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Bauer E, Levy MS, Domachevsky L, Anaby D, Nissan N. Background parenchymal enhancement and uptake as breast cancer imaging biomarkers: A state-of-the-art review. Clin Imaging 2021; 83:41-50. [PMID: 34953310 DOI: 10.1016/j.clinimag.2021.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/20/2022]
Abstract
Within the past decade, background parenchymal enhancement (BPE) and background parenchymal uptake (BPU) have emerged as novel imaging-derived biomarkers in the diagnosis and treatment monitoring of breast cancer. Growing evidence supports the role of breast parenchyma vascularity and metabolic activity as probable risk factors for breast cancer development. Furthermore, in the presence of a newly-diagnosed breast cancer, added clinically-relevant data was surprisingly found in the respective imaging properties of the non-affected contralateral breast. Evaluation of the contralateral BPE and BPU have been found to be especially instrumental in predicting the prognosis of a patient with breast cancer and even anticipating their response to neoadjuvant chemotherapy. Simultaneously, further research has found a link between these two biomarkers, even though they represent different physical properties. The aim of this review is to provide an up to date summary of the current clinical applications of BPE and BPU as breast cancer imaging biomarkers with the hope that it propels their further usage in clinical practice.
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Affiliation(s)
- Ethan Bauer
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Miri Sklair Levy
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Liran Domachevsky
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Debbie Anaby
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Noam Nissan
- Department of Radiology, Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
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Ragusi MAA, Bismeijer T, van der Velden BHM, Loo CE, Canisius S, Wesseling J, Wessels LFA, Elias SG, Gilhuijs KGA. Contralateral parenchymal enhancement on MRI is associated with tumor proteasome pathway gene expression and overall survival of early ER+/HER2-breast cancer patients. Breast 2021; 60:230-237. [PMID: 34763270 PMCID: PMC8591464 DOI: 10.1016/j.breast.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/26/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess whether contralateral parenchymal enhancement (CPE) on MRI is associated with gene expression pathways in ER+/HER2-breast cancer, and if so, whether such pathways are related to survival. Methods Preoperative breast MRIs were analyzed of early ER+/HER2-breast cancer patients eligible for breast-conserving surgery included in a prospective observational cohort study (MARGINS). The contralateral parenchyma was segmented and CPE was calculated as the average of the top-10% delayed enhancement. Total tumor RNA sequencing was performed and gene set enrichment analysis was used to reveal gene expression pathways associated with CPE (N = 226) and related to overall survival (OS) and invasive disease-free survival (IDFS) in multivariable survival analysis. The latter was also done for the METABRIC cohort (N = 1355). Results CPE was most strongly correlated with proteasome pathways (normalized enrichment statistic = 2.04, false discovery rate = .11). Patients with high CPE showed lower tumor proteasome gene expression. Proteasome gene expression had a hazard ratio (HR) of 1.40 (95% CI = 0.89, 2.16; P = .143) for OS in the MARGINS cohort and 1.53 (95% CI = 1.08, 2.14; P = .017) for IDFS, in METABRIC proteasome gene expression had an HR of 1.09 (95% CI = 1.01, 1.18; P = .020) for OS and 1.10 (95% CI = 1.02, 1.18; P = .012) for IDFS. Conclusion CPE was negatively correlated with tumor proteasome gene expression in early ER+/HER2-breast cancer patients. Low tumor proteasome gene expression was associated with improved survival in the METABRIC data. Contralateral parenchymal enhancement on MRI was associated with tumor proteasome gene expression in ER+/HER2-breast cancer. A high contralateral parenchymal enhancement was associated with a low proteasome gene expression in the breast cancer. Low proteasome tumor gene expression was associated with improved survival in an independent patient cohort.
