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Value of multi-parameter MRI combined with immune inflammatory markers in predicting axillary lymph node metastasis of breast cancer
DAI Xingwei  SHEN Yunxia  HUANG Yiqiao  YANG Chunyan  WANG Xiurong 

Cite this article as: Dai XW, Shen YX, Huang YQ, et al. Value of multi-parameter MRI combined with immune inflammatory markers in predicting axillary lymph node metastasis of breast cancer[J]. Chin J Magn Reson Imaging, 2022, 13(7): 116-120, 128. DOI:10.12015/issn.1674-8034.2022.07.021.

[Abstract] Objective To investigate the value of multi-parameter MRI combined with immune inflammatory markers in axillary lymph node metastasis (ALNM) of breast cancer.Materials and Methods In this retrospective analysis, 52 breast cancer patients were divided into lymph node metastasis group and non-metastasis group according to the pathological results. The relationship between clinical, pathological, immune inflammatory markers, multi-parameter MRI features and axillary lymph node metastasis was evaluated by univariate analysis. Multivariate logistic regression was used to screen clinical and MRI risk factors to establish clinical prediction model, MRI prediction model and combined model. The correlation between immune inflammatory markers, immunohistochemical factor expression and multi-parameter MRI features were analyzed by spearman rank correlation analysis. Evaluate model effectiveness by drawing receiver operating characteristic (ROC) curve and calibration curve. The predictive performance of different models was compared and verified by the Delong test and decision curve analysis (DCA).Results Logistic regression analysis showed that Ki-67 expression, platelet-lymphocyte ratio (PLR), tumor size, the peritumoral maximum apparent diffusion coefficient (ADCpmax), the ratio of peritumoral tumor ADC (ADCratio) and MRI lymph node characteristics were statistically significant (P<0.05). PLR was positively correlated with ADCpmax and ADCratio (P<0.05). The area under the curve (AUC) of the clinical prediction model (Ki-67+PLR) was 0.722, the AUC of the multi-parameter MRI prediction model (tumor length+ADCpmax+ADCratio+MRI lymph node characteristics) was 0.898, and the AUC of the combined prediction model was 0.914. DCA showed that the clinical value of the combined model was higher than that of the clinical prediction model.Conclusions Multi-parameter MRI combined with immune inflammatory index PLR can be used to predict the status of axillary lymph nodes in breast cancer patients non-invasively before surgery, and provide a reference for clinical diagnosis and prognosis evaluation.
[Keywords] breast cancer;magnetic resonance imaging;apparent diffusion coefficient;inflammatory markers;lymph node metastasis

DAI Xingwei1, 2   SHEN Yunxia2*   HUANG Yiqiao2   YANG Chunyan3   WANG Xiurong2  

1 Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen 518116, China

2 Department of Radiology, Longgang Central Hospital of Shenzhen, Shenzhen 518116, China

3 Department of Obstetrics and Gynecology, Longgang Central Hospital of Shenzhen, Shenzhen 518116, China

Shen YX, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Longgang Science and TechnoIogy Innovation Bureau,Medical and Health TechnoIogy Plan Project (No. LGKCYLWS2020005).
Received  2022-03-15
Accepted  2022-07-01
DOI: 10.12015/issn.1674-8034.2022.07.021
Cite this article as: Dai XW, Shen YX, Huang YQ, et al. Value of multi-parameter MRI combined with immune inflammatory markers in predicting axillary lymph node metastasis of breast cancer[J]. Chin J Magn Reson Imaging, 2022, 13(7): 116-120, 128. DOI:10.12015/issn.1674-8034.2022.07.021.

