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Title Page

ABSTRACT

Contents

Ⅰ. INTRODUCTION 9

Ⅱ. MATERIALS AND METHODS 10

A. Study Participants 10

B. MR Imaging and Image Analysis 10

C. Reverse Transcription of CDNA and Quantitative Real-Time Polymerase Chain Reaction 10

D. Statistical Analysis 11

Ⅲ. RESULTS 12

Ⅳ. DISCUSSION 13

Ⅴ. List of Tables 15

A. Table 1. Primer sequences used for quantitative real time-PCR 15

B. Table 2. Comparison of mRNA expression in breast cancer according to the imaging phenotypes 16

C. Table 3. Comparison of mRNA expression in breast parenchyma according to the mammographic breast density and background parenchymal enhancement on MRI 18

D. Table 4. Correlation analysis for mRNA expression between breast cancer and adjacent parenchyma 19

Ⅵ. List of Figures 20

A. Figure 1. Representative box plots to show relationship between mRNA expression with imaging feature. 20

B. Figure 2. Preoperative MR images in patients with breast cancer 21

C. Figure 3. Preoperative US images of breast cancer. 21

D. Figure 4. Preoperative images of the right breast in a 56-year-old woman with breast cancer. 22

E. Figure 5. Preoperative images of the left breast in a 81-year-old woman with breast cancer. 23

Ⅶ. References 24

초록보기

Purpose: The purpose of our study was to characterize the imaging phenotype of breast cancer and adjacent breast parenchymal tissue according to the mRNA expression of ER, PR, AR, HER2 and TP53.

Materials and methods: From June 2020 to January 2023, 83 women who were newly diagnosed with breast cancer at our hospital were included. We obtained tissues from both breast cancer and adjacent parenchyma for the evaluation of mRNA expression using a reverse transcriptase-polymerase chain reaction (qRT-PCR). All 83 breast cancer tissues were adequate for PCR analysis and 59 of 83 tissues from adjacent parenchyma were adequate. Two radiologists with 11 and 3 years of experience in breast imaging interpreted the images according to the BIRADS lexicon. Radiologists evaluated the mammographic breast composition, background parenchymal enhancement and tumor imaging phenotypes. We also evaluated T2 bright signal intensity within the tumor and peritumoral edema on T2-weighted image.

Results: Of 59 patients whose normal parenchymal tissue was available for PCR analysis, 17 patients had fatty breast or scattered areas of fibroglandular density on mammography and 42 patients had heterogeneously or extremely dense breast. Normal parenchymal tissue showing heterogeneous or extremely dense breast on MG showed significantly higher PR mRNA expression compared to patients with non-dense breast (p＝0.015). In terms of BPE on breast MRI, ER-α, PR, HER2 and TP53 mRNA expressions were significantly higher in patients with mild, moderate or marked BPE than patients with minimal BPE (p＝0.016, p＝0.0001, p＝0.038, p＝0.035, respectively).

Regarding the bright signal intensity (SI) within the mass on T2-weighted image, breast cancer with internal T2 bright SI showed higher expressions of ER-α, ER-β, PR, AR and TP53 mRNA compared to cancer without T2 bright SI. 62 (78%) of 79 cancers showed peritumoral edema on T2WI and 17 (22%) didn't show. Expressions of ER-α, PR and AR mRNA were significantly lower in breast cancer with peritumoral edema on T2WI.

Breast cancer with non-parallel orientation showed higher TP53 mRNA expression compared to parallel orientation (p＝0.006). Breast cancer with calcification showed higher AR and HER2 mRNA expression compared to cancer without calcification (p＝0.022 and p＝0.022, respectively).

Conclusion: Imaging phenotype of breast cancer and adjacent parenchymal tissue was associated with the mRNA expression of various hormone receptors, HER2 and TP53.

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