Open Access

Diagnostic value of molybdenum target combined with DCE-MRI in different types of breast cancer

  • Authors:
    • Ying Hu
    • Yan Zhang
    • Jingliang Cheng
  • View Affiliations

  • Published online on: August 14, 2019     https://doi.org/10.3892/ol.2019.10746
  • Pages: 4056-4063
  • Copyright: © Hu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

This study compared the diagnostic value of molybdenum target and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in different types of breast cancer. A retrospective analysis was performed on 120 female patients with breast cancer admitted to The First Affiliated Hospital of Zhengzhou University from February 2015 to October 2017. All of them underwent DCE-MRI and molybdenum target examination. Postoperatively, the pathological tissues were examined to determine their molecular typing. The sensitivity and diagnostic coincidence rates of Luminal-B breast cancer with different molecular types diagnosed by molybdenum target combined with DCE-MRI were significantly higher than those of molybdenum target or DCE-MRI alone. There were no statistical differences in sensitivity and diagnostic coincidence rates of breast cancer with different molecular types diagnosed by molybdenum target or DCE-MRI alone between the two groups (P>0.05). Molybdenum target combined with DCE-MRI in the diagnosis of different molecular types of breast cancer is better than the single imaging screening, which is of great clinical significance in the development of individualized comprehensive treatment for breast cancer patients and worthy of wide promotion in clinical practice.

Introduction

Breast cancer tends to occur in the epithelial tissue of the breast gland and is one of the most common female malignant tumors (1). Breast cancer has a great impact on women's physical and mental health, and in severe cases, it can even be life-threatening. According to statistics (2), the incidence of breast cancer worldwide is on the rise year by year (3). Since most surgical patients are already in the advanced stage of breast cancer when they visit the doctor, even if the cancerous tissue is removed, breast cancer has a high probability to metastasize (4). Statistical data show that the postoperative recurrence rate of breast cancer patients is high and the five-year survival rate is low at this stage (5). Clinical etiology of breast cancer is not completely clear, so early diagnosis of breast cancer helps patients get timely treatment, thus improving the survival rate of breast cancer patients (6). According to relevant reports, Luminal-A, Luminal-B, Her2-overexpressed and triple-negative breast cancers are four different molecular types, and different molecular types are more conducive for clinicians to choose the best individualized treatment according to the characteristics of different molecular sub-types (7). However, molecular typing depends on relevant pathological tissues. Although pathological tissue diagnosis is the gold standard for clinical staging diagnosis of breast cancer, some patients are still psychologically and physiologically unacceptable (8). With the continuous development and innovation of medical diagnostic technology, imaging technology for clinical diagnosis is also continuously upgraded, and the results of diagnostic coincidence rate and pathological tissue diagnosis are getting increasingly closer (9).

At present, molybdenum target imaging (10), breast ultrasound (11), magnetic resonance imaging (MRI) (12), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) (13) and positron emission tomography (PET) (14) are new imaging techniques commonly used in clinical diagnosis. However, the breast molybdenum target and other new imaging techniques of DCE-MRI have different limitations (15). Therefore, this study was performed to investigate the clinical efficacy of molybdenum target, DCE-MRI and molybdenum target combined with DCE-MRI in the diagnosis of breast cancer of different types.

Patients and methods

Data collection of the patients

From February 2015 to October 2017, 120 female patients with breast cancer admitted to The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) were diagnosed with breast cancer through surgery or pathological biopsy, with the age range of 28–67 years and the mean age of 47.46±4.54 years.

The inclusion and exclusion criteria were: i) Only breast cancer patients admitted to The First Affiliated Hospital of Zhengzhou University were included, and all tissue samples were diagnosed as breast cancer after joint examination by general surgery and pathology department (16). No radiotherapy and chemotherapy or other treatment was given. ii) Pregnant women and patients with allergic reaction, claustrophobia and other contraindications to contrast media were excluded. Informed consent forms were signed in advance by patients and their families.

The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University.