Trapani D, Ginsburg O, Fadelu T, et al. Global challenges and policy solutions in breast cancer control[J]. Cancer Treat Rev, 2022, 104: 102339. DOI: 10.1016/j.ctrv.2022.102339.
Cox K, Taylor-Phillips S, Sharma N, et al. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer: a potential replacement for axillary surger[J/OL]. Br J Radiol, 2017 [2022-03-15]. DOI: 10.1259/bjr.20170626.
Cooper KL, Harnan S, Meng Y, et al. Positron emission tomography (PET) for assessment of axillary lymph node status in early breast cancer: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2011, 37(3): 187-198. DOI: 10.1016/j.ejso.2011.01.003.
Wang MF, Xu W, Qin T. The differential diagnosis of benign and malignant breast tumors with MRI quantitative and semi-quantitative parameters and the correlation analysis with biological indicators of breast cancer[J]. Chin J Magn Reson Imaging, 2020, 11(12): 1174-1177. DOI: 10.12015/issn.1674-8034.2020.12.021.
Marques P, de Vries F, Dekkers OM, et al. Serum inflammation-based scores in endocrine tumors[J/OL]. J Clin Endocrinol Metab, 2021, 106(10) [2022-03-15]. DOI: 10.1210/clinem/dgab238.
Yang L, Wang H, Ma J, et al. Association between the platelet to lymphocyte ratio, neutrophil to lymphocyte ratio and axillary lymph node metastasis in cT1N0 breast cancer patients[J]. Am J Transl Res, 2021, 13(3): 1854-1861.
Cho U, Park HS, Im SY, et al. Prognostic value of systemic inflammatory markers and development of a nomogram in breast cancer[J/OL]. PLoS One, 2018, 13(7) [2022-6-27]. DOI: 10.1371/journal.pone.0200936.
Rajwa P, Huebner NA, Hostermann DI, et al. Evaluation of the predictive role of blood-based biomarkers in the context of suspicious prostate MRI in patients undergoing prostate biopsy[J]. J Pers Med, 2021, 11(11): 1231. DOI: 10.3390/jpm11111231.
Adamkiewicz M, Bryniarski P, Kowalik M, et al. Lymphocyte-to-monocyte ratio is the independent prognostic marker of progression in patients undergoing BCG-immunotherapy for bladder cancer[J/OL]. Front Oncol, 2021, 11 [2022-03-15]. DOI: 10.3389/fonc.2021.655000.
Peleg N, Schmilovitz-Weiss H, Shamah S, et al. Neutrophil to lymphocyte ratio and risk of neoplastic progression in patients with Barrett's esophagus[J]. Endoscopy, 2021, 53(8): 774-781. DOI: 10.1055/a-1292-8747.
Wen SD, Chen YZ, Hu CP, et al. Combination of tertiary lymphoid structure and neutrophil-to-lymphocyte ratio predicts survival in patients with hepatocellular carcinoma[J/OL]. Front Immunol, 2022, 12 [2022-03-15]. DOI: 10.3389/fimmu.2021.788640.
Hammond MEH, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer[J]. J Clin Oncol, 2010, 28(16): 2784-2795. DOI: 10.1200/JCO.2009.25.6529.
Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]. Ann Oncol, 2013, 24(9): 2206-2223. DOI: 10.1093/annonc/mdt303.
Liang CY, Xu ZY, Shen XP, et al. Correlation between neutrophil-to-lymphocyte ratio and pretreatment magnetic resonance imaging and their predictive significance in cervical carcinoma patients referred for radiotherapy[J/OL]. J Oncol, 2022 [2022-03-15]. DOI: 10.1155/2022/3409487.
Zou ZF, Fan XX, Liu Y, et al. Endogenous thrombopoietin promotes non-small-cell lung carcinoma cell proliferation and migration by regulating EGFR signalling[J]. J Cell Mol Med, 2020, 24(12): 6644-6657. DOI: 10.1111/jcmm.15314.
Gnatenko DV, Liu Z, Hearing P, et al. Cytokine pathway variants modulate platelet production: IFNA16 is a thrombocytosis susceptibility locus in humans[J/OL]. Blood Adv, 2022 [2022-03-15]. DOI: 10.1182/bloodadvances.2021005648.
Lim B, Woodward WA, Wang XP, et al. Inflammatory breast cancer biology: the tumour microenvironment is key [J]. Nat Rev Cancer, 2018, 18(8): 485-499. DOI: 10.1038/s41568-018-0010-y.
Kim JY, Jung EJ, Kim JM, et al. Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis[J]. BMC Cancer, 2020, 20(1): 1206. DOI: 10.1186/s12885-020-07700-9.
Bednarz-Knoll N, Popęda M, Kryczka T, et al. Higher platelet counts correlate to tumour progression and can be induced by intratumoural stroma in non-metastatic breast carcinomas[J]. Br J Cancer, 2022, 126(3): 464-471. DOI: 10.1038/s41416-021-01647-9.
Santucci D, Faiella E, Cordelli E, et al. The impact of tumor edema on T2-weighted 3T-MRI invasive breast cancer histological characterization: a pilot radiomics study[J]. Cancers, 2021, 13(18): 4635. DOI: 10.3390/cancers13184635.
