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Pre-Treatment Prediction by Hormone Receptor Subtype of Response to Neoadjuvant Chemotherapy in Node-Positive Breast Cancer Patients; a Radiomics Study

K Drukker*, A Edwards , C Doyle , J Papaioannou , K Kulkarni , M Giger , University of Chicago, Chicago, IL


(Sunday, 7/14/2019) 4:00 PM - 5:00 PM

Room: Exhibit Hall | Forum 2

Purpose: to evaluate breast MRI radiomics in predicting, prior to any treatment, the response to neoadjuvant chemotherapy (NAC) in patients with invasive lymph node-positive breast cancer in terms of post-NAC lymph node (LN) status.

Methods: Our study included 154 women; 41 women were post-NAC LN-negative (8 hormone receptor-positive/18 HER2-enriched/15 triple negative breast cancers) and 113 (69/21/23) remained LN-positive post-NAC. Only pre-NAC MRIs underwent computer analysis, initialized by an expert breast radiologist indicating index cancers and metastatic axillary sentinel lymph nodes on DCE-MRI images. We used 18 radiomics features, both for the primary cancers and for the metastatic sentinel lymph nodes, that showed promise in an earlier study (3 size, 3 shape, 2 morphology, 1 texture, 1 kinetics, 1 variance kinetics, and 7 statistics features). Analysis was performed by hormone receptor subtype of the primary breast cancer. Features promising for the prediction of LN response to NAC were identified using the Mann-Whitney U-test. ROC analysis was used to assess performance in the pre-NAC prediction of nodal response to NAC.

Results: For the hormone receptor-positive and the HER2-enriched breast cancers, 5 and 6 lymph node features, respectively, demonstrated a statistically significant difference (p<0.05) between lymph nodes going to respond to NAC and those unresponsive to NAC. Areas under the ROC curve were up to 0.81 [0.67; 0.94] and 0.78 [0.64; 0.93] for hormone receptor positive and HER2-enriched subgroups, respectively. For triple negative breast cancers no useful features could be identified, however. We were unable to identify any mass features useful for predicting post-NAC lymph node status for any of the hormone receptor subtypes.

Conclusion: In patients with hormone receptor-positive and HER2-enriched node positive breast cancer, radiomics of lymph nodes imaged pre-NAC could be helpful in treatment planning of NAC and potential avoidance of axillary dissection which is associated with substantial morbidity.

Funding Support, Disclosures, and Conflict of Interest: This project was funded in part by NIH grant U01CA195564 in the QIN (Quantitative Imaging Network). Karen Drukker receives royalties from Hologic. Maryellen Giger is a stockholder in Hologic Inc., is co-founder and equity holder in Quantitative Insights Inc., and receives royalties from Hologic Inc., General Electric Company, MEDIAN Technologies, Riverain Technologies LLC, Mitsubishi Corporation and Toshiba Corporation.


Breast, MRI, CAD


IM/TH- Image Analysis (Single modality or Multi-modality): Computer-aided decision support systems (detection, diagnosis, risk prediction, staging, treatment response assessment/monitoring, prognosis prediction)

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