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Magnetic Resonance Imaging Phenotypes of Breast Cancer Molecular Subtypes: A Systematic Review

Published:September 02, 2021DOI:https://doi.org/10.1016/j.acra.2021.07.017

      Objective

      Magnetic resonance imaging (MRI) is the most sensitive imaging modality in detecting breast cancer. The purpose of this systematic review is to investigate the role of human extracted MRI phenotypes in classifying molecular subtypes of breast cancer.

      Methods

      We performed a literature search of published articles on the application of MRI phenotypic features in invasive breast cancer molecular subtype classifications by radiologists' interpretation on Medline Complete, Pubmed, and Google scholar from 1st January 2000 to 31st March 2021. Of the 1453 literature identified, 42 fulfilled the inclusion criteria.

      Results

      All studies were case-controlled, retrospective study and research-based. The majority of the studies assessed the MRI features using American College of Radiology- Breast Imaging Reporting and Data System (ACR-BIRADS) classification and using dynamic contrast-enhanced (DCE) kinetic features, Apparent Diffusion Coefficient (ADC) values, and T2 sequence. Most studies divided invasive breast cancer into 4 main subtypes, luminal A, luminal B, HER2, and triple-negative (TN) cancers, and used 2 readers. We present a summary of the radiologists' extracted breast MRI phenotypical features and their correlating breast cancer subtypes classifications. The characteristic features are morphology, enhancement kinetics, and T2 signal intensity. We found that the TN subtype has the most distinctive MRI features compared to the other subtypes and luminal A and B have many similar features.

      Conclusion

      The MRI features which are predictive of each subtype are the morphology, internal enhancement features, and T2 signal intensity, predominantly between TN and the rest. Radiologists’ visual interpretation of some of MRI features may offer insight into the respective invasive breast cancer molecular subtype. However, current evidence are still limited to “suggestive” features instead of a diagnostic standard.  Further research is recommended to explore this potential application, for example, by augmentation of radiologists’ visual interpretation by artificial intelligence.

      Key words

      Abbreviations:

      ACR (American College of Radiology), ADC (apparent diffusion coefficient), AUC (area under curve), BI-RADS (Breast Imaging Reporting and Data System), BPE (breast parenchymal enhancement), CEP17 (chromosome 17 centromere), DWI (diffusion weighted imaging), DCE (dynamic contrast enhancement), Dt (diffusion coefficient), ER (oestrogen receptor), HER2 (human epidermal growth factor receptor -2), IHC (immunohistochemical), Lum A (Luminal A), Lum B (Luminal B), MRI (magnetic resonance imaging), NME (non mass enhancement), OR (odds ratio), PR (progesterone receptor), PRISMA (preferred reporting items for systemic review and meta-analyses), ROI (region of interest), SI (signal intensity), STIR (Short-T1 inversion recovery), TCGA (the cancer genome atlas), TN (triple negative), TTP (time to peak), tCho (total Choline), VEGF (vascular endothelial growth factor)
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