van der Velden, T, Kock, M, Westenend, P, Klomp, D, Gilhuijs, K, 7T Breast MR Imaging for Preoperative Characterization of Breast Cancer Using One-stop-Shop Dynamic Contrast Enhancement, Diffusion-weighted Imaging, and Phosphorus MR Spectroscopy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010625.html