Lee HJ, Lee JE, Jeong WG, et al. HER2-positive breast cancer: association of MRI and clinicopathologic features with tumor-infiltrating lymphocytes[J]. AJR Am J Roentgenol, 2022, 218(2): 258-269. DOI: 10.2214/AJR.21.26400.
Igarashi T, Furube H, Ashida H, et al. Breast MRI for prediction of lymphovascular invasion in breast cancer patients with clinically negative axillary lymph nodes[J]. Eur J Radiol, 2018, 107: 111-118. DOI: 10.1016/j.ejrad.2018.08.024.
Choi EJ, Youk JH, Choi H, et al. Dynamic contrast-enhanced and diffusion-weighted MRI of invasive breast cancer for the prediction of sentinel lymph node status[J]. J Magn Reson Imaging, 2020, 51(2): 615-626. DOI: 10.1002/jmri.26865.
Mei ZY, Jiang BQ, An M, et al. The value of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in predicting non-sentinel lymph node metastasis in breast cancer[J]. J Mod Oncol, 2021, 29(6): 955-960. DOI: 10.3969/j.issn.1672-4992.2021.06.010.
Morkavuk ŞB, Kocaöz S, Korukluoğlu B. Diagnostic value of Platelet/lymphocyte Ratio (PLR) for predicting sentinel axillary lymph node positivity in early-stage breast cancer compared with ultrasonography[J]. Int J Clin Pract, 2021, 75(12): e14939. DOI: 10.1111/ijcp.14939.
Lutz MS, Klimovich B, Maurer S, et al. Platelets subvert antitumor efficacy of T cell-recruiting bispecific antibodies[J]. J Immunother Cancer, 2022, 10(2): e003655. DOI: 10.1136/jitc-2021-003655.
Wang XY, Zhao SY, Wang ZX, et al. Platelets involved tumor cell EMT during circulation: communications and interventions[J]. Cell Commun Signal, 2022, 20(1): 82. DOI: 10.1186/s12964-022-00887-3.
Xu J, Ni C, Ma C, et al. Association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with ER and PR in breast cancer patients and their changes after neoadjuvant chemotherapy[J]. Clin Transl Oncol, 2017, 19(8): 989-996. DOI: 10.1007/s12094-017-1630-5.
Koh CH, Bhoo-Pathy N, Ng KL, et al. Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer[J]. Br J Cancer, 2015, 113(1): 150-158. DOI: 10.1038/bjc.2015.183.
Wariss BR, de Souza Abrahão K, de Aguiar SS, et al. Effectiveness of four inflammatory markers in predicting prognosis in 2374 women with breast cancer[J]. Maturitas, 2017, 101: 51-56. DOI: 10.1016/j.maturitas.2017.04.015.
Park JH, Yeo JH, Kim YS, et al. Predictive roles of HER2 gene amplification and neutrophil-to-lymphocyte ratio on survival in HER2-positive advanced gastric cancer treated with trastuzumab-based chemotherapy[J]. Am J Clin Oncol, 2021, 44(6): 232-238. DOI: 10.1097/COC.0000000000000810.
Tokumaru Y, Oshi M, Murthy V, et al. Low intratumoral genetic neutrophil-to-lymphocyte ratio (NLR) is associated with favorable tumor immune microenvironment and with survival in triple negative breast cancer (TNBC)[J/OL]. Am J Cancer Res, 2021, 11(11): 5743-5755 [2022-6-27].
Kheshtchin N, Hadjati J. Targeting hypoxia and hypoxia-inducible factor-1 in the tumor microenvironment for optimal cancer immunotherapy[J]. J Cell Physiol, 2022, 237(2): 1285-1298. DOI: 10.1002/jcp.30643.
Xue M, Che SN, Tian Y, et al. Nomogram based on breast MRI and clinicopathologic features for predicting axillary lymph node metastasis in patients with early-stage invasive breast cancer: a retrospective study[J]. Clin Breast Cancer, 2022, 22(4): e428-e437. DOI: 10.1016/j.clbc.2021.10.014.
Natale G, Stouthandel MEJ, van Hoof T, et al. The lymphatic system in breast cancer: anatomical and molecular approaches[J]. Medicina (Kaunas), 2021, 57(11): 1272. DOI: 10.3390/medicina57111272.
Derlatka P, Grabowska-Derlatka L, Halaburda-Rola M, et al. The value of magnetic resonance diffusion-weighted imaging and dynamic contrast enhancement in the diagnosis and prognosis of treatment response in patients with epithelial serous ovarian cancer[J]. Cancers, 2022, 14(10): 2464. DOI: 10.3390/cancers14102464.
Kim JJ, Kim JY, Suh HB, et al. Characterization of breast cancer subtypes based on quantitative assessment of intratumoral heterogeneity using dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging[J]. Eur Radiol, 2022, 32(2): 822-833. DOI: 10.1007/s00330-021-08166-4.
Choi BB. Effectiveness of ADC difference value on pre-neoadjuvant chemotherapy MRI for response evaluation of breast cancer[J]. Technol Cancer Res Treat, 2021, 20: 153303382110391. DOI: 10.1177/15330338211039129.

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