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Affiliation(s)
- Max A A Ragusi
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Tycho Bismeijer
- Division of Molecular Carcinogenesis - Oncode Institute, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Bas H M van der Velden
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Sander Canisius
- Division of Molecular Carcinogenesis - Oncode Institute, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis - Oncode Institute, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Faculty of Electrical Engineering, Mathematics, and Computer Science, Delft University of Technology, Mekelweg 5, 2628 CD Delft, the Netherlands
| | - Sjoerd G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Kenneth G A Gilhuijs
- Department of Radiology / Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Rella R, Contegiacomo A, Bufi E, Mercogliano S, Belli P, Manfredi R. Background parenchymal enhancement and breast cancer: a review of the emerging evidences about its potential use as imaging biomarker. Br J Radiol 2021; 94:20200630. [PMID: 33035073 DOI: 10.1259/bjr.20200630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To conduct a systematic review of evidences about the relationship between background parenchymal enhancement (BPE) of the contralateral healthy breast and breast cancer: its association with clinicopathological breast cancer characteristics, its potential as predictive and prognostic biomarker and the biological linkage between BPE and breast cancer. METHODS A computerized literature search using PubMed and Google Scholar was performed up to June 2020. Two authors independently conducted search, screening, quality assessment, and extraction of data from the eligible studies. Studies were assessed for quality and risk of bias using the revised Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS Of the 476 articles identified, 22 articles met the inclusion criteria. No significant association was found between BPE and invasiveness, histological cancer type, T- and N-stage, multifocality, lymphatic and vascular invasion and histological tumour grade while the association between BPE and molecular subtypes is still unclear. As predictive biomarker, a greater decrease in BPE during and after neoadjuvant chemotherapy was associated with pathological complete response. Results about the role of BPE as prognostic factor were inconsistent. An association between high BPE and microvessel density, CD34 and VEGF (histological markers of vascularization and angiogenesis) was found. CONCLUSIONS BPE of the contralateral breast is associated with breast cancer in several aspects, therefore it has been proposed as a tool to refine breast cancer decision-making process. ADVANCES IN KNOWLEDGE Additional researches with standardized BPE assessment are needed to translate this emerging biomarker into clinical practice in the era of personalized medicine.
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Affiliation(s)
- Rossella Rella
- UOC di Diagnostica per immagini ed Interventistica Generale, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italia
| | - Andrea Contegiacomo
- UOC di Diagnostica per immagini ed Interventistica Generale, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italia
| | - Enida Bufi
- UOC di Diagnostica per immagini ed Interventistica Generale, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italia
| | - Sara Mercogliano
- Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italia
| | - Paolo Belli
- UOC di Diagnostica per immagini ed Interventistica Generale, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italia.,Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italia
| | - Riccardo Manfredi
- UOC di Diagnostica per immagini ed Interventistica Generale, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italia.,Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italia
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Contralateral parenchymal enhancement on breast MRI before and during neoadjuvant endocrine therapy in relation to the preoperative endocrine prognostic index. Eur Radiol 2020; 30:6740-6748. [PMID: 32691100 PMCID: PMC7599193 DOI: 10.1007/s00330-020-07058-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/30/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Abstract
Objectives To investigate whether contralateral parenchymal enhancement (CPE) on MRI during neoadjuvant endocrine therapy (NET) is associated with the preoperative endocrine prognostic index (PEPI) of ER+/HER2− breast cancer. Methods This retrospective observational cohort study included 40 unilateral ER+/HER2− breast cancer patients treated with NET. Patients received NET for 6 to 9 months with MRI response monitoring after 3 and/or 6 months. PEPI was used as endpoint. PEPI is based on surgery-derived pathology (pT- and pN-stage, Ki67, and ER-status) and stratifies patients in three groups with distinct prognoses. Mixed effects and ROC analysis were performed to investigate whether CPE was associated with PEPI and to assess discriminatory ability. Results The median patient age was 61 (interquartile interval: 52, 69). Twelve patients had PEPI-1 (good prognosis), 15 PEPI-2 (intermediate), and 13 PEPI-3 (poor). High pretreatment CPE was associated with PEPI-3: pretreatment CPE was 39.4% higher on average (95% CI = 1.3, 91.9%; p = .047) compared with PEPI-1. CPE decreased after 3 months in PEPI-2 and PEPI-3. The average reduction was 24.4% (95% CI = 2.6, 41.3%; p = .032) in PEPI-2 and 29.2% (95% CI = 7.8, 45.6%; p = .011) in PEPI-3 compared with baseline. Change in CPE was predictive of PEPI-1 vs PEPI-2+3 (AUC = 0.77; 95% CI = 0.57, 0.96). Conclusions CPE during NET is associated with PEPI-group in ER+/HER2− breast cancer: a high pretreatment CPE and a decrease in CPE during NET were associated with a poor prognosis after NET on the basis of PEPI. Key Points • Change in contralateral breast parenchymal enhancement on MRI during neoadjuvant endocrine therapy distinguished between patients with a good and intermediate/poor prognosis at final pathology. • Patients with a poor prognosis at final pathology showed higher baseline parenchymal enhancement on average compared to patients with a good prognosis. • Patients with an intermediate/poor prognosis at final pathology showed a higher average reduction in parenchymal enhancement after 3 months of neoadjuvant endocrine therapy. Electronic supplementary material The online version of this article (10.1007/s00330-020-07058-3) contains supplementary material, which is available to authorized users.
