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Müller-Franzes G, Khader F, Tayebi Arasteh S, Huck L, Bode M, Han T, Lemainque T, Kather JN, Nebelung S, Kuhl C, Truhn D. Intraindividual Comparison of Different Methods for Automated BPE Assessment at Breast MRI: A Call for Standardization. Radiology 2024; 312:e232304. [PMID: 39012249 DOI: 10.1148/radiol.232304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Background The level of background parenchymal enhancement (BPE) at breast MRI provides predictive and prognostic information and can have diagnostic implications. However, there is a lack of standardization regarding BPE assessment. Purpose To investigate how well results of quantitative BPE assessment methods correlate among themselves and with assessments made by radiologists experienced in breast MRI. Materials and Methods In this pseudoprospective analysis of 5773 breast MRI examinations from 3207 patients (mean age, 60 years ± 10 [SD]), the level of BPE was prospectively categorized according to the Breast Imaging Reporting and Data System by radiologists experienced in breast MRI. For automated extraction of BPE, fibroglandular tissue (FGT) was segmented in an automated pipeline. Four different published methods for automated quantitative BPE extractions were used: two methods (A and B) based on enhancement intensity and two methods (C and D) based on the volume of enhanced FGT. The results from all methods were correlated, and agreement was investigated in comparison with the respective radiologist-based categorization. For surrogate validation of BPE assessment, how accurately the methods distinguished premenopausal women with (n = 50) versus without (n = 896) antihormonal treatment was determined. Results Intensity-based methods (A and B) exhibited a correlation with radiologist-based categorization of 0.56 ± 0.01 and 0.55 ± 0.01, respectively, and volume-based methods (C and D) had a correlation of 0.52 ± 0.01 and 0.50 ± 0.01 (P < .001). There were notable correlation differences (P < .001) between the BPE determined with the four methods. Among the four quantitation methods, method D offered the highest accuracy for distinguishing women with versus without antihormonal therapy (P = .01). Conclusion Results of different methods for quantitative BPE assessment agree only moderately among themselves or with visual categories reported by experienced radiologists; intensity-based methods correlate more closely with radiologists' ratings than volume-based methods. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Mann in this issue.
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Affiliation(s)
- Gustav Müller-Franzes
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Firas Khader
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Soroosh Tayebi Arasteh
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Luisa Huck
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Maike Bode
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Tianyu Han
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Teresa Lemainque
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Jakob Nikolas Kather
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Sven Nebelung
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Christiane Kuhl
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
| | - Daniel Truhn
- From the Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstr 30, 52074 Aachen, Germany (G.M.F., F.K., S.T.A., L.H., M.B., T.H., T.L., S.N., C.K., D.T.); National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany (J.N.K.); Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany (J.N.K.); and Department of Medicine I, University Hospital Dresden, Dresden, Germany (J.N.K.)
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Wang H, H M van der Velden B, Verburg E, Bakker MF, Pijnappel RM, Veldhuis WB, van Gils CH, Gilhuijs KGA. Automated rating of background parenchymal enhancement in MRI of extremely dense breasts without compromising the association with breast cancer in the DENSE trial. Eur J Radiol 2024; 175:111442. [PMID: 38583349 DOI: 10.1016/j.ejrad.2024.111442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/06/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Background parenchymal enhancement (BPE) on dynamic contrast-enhanced MRI (DCE-MRI) as rated by radiologists is subject to inter- and intrareader variability. We aim to automate BPE category from DCE-MRI. METHODS This study represents a secondary analysis of the Dense Tissue and Early Breast Neoplasm Screening trial. 4553 women with extremely dense breasts who received supplemental breast MRI screening in eight hospitals were included. Minimal, mild, moderate and marked BPE rated by radiologists were used as reference. Fifteen quantitative MRI features of the fibroglandular tissue were extracted to predict BPE using Random Forest, Naïve Bayes, and KNN classifiers. Majority voting was used to combine the predictions. Internal-external validation was used for training and validation. The inverse-variance weighted mean accuracy was used to express mean performance across the eight hospitals. Cox regression was used to verify non inferiority of the association between automated rating and breast cancer occurrence compared to the association for manual rating. RESULTS The accuracy of majority voting ranged between 0.56 and 0.84 across the eight hospitals. The weighted mean prediction accuracy for the four BPE categories was 0.76. The hazard ratio (HR) of BPE for breast cancer occurrence was comparable between automated rating and manual rating (HR = 2.12 versus HR = 1.97, P = 0.65 for mild/moderate/marked BPE relative to minimal BPE). CONCLUSION It is feasible to rate BPE automatically in DCE-MRI of women with extremely dense breasts without compromising the underlying association between BPE and breast cancer occurrence. The accuracy for minimal BPE is superior to that for other BPE categories.
