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Can Contrast-Enhanced MR Imaging Predict Survival in Breast Cancer?


Botond K. Szabó, Department of Diagnostic Radiology, Huddinge University Hospital, SE-14186 Huddinge, Sweden.
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Purpose:  To investigate the value of pre-operative contrast-enhanced MR imaging (CE-MRI) in predicting the disease-free and overall survival in breast cancer.

Material and Methods:  The study population consisted of 50 consecutive patients with histopathologically verified primary breast cancer who pre-operatively underwent CE-MRI examination between 1992 and 1993. A three-time point MR examination was performed where the enhancement rates (C1 and C2), signal enhancement ratio (SER = C1/C2) and washout (W = C1–C2) were calculated. The relation of these MR parameters to disease-free and overall survival was investigated. The median follow-up for surviving patients was 95 months. Univariate and multivariate statistical analyses were performed to evaluate the impact of different factors on prediction of survival.

Results:  Of the MR parameters examined at univariate analysis, increased C1 (p = 0.029), W (p = 0.0081) and SER values (p = 0.0081) were significantly associated with shorter disease-free survival, and only C1 (p = 0.016) was related significantly to overall survival. Multivariate analysis for disease-free survival showed that the SER (p = 0.014) and tumor size (p = 0.001) were significant and independent predictors. Age (p = 0.003), lymph node status (p = 0.014), tumor size (p = 0.039) and proliferating cell nuclear antigen index (p = 0.053) remained independently associated with overall survival at multivariate analysis. C1 was not confirmed as an independent predictor of overall survival.

Conclusion:  Our findings support the presumption that CE-MRI is useful in predicting the disease-free survival in patients with breast cancer.