PURPOSE To determine if tumor necrosis by pretreatment breast MRI and its quantitative imaging characteristics are associated with response to NAST in TNBC. METHODS This retrospective study included 85 TNBC patients (mean age 51.8 ± 13 years) with MRI before NAST and definitive surgery during 2010-2018. Each MRI included T2-weighted, diffusion-weighted (DWI), and dynamic contrast-enhanced (DCE) imaging. For each index carcinoma, total tumor volume including necrosis (TTV), excluding necrosis (TV), and the necrosis-only volume (NV) were segmented on early-phase DCE subtractions and DWI images. NV and %NV were calculated. Percent enhancement on early and late phases of DCE and apparent diffusion coefficient were extracted from TTV, TV, and NV. Association between necrosis with pathological complete response (pCR) was assessed using odds ratio (OR). Multivariable analysis was used to evaluate the prognostic value of necrosis with T stage and nodal status at staging. Mann-Whitney U tests and area under the curve (AUC) were used to assess performance of imaging metrics for discriminating pCR vs non-pCR. RESULTS Of 39 patients (46%) with necrosis, 17 had pCR and 22 did not. Necrosis was not associated with pCR (OR, 0.995; 95% confidence interval [CI] 0.4-2.3) and was not an independent prognostic factor when combined with T stage and nodal status at staging (P = 0.46). None of the imaging metrics differed significantly between pCR and non-pCR in patients with necrosis (AUC < 0.6 and P > 0.40). CONCLUSION No significant association was found between necrosis by pretreatment MRI or the quantitative imaging characteristics of tumor necrosis and response to NAST in TNBC.

中文翻译：

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预处理乳房 MRI 的肿瘤坏死：与三阴性乳腺癌 (TNBC) 的新辅助全身治疗 (NAST) 反应的关联。

目的通过预处理乳房 MRI 及其定量成像特征确定肿瘤坏死是否与 TNBC 中对 NAST 的反应相关。方法 这项回顾性研究纳入了 85 名 TNBC 患者（平均年龄 51.8 ± 13 岁），在 2010-2018 年期间进行了 NAST 和根治性手术前的 MRI。每个 MRI 包括 T2 加权、弥散加权 (DWI) 和动态对比增强 (DCE) 成像。对于每个指标癌，包括坏死 (TTV)、不包括坏死 (TV) 和仅坏死体积 (NV) 的总肿瘤体积在早期 DCE 减影和 DWI 图像上进行分割。计算了 NV 和 %NV。从 TTV、TV 和 NV 中提取 DCE 早期和晚期的百分比增强和表观扩散系数。使用优势比 (OR) 评估坏死与病理完全反应 (pCR) 之间的关联。多变量分析用于评估坏死与 T 分期和分期淋巴结状态的预后价值。Mann-Whitney U 检验和曲线下面积 (AUC) 用于评估成像指标在区分 pCR 与非 pCR 方面的性能。结果 在有坏死的 39 名患者 (46%) 中，17 名有 pCR，22 名没有。坏死与 pCR 无关（OR，0.995；95% 置信区间 [CI] 0.4-2.3），当与 T 分期和分期淋巴结状态相结合时，它不是一个独立的预后因素（P = 0.46）。在坏死患者中，pCR 和非 pCR 之间的成像指标没有显着差异（AUC < 0.6 和 P > 0.40）。结论 治疗前 MRI 显示的坏死或肿瘤坏死的定量成像特征与 TNBC 中对 NAST 的反应之间未发现显着关联。