Instruments and methods

GE Seno molybdenum target mammography machine (purchased from Shenzhen Mercery Electronics Co., Ltd.) was used. Automatic parameters were selected and X-ray exposure was automatically adjusted according to the density of mammary glands. All patients underwent imagings in double nipple caudal position (CC position) and mediolateral oblique (MLO position), with breast being moderately squeezed from left and right. DCE-MRI (Siemens) scanning was performed in 3DT1-weighted sequence axial, with a total of 6 phases (the first phase was plain scanning of the mask, and the following 5 phases were enhanced scanning). Scan parameters: TR/TE: 4.32/1.57 msec, double Angle (FA) 10°, FOV: 34×34 cm, matrix: 448×448, incentive number: 1 time, layer thickness: 1 mm; there was no distance between scan, each scan lasted 1 min and 7 sec, with a total scanning time of 7 min and 2 sec. The contrast enhancement agent gadolinium Gd-DTPA (purchased from ACCDON Inc.) was injected with a dose of 0.1 mmol/kg and a rate of 3.0 ml/sec through the elbow vein.

Significant image features of breast cancer with different types of molybdenum target and DCE-MRI. The significant image features of breast cancer with different types of molybdenum target and DCE-MRI are shown in Figs. 1 and 2.

Figure 2.

DCE-MRI image features of different types of breast cancer. (A) Luminal-A breast cancer. DCE-MRI shows a larger mass with smooth edges, less calcification and structural distortion. Irregular mass shadow can be seen at about 9 o'clock in the left breast. The lesion margin is rough with visible bristles, and the signal shadow is equal to T1 mixed with long T2. The dispersion of DWI is limited and shows uneven enhancement, and the time signal intensity curve shows an inflow pattern. (B) Luminal B breast cancer. DCE-MRI shows most uneven enhancement in the lesion area with burrs on the margin. Irregular mass shadow can be seen at about 1 o'clock in the right breast, with multiple bristles on the edge, showing equal T1 and long T2 signal shadow. The dispersion of DWI is limited and shows uneven enhancement, and the time signal intensity curve shows an outflow pattern. (C) Her2 overexpressed breast cancer. DCE-MRI shows dynamic enhancement of the lesion area. Multiple clumps and focal distribution lesions can be seen in the upper and lower quadrant of the right breast, showing equal/slightly longer T1 mixed with slightly longer T2 signals. DWI has limited dispersion and unclear boundary. There are burrs and uneven enhancement at the edge of the mass in the outer upper quadrant of the right breast. The curve of time signal intensity is plateau, and multiple lymph node shadows are seen in the right axilla. (D) Triple-negative breast cancer. DCE-MRI shows ring enhancement in the lesion area. Irregular mass shadow can be seen at 5 o'clock in the left breast, showing mixed t1-long and t2-long signal shadows. The non-uniform annular dispersion of DWI is limited, and the non-uniform annular enhancement is enhanced. Burrs are visible at the edges, and the time signal intensity curve presents an outflow pattern. DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Statistical analysis

Application of SPSS 17.0 (Beijing Boyizhixun Information Technology Co., Ltd.) software system was used for statistical analysis and χ2 inspection for comparison of accuracy rate of diagnosis. Enumeration data were expressed as [n (%)]. P<0.05 was considered to indicate a statistically significant difference.

Results

General data

General clinical data of the patients are shown in Table I.

Table I.

General clinical data of the patients.

Table I.

General clinical data of the patients.

Factors[n (%)]
Age (years)
  <47.4648 (40.00)
  ≥47.4672 (60.00)
Smoking
  Yes84 (70.00)
  No36 (30.00)
Alcohol consumption
  Yes65 (54.17)
  No55 (45.83)
Menopausal status
  Premenopause80 (66.67)
  Post-menopause40 (33.33)
Differentiated degree
  High51 (42.50)
  Middle30 (25.00)
  Low39 (32.50)
Lymphatic metastasis
  Yes39 (32.50)
  No81 (67.50)
Different classification
  Luminal-A type50 (41.67)
  Luminal-B type31 (25.83)
  Her2-overexpressed type20 (16.67)
  Triple-negative type19 (15.83)

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of different types of breast cancer

Luminal-A breast cancer

The sensitivity, specificity and diagnostic coincidence rates of Luminal-A breast cancer diagnosed by molybdenum target were 84.00, 82.86 and 83.33%, respectively. The sensitivity, specificity and diagnostic coincidence rates of Luminal-A breast cancer diagnosed by DCE-MRI were 90.00, 88.57 and 89.17%, respectively. The sensitivity, specificity and diagnostic coincidence rates of Luminal-A breast cancer diagnosed by molybdenum target combined with DCE-MRI were 98.00, 88.57 and 92.50%, respectively. The sensitivity and diagnostic coincidence rates of Luminal-A breast cancer diagnosed by molybdenum target combined with DCE-MRI were significantly higher than those of Luminal-A breast cancer diagnosed by molybdenum target or DCE-MRI alone. There was no statistical difference in sensitivity and diagnostic coincidence rates of Luminal-A breast cancer diagnosed by molybdenum target or DCE-MRI alone (P>0.05) (Tables II and III).

