Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal study

Abstract Background Little is known regarding biomechanical properties derived from multifrequency MR elastography temporal changes during neoadjuvant chemotherapy (NAC) and associated with pathologic complete response (pCR) and disease-free survival (DFS) in breast cancer. We aimed to investigate t...

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Main Authors: Xiaoxia Wang, Yao Huang, Jinfang Shi, Ying Cao, Huifang Chen, Lan Li, Lu Wang, Sun Tang, Xueqin Gong, Haiping Huang, Ting Yin, Jiuquan Zhang
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Breast Cancer Research
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Online Access:https://doi.org/10.1186/s13058-025-02035-4
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author Xiaoxia Wang
Yao Huang
Jinfang Shi
Ying Cao
Huifang Chen
Lan Li
Lu Wang
Sun Tang
Xueqin Gong
Haiping Huang
Ting Yin
Jiuquan Zhang
author_facet Xiaoxia Wang
Yao Huang
Jinfang Shi
Ying Cao
Huifang Chen
Lan Li
Lu Wang
Sun Tang
Xueqin Gong
Haiping Huang
Ting Yin
Jiuquan Zhang
author_sort Xiaoxia Wang
collection DOAJ
description Abstract Background Little is known regarding biomechanical properties derived from multifrequency MR elastography temporal changes during neoadjuvant chemotherapy (NAC) and associated with pathologic complete response (pCR) and disease-free survival (DFS) in breast cancer. We aimed to investigate temporal changes in NAC-associated biomechanical parameters and assess biomechanical parameters as a predictor of pCR and DFS in breast cancer. Methods In this prospective longitudinal study, participants with breast cancer who received NAC were enrolled from February 2021 to May 2023. All participants underwent multifrequency MR-elastography at four timepoints: before NAC (T1) and after 2 (T2), 4 (T3), and 6 (T4) cycles. Tomoelastography postprocessing provided biomechanical maps of shear-wave-speed (c) and loss-angle (φ) as proxies of stiffness and viscosity. The biomechanical parameters were validated by means of correlation with histopathologic measurements. Generalized estimating equations were used to compare temporal changes in biomechanical parameters at four time points. Logistic regression was used for pCR analysis and Cox proportional hazards regression was used for survival analysis. Predictive performance was assessed with area under the receiver operating characteristic curve (AUC) analysis. Results A total of 235 women (50.6 ± 7.9 years) with 964 scans were enrolled. Biomechanical parameters were supported by positive correlations with pathologic examination–based stroma fraction (c: r =.76, P <.001; φ: r =.49, P =.008) and cellularity (c: r =.58, P =.001; φ: r =.40, P =.035). Progesterone receptor, human epidermal growth factor receptor-2 (HER2), T2-c, and T2-φ were independently associated with pCR (all P <.05). Estrogen receptor, HER2, clinical stage, and change in φ at the early stage of NAC were associated with PFS (all P <.05). The predictive model, which incorporated biomechanical parameters and clinicopathologic characteristics significantly outperformed the clinicopathologic model in predicting pCR (AUC: 0.95, 95% confidence interval [CI]: 0.92, 0.98 vs. 0.79, 95%CI: 0.73, 0.84; P <.001). The predictive model also showed good discrimination ability for DFS (C-index = 0.82, 95%CI: 0.72, 0.90) and stratified prognosis into low-risk and high-risk groups (log-rank, P <.001). Conclusions During NAC, patients with higher tumor stiffness and viscosity are less likely to achieve DFS and pCR. The biomechanical parameters exhibit excellent biological interpretability and serve as valuable biomarkers for predicting pCR and DFS in patients with breast cancer.