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Affiliation(s)
- Hui Wang
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Erik Verburg
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Kenneth G A Gilhuijs
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
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Li X, Yan F. Predictive value of background parenchymal enhancement on breast magnetic resonance imaging for pathological tumor response to neoadjuvant chemotherapy in breast cancers: a systematic review. Cancer Imaging 2024; 24:35. [PMID: 38462607 PMCID: PMC10926651 DOI: 10.1186/s40644-024-00672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES This review aimed to assess the predictive value of background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) as an imaging biomarker for pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT). METHODS Two reviewers independently performed a systemic literature search using the PubMed, MEDLINE, and Embase databases for studies published up to 11 June 2022. Data from relevant articles were extracted to assess the relationship between BPE and pCR. RESULTS This systematic review included 13 studies with extensive heterogeneity in population characteristics, MRI follow-up points, MRI protocol, NACT protocol, pCR definition, and BPE assessment. Baseline BPE levels were not associated with pCR, except in 1 study that reported higher baseline BPE of the younger participants (< 55 years) in the pCR group than the non-pCR group. A total of 5 studies qualitatively assessed BPE levels and indicated a correlation between reduced BPE after NACT and pCR; however, among the studies that quantitatively measured BPE, the same association was observed only in the subgroup analysis of 2 articles that assessed the status of hormone receptor and human epidermal growth factor receptor 2. In addition, the predictive ability of early BPE changes for pCR was reported in several articles and remains controversial. CONCLUSIONS Changes in BPE may be a promising imaging biomarker for predicting pCR in breast cancer. Because current studies remain insufficient, particularly those that quantitatively measure BPE, prospective and multicenter large-sample studies are needed to confirm this relationship.
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Affiliation(s)
- Xue Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China
- Graduate School of Peking, Union Medical College, Beijing, PR China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
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Zhang B, Zhu J, Zhang P, Wei Y, Li Y, Xu A, Zhang Y, Zheng H, Dong X, Yang K, Dong C, Chen Z, Li X, Cheng L. A background parenchymal enhancement quantification framework of breast magnetic resonance imaging. Quant Imaging Med Surg 2023; 13:8350-8357. [PMID: 38106260 PMCID: PMC10721989 DOI: 10.21037/qims-23-514] [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: 04/16/2023] [Accepted: 09/15/2023] [Indexed: 12/19/2023]
Abstract
Background Background parenchymal enhancement (BPE) is defined as the enhanced proportion of normal fibroglandular tissue on enhanced magnetic resonance imaging. BPE shows promise as a quantitative imaging biomarker (QIB). However, the lack of consensus among radiologists in their semi-quantitative grading of BPE limits its clinical utility. Methods The main objective of this study was to develop a BPE quantification model according to clinical expertise, with the BPE integral being used as a QIB to incorporate both the volume and intensity of the enhancement metrics. The model was applied to 2,786 cases to compare our quantitative results with radiologists' semi-quantitative BPE grading to evaluate the effectiveness of using the BPE integral as a QIB for analyzing BPE. Comparisons between multiple groups of nonnormally distributed BPE integrals were performed using the Kruskal-Wallis test. Results Our study found a considerable degree of concordance between our BPE quantitative integral and radiologists' semi-quantitative assessments. Specifically, our research results revealed significant variability in BPE integral attained through the BPE quantification framework among all semi-quantitative BPE grading groups labeled by experienced radiologists, including mild-moderate (P<0.001), mild-marked (P<0.001), and moderate-marked (P<0.001). Furthermore, there was an apparent correlation between BPE integral and BPE grades, with marked BPE displaying the highest BPE integral, followed by moderate BPE, with mild BPE exhibiting the lowest BPE integral value. Conclusions The study developed and implemented a BPE quantification framework, which incorporated both the volume and intensity of enhancement and which could serve as a QIB for BPE.
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Affiliation(s)
- Boya Zhang
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jingjin Zhu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Peifang Zhang
- Department of Big Data Center, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yan Li
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Aoxi Xu
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yiheng Zhang
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Hongye Zheng
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiaohan Dong
- Department of Radiology, The Sixth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Kaizhou Yang
- Department of Radiology, The Sixth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Chuang Dong
- Department of Radiology, The Sixth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Zhengming Chen
- Department of Radiology, The Sixth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- School of Medicine, Nankai University, Tianjin, China
- Department of General Surgery, The First Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liuquan Cheng
- Department of Radiology, The Sixth Medical Center of Chinese People’s Liberation Army General Hospital, Beijing, China
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Ren Z, Pineda FD, Howard FM, Fan X, Nanda R, Abe H, Kulkarni K, Karczmar GS. Bilateral asymmetry of quantitative parenchymal kinetics at ultrafast DCE-MRI predict response to neoadjuvant chemotherapy in patients with HER2+ breast cancer. Magn Reson Imaging 2023; 104:9-15. [PMID: 37611646 PMCID: PMC10879456 DOI: 10.1016/j.mri.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE To assess whether measurement of the bilateral asymmetry of semiquantitative and quantitative perfusion parameters from ultrafast dynamic contrast-enhanced MRI (DCE-MRI), allows early prediction of pathologic response after neoadjuvant chemotherapy (NAC) in patients with HER2+ breast cancer. MATERIALS AND METHODS Twenty-eight female patients with HER2+ breast cancer treated with NAC who underwent pre-NAC ultrafast DCE-MRI (3-9 s/phase) were enrolled for this study. Four semiquantitative and two quantitative parenchymal parameters were calculated for each patient. Ipsilateral/contralateral (I/C) ratio (for four parameters) and the difference between (for two parameters) ipsi- and contra-lateral parenchymal kinetic parameters (kBPE) were compared for patients with pathologic complete response (pCR) and those having residual disease. Lasso regression with leave-one-out cross validation was used to determine the optimal combination of parameters for a regression model and multivariable logistic regression was used to identify independent predictors for pCR. Chi-squared test, two-sided t-test and Kruskal-Wallis test were used. RESULTS The Ktrans I/C ratio cutoff value of 1.11 had a sensitivity of 83.3% and specificity of 75% for pCR. The ve I/C ratio cutoff value of 1.1 had a sensitivity of 75% and specificity of 81.3% for pCR. The area under the receiver operating characteristic curve of the three-kBPE parameter model, including initial area under the enhancement curve (AUC30) I/C ratio, KtransI/C ratio and ve I/C ratio, was 0.89 with sensitivity of 91.7% at specificity of 81.3%. CONCLUSION Quantitative assessment of bilateral asymmetry kBPE from pre-NAC ultrafast DCE-MRI can predict pCR in patients with HER2+ breast cancer.