Table II.

Results of Luminal-A breast cancer diagnosed by different method.

Table II.

Results of Luminal-A breast cancer diagnosed by different method.

Pathological results

Diagnosis methodsGroupLuminal-A typeNon-luminal-A typeTotal
Molybdenum targetLuminal-A type4212  54
Non-luminal-A type  858  66
Total5070120
DCE-MRILuminal-A type45  8  53
Non-luminal-A type  562  67
Total5070120
Molybdenum target combinedLuminal-A type49  8  57
with DCE-MRINon-luminal-A type  162  63
Total5070120

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Table III.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of Luminal-A breast cancer.

Table III.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of Luminal-A breast cancer.

GroupsMolybdenum target diagnosisDCE-MRI diagnosisJoint diagnosisχ2 valueP-value
Sensitivity84.00% (42/50)90.00% (45/50)98.00% (49/50)0.2840.868
Specificity82.86% (58/70)88.57% (62/70)88.57% (62/70)0.0950.954
Diagnostic coincidence rate83.33% (100/120)89.17% (107/120)92.50% (111/120)0.3130.855

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Luminal-B breast cancer

The sensitivity, specificity and diagnostic coincidence rates of Luminal-B breast cancer diagnosed by molybdenum target were 80.65, 82.02 and 81.67%, respectively. The sensitivity, specificity and diagnostic coincidence rate of Luminal-B breast cancer diagnosed by DCE-MRI were 87.10, 87.64 and 87.50%, respectively. The sensitivity, specificity and diagnostic coincidence rates of Luminal-B breast cancer diagnosed by molybdenum target combined with DCE-MRI were 96.77, 86.51 and 89.17%, respectively. The sensitivity and diagnostic coincidence rate of Luminal-B breast cancer diagnosed by molybdenum target combined with DCE-MRI were significantly higher than those of Luminal-B breast cancer diagnosed by molybdenum target or DCE-MRI alone. There was no statistical difference in sensitivity and diagnostic coincidence rates of Luminal-B breast cancer diagnosed by molybdenum target or DCE-MRI alone (P>0.05) (Tables IV and V).

Table IV.

Results of Luminal-B breast cancer diagnosed by different methods.

Table IV.

Results of Luminal-B breast cancer diagnosed by different methods.

Pathological results

Diagnosis methodsGroupLuminal-B typeNon-luminal-B typeTotal
Molybdenum targetLuminal-B type2516  41
Non-luminal-B type  673  79
Total3189120
DCE-MRILuminal-B type2711  38
Non-luminal-B type  478  82
Total3189120
Molybdenum target combinedLuminal-B type3012  42
with DCE-MRINon-luminal-B type  177  78
Total3189120

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Table V.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of Luminal-B breast cancer.

Table V.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of Luminal-B breast cancer.

GroupsMolybdenum target diagnosisDCE-MRI diagnosisJoint diagnosisχ2 valueP-value
Sensitivity80.65% (25/31)87.10% (27/31)96.77% (30/31)0.2450.885
Specificity82.02% (73/89)87.64% (78/89)86.51% (77/89)0.1000.951
Diagnostic coincidence rate81.67% (98/120)87.50% (105/120)89.17% (107/120)0.2350.890

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Her2-overexpressed breast cancer

The sensitivity, specificity and diagnostic coincidence rates of Her2-overexpressed breast cancer diagnosed by molybdenum target were 80.00, 87.00 and 85.83%, respectively. The sensitivity and diagnostic coincidence rates of Her2-overexpressed breast cancer diagnosed by DCE-MRI were 85.00, 88.00 and 87.50%, respectively. The sensitivity, specificity and diagnostic coincidence rates of Her2-overexpressed breast cancer diagnosed by molybdenum target combined with DCE-MRI were 95.00, 88.00 and 89.17%, respectively. The sensitivity, specificity and diagnostic coincidence rates of Her2-overexpressed breast cancer diagnosed by molybdenum target combined with DCE-MRI were significantly higher than those of Her2-overexpressed breast cancer diagnosed by molybdenum target or DCE-MRI alone. There was no statistical difference in sensitivity and diagnostic coincidence rates of Her2-overexpressed breast cancer diagnosed by molybdenum target or DCE-MRI alone (P>0.05) (Tables VI and VII).

