ArticleQuantitative imaging in medicine and surgery2026
The value of non-enhanced magnetic resonance imaging based on T2-weighted imaging and apparent diffusion coefficient in the study of three-tiered HER2 status in patients with breast cancer.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Preoperative assessment of human epidermal growth factor receptor 2 (HER2) status relies on invasive biopsy, which is subject to sampling limitations. Meanwhile, conventional contrast-enhanced magnetic resonance imaging (MRI) and radiomics face barriers to widespread adoption due to high costs, complexity, and poor reproducibility. In contrast, non-contrast MRI based on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) offers a non-invasive, cost-effective, and safe alternative. This study aimed to evaluate whether non-contrast T2WI combined with ADC can non-invasively stratify HER2-zero, HER2-low, and HER2-overexpressing invasive breast cancer. Methods: In this retrospective single-center study, 361 women with surgically confirmed invasive breast cancer (February 2015-December 2023) were stratified into HER2-zero expressing (n=63), HER2-low expressing (n=181), and HER2-overexpressing (n=117) cohorts. All underwent preoperative 3 Tesla (T) breast MRI including fat-suppressed (FS) T2WI and DWI. Two readers assessed breast edema score (BES 1-4) and lesion-to-muscle T2 signal ratio (L/M). ADC maps were generated based on the b values of 50 and 800 s/mm Results: After pairwise comparison, tumor edema extent differed significantly between HER2-low and HER2-overexpressing (P=0.032). Intratumoral T2FS hyperintensity also differed between HER2-zero and HER2-low (P<0.001) and between HER2-low and HER2-overexpressing (P=0.004). Multivariate logistic regression analysis revealed that intratumoral T2FS hyperintensity (P=0.001) and L/M ratio (P=0.004) were independent predictors for differentiating the HER2-zero group from the HER2-low group, whereas ADC values (P<0.001), L/M ratio (P=0.028) and Ki-67 levels (P<0.001) were independent predictors for distinguishing the HER2-low group from the HER2-high group. The predictive model achieved areas under the curve (AUCs) of 0.737 for differentiating HER2-zero versus HER2-low and 0.761 for differentiating HER2-low versus HER2-overexpressing. Conclusions: T2WI-derived edema and signal intensity (SI), together with ADC, may serve as valuable noninvasive MRI biomarkers to complement existing approaches for HER2 level assessment, offering a simple and reproducible adjunctive screening method in clinical practice.
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