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Cone-beam breast CT features associated with HER2/neu overexpression in patients with primary breast cancer

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A Correction to this article was published on 17 February 2020

This article has been updated

Abstract

Objectives

To identify the relationship between human epidermal growth factor receptor 2 (HER2) status and cone-beam breast CT (CBBCT) characteristics in surgically resected breast cancer.

Methods

Preoperative CBBCT of patients with BI-RADS 4 or 5 lesions identified on mammography or ultrasound and dense or very dense breast tissue were retrospectively evaluated in 181 surgically resected breast cancer (triple-negative excluded) between May 2012 and November 2014. A set of CBBCT descriptors was semiquantitatively assessed by consensus double reading. Reader reproducibility was analyzed. Multivariable logistic regression analysis using backward elimination (BEA) with the Wald criterion was performed to identify independent predictive factors of harboring HER2/neu. Principle component analysis (PCA) was used to determine characteristics that might differentiate HER2 status. Receiver operating characteristic (ROC) curve analyses were conducted to determine the predictive capability.

Results

HER2 positive was found in 101 (55.8%) of 181 patients. Inter-observer agreement was high for characteristics’ assessment. Based on BEA, pathologic grade, maximum dimension, lobulation, ΔCT, and calcification morphology were confirmed as independent predictive factors of HER2/neu overexpression. PCA showed that calcification- and border-related characteristics were the most important for differentiation. ROC curve analyses showed that CBBCT features (AUC = 0.853) were superior to clinicopathologic features (AUC = 0.613, p < 0.001) and comparable with combination (AUC = 0.856, p = 0.866).

Conclusions

CBBCT features could be used to prognosticate HER2 status independently, which are potentially complementary to histopathologic result and helpful in guiding biopsy.

Key Points

• Dmax, lobulation, ΔCT, and calcification morphology are independent predictors of HER2 status.

• CBBCT features are superior to clinicopathologic features in HER2+/− discrimination.

• CBBCT features are comparable with combination with clinicopathologic features in HER2+/− discrimination.

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Change history

  • 17 February 2020

    The original version of this article, published on 03 January 2020, unfortunately contained two mistakes.

Abbreviations

AUC:

Area under the ROC curve

BEA:

Backward elimination analysis

BI-RADS:

Breast Imaging Reporting and Data System

CBBCT:

Cone-beam breast computed tomography

FISH:

Fluorescent in situ hybridization

HER2:

Human epidermal growth factor receptor 2

IHC:

Immunohistochemical

NME:

Non-mass enhancement

PCA:

Principle component analysis

ROC:

Receiver operating characteristic

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Funding

This study has received funding by the National Key R&D Program of China (No. 2017YFC0112600 and 2017YFC0112601), National Natural Science Foundation of China (No. 81571671), Tianjin Science and Technology Major Project (No. 19ZXDBSY00080), and Key Project of Tianjin Medical Industry (No. 16KG130).

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Authors and Affiliations

  1. Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, China

    Yueqiang Zhu, Yuwei Zhang, Yue Ma, Haijie Li, Aidi Liu, Peng Han, Lu Yin, Nan Lv, Zhijun Li, Hong Lu, Peifang Liu & Zhaoxiang Ye

Authors
  1. Yueqiang Zhu
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  2. Yuwei Zhang
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  9. Zhijun Li
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  10. Hong Lu
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Corresponding author

Correspondence to Zhaoxiang Ye.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Prof. Dr. Zhaoxiang Ye.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Yuwei Zhang) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained (E2012036).

Study subjects or cohorts overlap

This study included the population of a clinical trial (NCT01792999) of which subgroup analyses had been published previously regarding diagnostic performance analysis, visual and quantitative breast density assessment, breast tissue coverage and comfort comparison, and tumor size evaluation. In comparison, here we investigated molecular subtype prediction that had not been evaluated previously.

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③ Liu A, Ma Y, Yin L, Han P, Li H, Ye Z (2018) Diagnostic value of contrast-enhanced cone beam breast CT in dense breast lesions. China Oncology 28:807–812 in Chinese

④ Liu A, Ye Z, Ma Y, Cao Y (2018) Reliability of breast density estimation based on cone beam breast CT. Chin J Clin Oncol 45:246–250 in Chinese

⑤ Ma Y, Ye Z, Liu A, Yin L, Han P, Li H (2019) The accuracy of tumor size evaluation on invasive breast cancer based on cone beam breast CT. Chin J Radiol 53:286–291 in Chinese

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Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Publisher’s note

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Firstly, in the third paragraph of section “Introduction”, the second sentence was worded incorrectly. The correct wording is: “Advantages of CBBCT include patient comfort improvement due to lack of breast compression and lesion conspicuity increasing with avoiding tissue overlap owing to true 3D display compared with mammography and tomosynthesis, elimination of operator subjectivity in contrast to ultrasound, rapid acquisition and less cost in comparison with magnetic resonance imaging (MRI), and available simultaneous assessment of calcification and contrast enhancement [5].” Secondly, the presentation of Figure 2b was incorrect. The Δ in ΔCT was missing.

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Zhu, Y., Zhang, Y., Ma, Y. et al. Cone-beam breast CT features associated with HER2/neu overexpression in patients with primary breast cancer. Eur Radiol 30, 2731–2739 (2020). https://doi.org/10.1007/s00330-019-06587-w

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