Table VI.

Results of Her2-overexpressed breast cancer diagnosed by different method.

Table VI.

Results of Her2-overexpressed breast cancer diagnosed by different method.

Pathological results

Diagnosis methodsGroupHer2-overexpressed type Non-Her2-overexpressed typeTotal
Molybdenum targetHer2-overexpressed type16  12  28
Non-Her2-overexpressed type  4  87  91
Total20100120
DCE-MRIHer2-overexpressed type17  12  29
Non-Her2-overexpressed type  3  88  91
Total20100120
Molybdenum target combinedHer2-overexpressed type19  12  31
with DCE-MRI Non-Her2-overexpressed type  1  88  89
Total20100120

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Table VII.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of Her2-overexpressed breast cancer.

Table VII.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of Her2-overexpressed breast cancer.

GroupsMolybdenum target diagnosisDCE-MRI diagnosisJoint diagnosisχ2 valueP-value
Sensitivity80.00% (16/20)85.00% (17/20)95.00% (19/20)0.1430.931
Specificity87.00% (87/100)88.00% (88/100)88.00% (88/100)0.0040.998
Diagnostic coincidence rate85.83% (103/120)87.50% (105/120)89.17% (107/120)0.0410.980

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Triple-negative breast cancer

The sensitivity, specificity and diagnostic coincidence rates of triple-negative breast cancer diagnosed by molybdenum target were 78.94, 80.20 and 80.00%, respectively. The sensitivity, specificity and diagnostic coincidence rates of triple-negative breast cancer diagnosed by DCE-MRI were 84.21, 89.11 and 88.33%, respectively. The sensitivity, specificity and diagnostic coincidence rates of triple-negative breast cancer diagnosed by molybdenum target combined with DCE-MRI were 94.74, 88.12 and 89.17%, respectively. The sensitivity and diagnostic coincidence rates of triple-negative breast cancer diagnosed by molybdenum target combined with DCE-MRI were significantly higher than those of triple-negative breast cancer diagnosed by molybdenum target or DCE-MRI alone. There was no statistical difference in sensitivity and diagnostic coincidence rates between the two groups in the diagnosis of triple-negative breast cancer with molybdenum target or DCE-MRI alone (P>0.05) (Tables VIII and IX).

Table VIII.

Results of triple-negative breast cancer diagnosed by different method.

Table VIII.

Results of triple-negative breast cancer diagnosed by different method.

Pathological results

Diagnosis methodsGroupTriple-negative breast cancerNon-triple-negative breast cancerTotal
Molybdenum targetTriple-negative breast cancer15  20  35
Non-triple-negative breast cancer  4  81  85
Total19101120
DCE-MRITriple-negative breast cancer16  11  27
Non-triple-negative breast cancer  3  90  93
Total19101120
Molybdenum target combined with DCE-MRITriple-negative breast cancer18  12  30
Non triple-negative breast cancer  1  89  90
Total19101120

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Table IX.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of triple-negative breast cancer.

Table IX.

Diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of triple-negative breast cancer.

GroupsMolybdenum target diagnosisDCE-MRI diagnosisJoint diagnosisχ2 valueP-value
Sensitivity78.94% (15/19)84.21% (16/19)94.74% (18/19)0.1520.927
Specificity80.20% (81/101)89.11% (90/101)88.12% (89/101)0.3070.858
Diagnostic coincidence rate80.00% (96/120)88.33% (106/120)89.17% (107/120)0.3930.822

[i] DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging.

Discussion

The morbidity and mortality of breast cancer are increasing year by year (17). Since the mechanism of breast cancer cannot be clearly explained at present, the key to reduce morbidity and mortality is to accurately diagnose the conditions of breast cancer patients and provide corresponding treatment schemes (18). Medically, specific genotypes are made according to the gene level of breast cancer patients, and treatment plans are made according to different molecular genotypes of breast cancer. Treatment plans and prognosis of breast cancer patients with different molecular genotypes are greatly different (19,20). In this study, molybdenum target, DCE-MRI and molybdenum target combined with DCE-MRI were performed on the patients, respectively, and the examination results were compared with the pathological examination results of the patients, in order to investigate the clinical efficacy of molybdenum target, DCE-MRI and molybdenum target combined with DCE-MRI with different types of breast cancer. First, we analyzed the diagnostic efficacy of molybdenum target, DCE-MRI and their combined detection in the diagnosis of Luminal-A and Luminal-B breast cancer, and found that the sensitivity and diagnostic coincidence rates of Luminal-A and Luminal-B breast cancer were significantly higher than those of molybdenum target or DCE-MRI alone. There were no statistical differences in sensitivity and diagnostic coincidence rates between Luminal-A and Luminal-B breast cancer diagnosed by molybdenum target or DCE-MRI alone. Luminal-A type is common in early breast cancer with low recurrence rate (21), while Luminal-B type with high histological grade is common in older breast cancer patients (22).