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spelling doaj-art-7ab60ab2eb00449f8c506d31f51a2f552025-08-20T03:53:16ZengBMCBreast Cancer Research1465-542X2025-05-0127111510.1186/s13058-025-02035-4Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal studyXiaoxia Wang0Yao Huang1Jinfang Shi2Ying Cao3Huifang Chen4Lan Li5Lu Wang6Sun Tang7Xueqin Gong8Haiping Huang9Ting Yin10Jiuquan Zhang11Department of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Radiology, Chongqing University Cancer HospitalDepartment of Pathology, Chongqing Key Laboratory for Intelligent Oncology in Breast Cancer (iCQBC), Chongqing University Cancer HospitalMR Collaborations, Siemens Healthineers LtdDepartment of Radiology, Chongqing University Cancer HospitalAbstract Background Little is known regarding biomechanical properties derived from multifrequency MR elastography temporal changes during neoadjuvant chemotherapy (NAC) and associated with pathologic complete response (pCR) and disease-free survival (DFS) in breast cancer. We aimed to investigate temporal changes in NAC-associated biomechanical parameters and assess biomechanical parameters as a predictor of pCR and DFS in breast cancer. Methods In this prospective longitudinal study, participants with breast cancer who received NAC were enrolled from February 2021 to May 2023. All participants underwent multifrequency MR-elastography at four timepoints: before NAC (T1) and after 2 (T2), 4 (T3), and 6 (T4) cycles. Tomoelastography postprocessing provided biomechanical maps of shear-wave-speed (c) and loss-angle (φ) as proxies of stiffness and viscosity. The biomechanical parameters were validated by means of correlation with histopathologic measurements. Generalized estimating equations were used to compare temporal changes in biomechanical parameters at four time points. Logistic regression was used for pCR analysis and Cox proportional hazards regression was used for survival analysis. Predictive performance was assessed with area under the receiver operating characteristic curve (AUC) analysis. Results A total of 235 women (50.6 ± 7.9 years) with 964 scans were enrolled. Biomechanical parameters were supported by positive correlations with pathologic examination–based stroma fraction (c: r =.76, P <.001; φ: r =.49, P =.008) and cellularity (c: r =.58, P =.001; φ: r =.40, P =.035). Progesterone receptor, human epidermal growth factor receptor-2 (HER2), T2-c, and T2-φ were independently associated with pCR (all P <.05). Estrogen receptor, HER2, clinical stage, and change in φ at the early stage of NAC were associated with PFS (all P <.05). The predictive model, which incorporated biomechanical parameters and clinicopathologic characteristics significantly outperformed the clinicopathologic model in predicting pCR (AUC: 0.95, 95% confidence interval [CI]: 0.92, 0.98 vs. 0.79, 95%CI: 0.73, 0.84; P <.001). The predictive model also showed good discrimination ability for DFS (C-index = 0.82, 95%CI: 0.72, 0.90) and stratified prognosis into low-risk and high-risk groups (log-rank, P <.001). Conclusions During NAC, patients with higher tumor stiffness and viscosity are less likely to achieve DFS and pCR. The biomechanical parameters exhibit excellent biological interpretability and serve as valuable biomarkers for predicting pCR and DFS in patients with breast cancer.https://doi.org/10.1186/s13058-025-02035-4Breast neoplasmsNeoadjuvant therapyElasticity imaging techniquesMagnetic resonance imaging
spellingShingle Xiaoxia Wang
Yao Huang
Jinfang Shi
Ying Cao
Huifang Chen
Lan Li
Lu Wang
Sun Tang
Xueqin Gong
Haiping Huang
Ting Yin
Jiuquan Zhang
Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal study
Breast Cancer Research
Breast neoplasms
Neoadjuvant therapy
Elasticity imaging techniques
Magnetic resonance imaging
title Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal study
title_full Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal study
title_fullStr Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal study
title_full_unstemmed Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal study
title_short Biomechanical parameters quantified by MR elastography for predicting response to neoadjuvant chemotherapy and disease-free survival in breast cancer: a prospective longitudinal study
title_sort biomechanical parameters quantified by mr elastography for predicting response to neoadjuvant chemotherapy and disease free survival in breast cancer a prospective longitudinal study
topic Breast neoplasms
Neoadjuvant therapy
Elasticity imaging techniques
Magnetic resonance imaging
url https://doi.org/10.1186/s13058-025-02035-4
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