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Clinical Article
Diagnostic value analysis of multimodal magnetic resonance imaging combined with prognostic factors in HER-2 low expression breast cancer
ZOU Ziqin  HUANG Yanfang  YANG Yu 

Cite this article as: ZOU Z Q, HUANG Y F, YANG Y. Diagnostic value analysis of multimodal magnetic resonance imaging combined with prognostic factors in HER-2 low expression breast cancer[J]. Chin J Magn Reson Imaging, 2023, 14(11): 48-55. DOI:10.12015/issn.1674-8034.2023.11.009.

[Abstract] Objective To investigate the diagnostic value of multiparametric MRI image features and related parameters for human epidermal growth factor receptor 2 (HER-2) low expression breast cancer, to predict the expression status of prognostic factors within the tumor tissue, and to summarize the characteristics of MRI signs of HER-2 low expression breast cancer.Materials and Methods Fifty-two patients with HER-2 low-expression breast cancer who received treatment from January 1, 2014 to April 12, 2022 were selected as subjects for retrospective study. The MRI sign characteristics of HER-2 low expression breast cancer were analyzed. The results of immunohistochemical staining examination were also used as the gold standard, and the results were analyzed according to the prognostic factors [estrogen receptor (ER), progesterone receptor (PR), marker of proliferation Ki-67 (Ki-67), and the positive/positive ratio of HER-2] positive/negative expression were grouped four times. The intra-class correlation coefficient (ICC) was used to evaluate the consistency of the results of the basic characterization of MRI images between different physicians. Depending on the type of raw data, the differences of each parameter between the groups were compared and analyzed using one-way analysis (independent samples t-test, Fisher's exact probability method, Mann-Whitney U-test, etc.), respectively, and a joint diagnostic model was established by using biclassified logistic regression analysis to compare the differences of the basic clinicopathological and MRI signs among the four groups, which led to the conclusion that the differences of the basic clinicopathological and MRI signs between the four groups of HER-2 low The common MRI signs of HER-2 low expression breast cancer were characterized, and the correlation between clinical imaging features and prognostic factors was explored.Results The results of basic characterization of MRI images were in good agreement between different physicians (ICC range 0.883-0.972). HER-2 low-expression breast cancer clinicopathologically and on MRI mostly showed age 29-74 (51.10±10.67) years old, pathologic type: non-specific invasive breast cancer accounted for the majority (50/52, 96.2%); histologic grading was predominantly Ⅱ-Ⅲ (47/54, 87.0%); MRI signs mostly showed a single lesion (41/52, 78.8%), burr edges (33/52, 63.5%), lobular signs (30/52, 61.5%), internal inhomogeneous enhancement (36/52, 69.2%), time intensity curve (TIC) type Ⅲ predominantly (46/52, 88.5%), and almost no or small amount of background parenchymal The mean value of apparent diffusion coefficient (ADC) was about (0.767±0.143)×10-3 mm2/s, and the range of values was (0.512-1.200)×10-3 mm2/s. The prognostic value of clinicopathological and MRI features on prognostic factors: ER, PR, and TIC. Predictive value: In the ER and PR positive group, burr sign was mostly seen at the edge of the mass (ER and PR positive: 72.1%, P=0.008), internal enhancement was more heterogeneous (ER positive: 76.7%, P=0.030, PR positive: 79.1%, P=0.003), and histologic grading was lower (ER positive: P=0.008, PR positive: P=0.003). In the ER and PR negative group, there were more blurred margins (ER and PR negative: 55.6%, P=0.008), and internal enhancement was predominantly circumferential (ER negative: 66.7%, P=0.030, PR negative: 77.8%, P=0.003). In the Ki-67 positive group, the morphology of the mass was more lobular (68.2%, P=0.034) compared to the negative group, with a higher histologic grading was higher (P=0.003). Two-category logistic regression analysis suggested that histologic grading was an independent correlate for predicting the expression of ER, PR, and Ki-67 in HER-2 low-expressing breast cancers (P=0.032, P=0.022, P=0.003), and internal enhancement features were an independent correlate for predicting the expression of ER and PR in HER-2 low-expressing breast cancers (P=0.041, P=0.014).Conclusions The clinicopathologic and MRI features of HER-2 low-expression breast cancer have certain specificity, and multiparametric MRI is valuable for the early clinical diagnosis of HER-2 low-expression breast cancer and the prediction of the expression status of its related prognostic factors.
[Keywords] breast cancer;HER-2 low expression breast cancer;human epidermal growth factor receptor-2;prognostic factors;magnetic resonance imaging

ZOU Ziqin   HUANG Yanfang   YANG Yu*  

Department of Radiology, the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha 410021, China

Corresponding author: YANG Y, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Natural Science Foundation of Hunan Province (No. 2022JJ70114).
Received  2023-04-13
Accepted  2023-10-31
DOI: 10.12015/issn.1674-8034.2023.11.009
Cite this article as: ZOU Z Q, HUANG Y F, YANG Y. Diagnostic value analysis of multimodal magnetic resonance imaging combined with prognostic factors in HER-2 low expression breast cancer[J]. Chin J Magn Reson Imaging, 2023, 14(11): 48-55. DOI:10.12015/issn.1674-8034.2023.11.009.

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