It has been reported that there is a certain correlation between histopathology, molecular biology and related imaging features of tumors, indicating that breast cancer with different molecular types has different imaging manifestations (23). However, in the study of Goffin et al (24) on breast cancer diagnosed by molybdenum target combined with DCE-MRI, it was found that the diagnostic coincidence rates of breast cancer diagnosed by molybdenum target combined with DCE-MRI were significantly higher than those of breast cancer diagnosed by molybdenum target or DCE-MRI alone. This is similar to the research results of this study, which to some extent supports our results. Then, we analyzed the diagnostic efficacy of molybdenum target, DCE-MRI, and molybdenum target combined with DCE-MRI in Her2-overexpressed type and triple-negative breast cancer, and found that the sensitivity and diagnostic coincidence rates of Her2-overexpressed type and triple-negative breast cancer diagnosed by molybdenum target combined with DCE-MRI were apparently higher than those of diagnosis with molybdenum target or DCE-MRI alone. There was no statistical difference in the sensitivity and diagnostic coincidence rate between the two groups of Her2-overexpressed breast cancer and triple-negative breast cancer diagnosed by molybdenum target or DCE-MRI alone. It is reported that although molybdenum target is widely used in the screening of breast lesions, it shows poor sensitivity to small lesions located at the edge of the breast, and the sensitivity of molybdenum target to very dense breasts decreases by >40% (25). DCE-MRI, applied to the examination of breast cancer, can better show the hemodynamic characteristics of small breast cancer lesions, but it also has a certain rate of missed diagnosis for small sand-like calcification lesions (26). Clinical studies on tumor lesions detected by DCE-MRI combined with molybdenum target showed that DCE-MRI combined with molybdenum target could significantly improve the clinical diagnosis rate (27). Kriege et al (28) also carried out DCE-MRI, molybdenum target and DCE-MRI combined with molybdenum target detection for breast cancer with different molecular types, and also found that the diagnostic coincidence rates of DCE-MRI combined with molybdenum target for breast cancer were significantly higher than those of the single imaging detection.

In this study, due to the regional limitations of the inclusion of research objects, the experimental results may be biased to some extent. Therefore, we will continue to expand the number of subjects in different regions for this research, and conduct follow-up.

Collectively, the diagnostic efficacy of molybdenum target combined with DCE-MRI in breast cancer with different molecular types is better than that of imaging screening alone, which is of great clinical significance in the development of individualized comprehensive treatment for breast cancer patients and is worthy of wide promotion in clinical practice.

Acknowledgements

Not applicable.

Funding

No funding was received.

Availability of data and materials

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.

Authors' contributions

YH wrote the manuscript. YH and YZ collected and analyzed the general data of patients. JC was responsible for the analysis and discussion of the data. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (Zhengzhou, China). Patients who participated in this research had complete clinical data. Informed consent forms were signed in advance by the patients and their families.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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October 2019
Volume 18 Issue 4

Print ISSN: 1792-1074
Online ISSN:1792-1082

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APA
Hu, Y., Zhang, Y., & Cheng, J. (2019). Diagnostic value of molybdenum target combined with DCE-MRI in different types of breast cancer. Oncology Letters, 18, 4056-4063. https://doi.org/10.3892/ol.2019.10746
MLA
Hu, Y., Zhang, Y., Cheng, J."Diagnostic value of molybdenum target combined with DCE-MRI in different types of breast cancer". Oncology Letters 18.4 (2019): 4056-4063.
Chicago
Hu, Y., Zhang, Y., Cheng, J."Diagnostic value of molybdenum target combined with DCE-MRI in different types of breast cancer". Oncology Letters 18, no. 4 (2019): 4056-4063. https://doi.org/10.3892/ol.2019.10746