Correlation of CT-data derived from multiparametric dual-layer CT-maps with immunohistochemical biomarkers in invasive breast carcinomas. Issue 156 (November 2022)

• Record Type: Journal Article
• Authors: Barbara Krug, Kathrin; Schömig-Markiefka, Birgid; Campbell, Graeme M.; Püsken, Michael; Maintz, David; Schlamann, Marc; Klein, Konstantin; Gabriel Schafigh, Darius; Malter, Wolfram; Hellmich, Martin
• Is Part Of: European journal of radiology. Issue 156(2022)
• Publication Date: 2022-11
• Subjects: Spectral computed tomography (CT) -- Chest CT -- Dual-energy computed tomography (CT), biomarkers in breast cancer -- Quantitative CT-texture analysis; AUC area under the curve -- ER estrogen receptor -- DE Dual Energy -- DL Dual Layer -- FISH fluorescence in situ hybridization -- HER2 human epidermal growth factor receptor 2 -- HU Hounsfield unit -- IRB Institutional Review Board -- J Youden index -- PR progesterone receptor -- ROC receiver operating characteristic curves -- ROI region of interest -- VM virtual monoenergetic; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2022.110544
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: The optimal cutpoints for the differentiation of benign and malignant breast masses recently published were confirmed in 184 dual-layer CT-examinations (DLCT) with invasive breast cancers. In clinical routine, the spectral CT-evaluation of iodine content and zeffective within breast masses thus may contribute to avoid further senological diagnostics in case of certainly benign DLCT-constellations and may be helpful in the assessment of multicentricity, bilaterality and resection volume in breast conserving therapies. Iodine content and Zeffective values derived from DLCT-examinations correlated with hormone receptor expression, Her2 receptor expression and immunohistochemical subtyping of invasive breast carcinomas. Further investigations are warranted in order to assess the diagnostic and prognostic value of none-invasive CT-based estimations of the immunohistological subtype in the staging and restaging of breast carcinomas. The optimal cutpoints and for the differentiation of benign and malignant breast masses recently published (iodine content: ≥0.9 mg/ml, Zeffective value ≥ 7.7) were confirmed in 184 dual-layer CT-examinations (DLCT) with invasive breast cancers. Quantitative evaluations of iodine content and Zeffective numbers derived from DLCT-examinations correlated with estrogen receptor, progesterone receptor, HER2 receptor expression and immunohistochemical subtyping of invasive breast carcinomas. The spectral CT-evaluation of iodine content and zeffective values within breast masses allows the avoidance of further senological diagnostics in the case of certainly benign incidental CT-findings and the estimation of multicentricity and bilaterality in the case of known breast carcinomas and may be clinically helpful in the diagnostic assessment of multicentricity, bilaterality and resection volume in breast conserving resections. Our preliminary results indicate that quantitative DLCT-analyses may also be used to estimate the immunohistological cancer subtype of mass lesions suspicious of breast cancer and thus may provide prognostic information on the long term. Abstract: Objective: To examine the correlation of quantitative measurements from material decomposition maps calculated from dual-layer CT (DLCT)-image datasets with immunohistochemical biomarkers of invasive breast carcinomas. Material and Methods: All patients at the University Breast Cancer Center who underwent a clinically indicated dual-layer CT-scan for staging of invasive ductal breast carcinoma from 01/2016 to 07/2020 were prospectively included. Iodine concentration maps and maps of the effective atomic numbers (Zeffective) were reconstructed from the image datasets. ROI-based evaluations of the index tumors and predefined references tissues for normalization were performed semi-automatically in identical anatomical positions using dedicated evaluation software. Statistical analysis was essentially descriptive using Spearmańs rank correlation and (multivariable) partial correlation. Results: Bivariate showed statistically significant correlations of iodine contents (r = -0.154/-0.202/0.180, p = 0.039/0.006/0.015), and Zeffective-values (r = -0.158/-0.199/0.179, p = 0.034/0.007/0.016) for all 184 carcinomas and the subgroup of 168 invasive ductal carcinomas. The results were confirmed by multivariate analyses with "age", "diameter" and "ACR-grade" as possible confounders. Normalization of the measured target values with those in the aorta confirmed significant correlations of iodine content and Zeffective compared to Estrogen (r = 0.174, p = 0.019), Progesteron (r = 0.168/0.177, p = 0.024/0.017), and HER2 receptor expression (r = -0.222/-0.184, p = 0.003/0.013). All CT-parameters showed significant correlations with immunohistochemical subtyping (r = 0.191/0.192, p = 0.010). Conclusions: Our preliminary results indicate that iodine content and Zeffective-values derived from DLCT-examinations correlate with hormone receptor expression in invasive breast carcinomas. Assignments to benign entities already seam feasible in clinical routine CT-diagnostics. After further investigations iodine content and Zeffective may be translated as diagnostical and prognostical biomarkers into clinical routine in the long term.