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Preliminary study on discriminating HER2 2+ amplification status of breast cancers based on texture features semi-automatically derived from pre-, post-contrast, and subtraction images of DCE-MRI. PLoS One 2020; 15:e0234800. [PMID: 32555662 PMCID: PMC7299320 DOI: 10.1371/journal.pone.0234800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/02/2020] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate whether texture features extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are associated with human epidermal growth factor receptor type 2 (HER2) 2+ status of breast cancer. Materials and methods 92 MRI cases including 52 HER2 2+ positive and 40 negative patients confirmed by fluorescence in situ hybridization were retrospectively selected. The lesion area was semi-automatically delineated, and a total of 488 texture features were respectively extracted from precontrast, postcontrast, and subtraction images. The Student’s t-test or Mann-Whitney U test was performed to identify statistically significant features between different HER2 2+ amplification groups. Least absolute shrinkage and selection operator (LASSO) was used to search for the optimal feature subsets. Three machine learning classifiers, logistic regression analysis (LRA), quadratic discriminant analysis (QDA), and support vector machine (SVM), were used with a leave-one-out cross validation method to establish the classification models of HER2 2+ status. Classification performance was evaluated by receiver operating characteristic (ROC) analysis. Results Based on the texture analysis with SVM model, the areas under the ROC curve (AUCs) were 0.890 for subtraction images, 0.736 for postcontrast images, and 0.672 for precontrast images, respectively. For LRA model, the AUCs were 0.884, 0.733, and 0.623, respectively. For QDA model, the AUCs were 0.831, 0.726, and 0.568, respectively. LRA and the SVM model with subtraction images reached significantly better performance than the QDA model (P = 0.0227 and P = 0.0088, respectively). Conclusion Texture features of breast cancer extracted from DCE-MRI are associated with HER2 2+ status. Additional studies are necessary to confirm the present preliminary findings.
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van der Velden BHM, van Rijssel MJ, Lena B, Philippens MEP, Loo CE, Ragusi MAA, Elias SG, Sutton EJ, Morris EA, Bartels LW, Gilhuijs KGA. Harmonization of Quantitative Parenchymal Enhancement in T 1 -Weighted Breast MRI. J Magn Reson Imaging 2020; 52:1374-1382. [PMID: 32491246 PMCID: PMC7687185 DOI: 10.1002/jmri.27244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Differences in imaging parameters influence computer‐extracted parenchymal enhancement measures from breast MRI. Purpose To investigate the effect of differences in dynamic contrast‐enhanced MRI acquisition parameter settings on quantitative parenchymal enhancement of the breast, and to evaluate harmonization of contrast‐enhancement values with respect to flip angle and repetition time. Study Type Retrospective. Phantom/Populations We modeled parenchymal enhancement using simulations, a phantom, and two cohorts (N = 398 and N = 302) from independent cancer centers. Sequence Field/Strength 1.5T dynamic contrast‐enhanced T1‐weighted spoiled gradient echo MRI. Vendors: Philips, Siemens, General Electric Medical Systems. Assessment We assessed harmonization of parenchymal enhancement in simulations and phantom by varying the MR parameters that influence the amount of T1‐weighting: flip angle (8°–25°) and repetition time (4–12 msec). We calculated the median and interquartile range (IQR) of the enhancement values before and after harmonization. In vivo, we assessed overlap of quantitative parenchymal enhancement in the cohorts before and after harmonization using kernel density estimations. Cohort 1 was scanned with flip angle 20° and repetition time 8 msec; cohort 2 with flip angle 10° and repetition time 6 msec. Statistical Tests Paired Wilcoxon signed‐rank‐test of bootstrapped kernel density estimations. Results Before harmonization, simulated enhancement values had a median (IQR) of 0.46 (0.34–0.49). After harmonization, the IQR was reduced: median (IQR): 0.44 (0.44–0.45). In the phantom, the IQR also decreased, median (IQR): 0.96 (0.59–1.22) before harmonization, 0.96 (0.91–1.02) after harmonization. Harmonization yielded significantly (P < 0.001) better overlap in parenchymal enhancement between the cohorts: median (IQR) was 0.46 (0.37–0.58) for cohort 1 vs. 0.37 (0.30–0.44) for cohort 2 before harmonization (57% overlap); and 0.35 (0.28–0.43) vs. .0.37 (0.30–0.44) after harmonization (85% overlap). Data Conclusion The proposed practical harmonization method enables an accurate comparison between patients scanned with differences in imaging parameters. Level of Evidence 3 Technical Efficacy Stage 4
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Affiliation(s)
- Bas H M van der Velden
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michael J van Rijssel
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Beatrice Lena
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marielle E P Philippens
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Max A A Ragusi
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elizabeth J Sutton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lambertus W Bartels
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kenneth G A Gilhuijs
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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