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. 2017 Dec;10(6):904-910.
doi: 10.1016/j.tranon.2017.08.010. Epub 2017 Sep 22.

Contrast Enhancement on Cone-Beam Breast-CT for Discrimination of Breast Cancer Immunohistochemical Subtypes

Johannes Uhlig  1 , Uwe Fischer  2 , Eva von Fintel  3 , Vera Stahnke  1 , Christina Perske  3 , Joachim Lotz  1 , Susanne Wienbeck  4
Affiliations

Contrast Enhancement on Cone-Beam Breast-CT for Discrimination of Breast Cancer Immunohistochemical Subtypes

Johannes Uhlig et al. Transl Oncol. 2017 Dec.

Abstract

Purpose: To evaluate whether contrast enhancement on cone-beam breast-CT (CBBCT) could aid in discrimination of breast cancer subtypes and receptor status.

Methods: This study included female patients age >40 years with malignant breast lesions identified on contrast-enhanced CBBCT. Contrast enhancement of malignant breast lesions was standardized to breast fat tissue contrast enhancement. All breast lesions were approved via image-guided biopsy or surgery. Immunohistochemical staining was conducted for expression of estrogen (ER), progesterone (PR), human epidermal growth factor receptor-2 (HER2) and Ki-67 index. Contrast enhancement of breast lesions was correlated with immunohistochemical breast cancer subtypes (Luminal A, Luminal B, HER2 positive, triple negative), receptor status and Ki-67 expression.

Results: Highest contrast enhancement was seen for Luminal A lesions (93.6 HU) compared to Luminal B lesions (47.6 HU, P=.002), HER2 positive lesions (83.5 HU, P=.359) and triple negative lesions (45.3 HU, P=.005). Contrast enhancement of HER2 positive lesions was higher than Luminal B lesions (P=.044) and triple negative lesions (P=.039). No significant difference was evident between Luminal B and triple negative lesions (P=.439). Lesions with high Ki-67 index showed lower contrast enhancement than those with low Ki-67 index (P=.0043). ER, PR and HER2 positive lesions demonstrated higher contrast enhancement than their receptor negative counterparts, although differences did not reach statistical significance (P=.1714; P=.3603; P=.2166).

Conclusions: Contrast enhancement of malignant breast lesions on CBBCT correlates with immunohistochemical subtype and proliferative potential. Thereby, CBBCT might aid in selecting individualized treatment strategies for breast cancer patients based on pre-operative imaging.

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Figures

Figure 1
Figure 1
Boxplot chart of contrast enhancement among immunohistochemical breast cancer subtypes; boxes indicate interquartile range and horizontal bars median enhancement. * P < .05; *** P < .01; n.s. non-significant. Luminal A vs. triple negative p = .005; Luminal A vs. Luminal B p = .002; Luminal A vs. HER2 positive p = .359; HER2 positive vs. triple negative p = .044; HER2 positive vs. Luminal B p = .039; Luminal B vs. triple negative P = .439.
Figure 2
Figure 2
(A) Case of a postmenopausal 69-year-old woman presenting with right-sided breast mass adjacent to the thoracic wall. Contrast enhancement on CBBCT was 62 HU. (B) Immunohistochemical analyses revealed “HER2 positive” breast cancer subtype with a Ki-67 index of 0.8 and without expression of ER or PR. HER2 expression was positive (Dako-Score 3+).
Figure 3
Figure 3
(A) Case of a premenopausal 43-year-old woman presenting with right-sided breast mass. Contrast enhancement on CBBCT was 113 HU. (B) Immunohistochemical analyses revealed “Luminal A” breast cancer subtype with a Ki-67 index of 0.1 and expression of ER and PR. HER2 expression was negative (Dako-Score 0).
Figure 4
Figure 4
(A) Case of a postmenopausal 62-year-old woman presenting with right-sided breast mass. Contrast enhancement on CBBCT was 72 HU. (B) Immunohistochemical analyses revealed “Luminal B” breast cancer subtype with a Ki-67 index of 0.8, weak expression of ER and no expression of PR. HER2 expression was negative (Dako-Score 0).
Figure 5
Figure 5
(A) Case of a postmenopausal 57-year-old woman presenting with right-sided breast mass. Contrast enhancement on CBBCT was 50 HU. (B) Immunohistochemical analyses revealed “triple negative” breast cancer subtype with a Ki-67 index of 0.8 and without expression of ER and PR. HER2 expression was negative (Dako-Score 0).
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