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Affiliation(s)
- Zhen Ren
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States of America.
| | - Federico D Pineda
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15260, United States of America.
| | - Frederick M Howard
- Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, IL 60637, United States of America.
| | - Xiaobing Fan
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States of America.
| | - Rita Nanda
- Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, IL 60637, United States of America.
| | - Hiroyuki Abe
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States of America.
| | - Kirti Kulkarni
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States of America.
| | - Gregory S Karczmar
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States of America.
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Zdanowski A, Sartor H, Feldt M, Skarping I. Mammographic density in relation to breast cancer recurrence and survival in women receiving neoadjuvant chemotherapy. Front Oncol 2023; 13:1177310. [PMID: 37388229 PMCID: PMC10304818 DOI: 10.3389/fonc.2023.1177310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The association between mammographic density (MD) and breast cancer (BC) recurrence and survival remains unclear. Patients receiving neoadjuvant chemotherapy (NACT) are in a vulnerable situation with the tumor within the breast during treatment. This study evaluated the association between MD and recurrence/survival in BC patients treated with NACT. Methods Patients with BC treated with NACT in Sweden (2005-2016) were retrospectively included (N=302). Associations between MD (Breast Imaging-Reporting and Data System (BI-RADS) 5th Edition) and recurrence-free/BC-specific survival at follow-up (Q1 2022) were addressed. Hazard ratios (HRs) for recurrence/BC-specific survival (BI-RADS a/b/c vs. d) were estimated using Cox regression analysis and adjusted for age, estrogen receptor status, human epidermal growth factor receptor 2 status, axillary lymph node status, tumor size, and complete pathological response. Results A total of 86 recurrences and 64 deaths were recorded. The adjusted models showed that patients with BI-RADS d vs. BI-RADS a/b/c had an increased risk of recurrence (HR 1.96 (95% confidence interval (CI) 0.98-3.92)) and an increased risk of BC-specific death (HR 2.94 (95% CI 1.43-6.06)). Conclusion These findings raise questions regarding personalized follow-up for BC patients with extremely dense breasts (BI-RADS d) pre-NACT. More extensive studies are required to confirm our findings.
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Affiliation(s)
| | - Hanna Sartor
- Department of Translational Medicine, Diagnostic Radiology, Skåne University Hospital, Lund University, Lund/Malmö, Sweden
| | - Maria Feldt
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Ida Skarping
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund, Sweden
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Ren Z, Pineda FD, Howard FM, Hill E, Szasz T, Safi R, Medved M, Nanda R, Yankeelov TE, Abe H, Karczmar GS. Differences Between Ipsilateral and Contralateral Early Parenchymal Enhancement Kinetics Predict Response of Breast Cancer to Neoadjuvant Therapy. Acad Radiol 2022; 29:1469-1479. [PMID: 35351365 DOI: 10.1016/j.acra.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES To determine whether kinetics measured with ultrafast dynamic contrast-enhanced magnetic resonance imaging in tumor and normal parenchyma pre- and post-neoadjuvant therapy (NAT) can predict the response of breast cancer to NAT. MATERIALS AND METHODS Twenty-four patients with histologically confirmed invasive breast cancer were enrolled. They were scanned with ultrafast dynamic contrast-enhanced magnetic resonance imaging (3-7 seconds/frame) pre- and post-NAT. Four kinetic parameters were calculated in the segmented tumors, and ipsi- and contra-lateral normal parenchyma: (1) tumor (tSE30) or background parenchymal relative enhancement at 30 seconds (BPE30), (2) maximum relative enhancement slope (MaxSlope), (3) bolus arrival time (BAT), and (4) area under relative signal enhancement curve for the initial 30 seconds (AUC30). The tumor kinetics and the differences between ipsi- and contra-lateral parenchymal kinetics were compared for patients achieving pathologic complete response (pCR) vs those who had residual disease after NAT. The chi-squared test and two-sided t-test were used for baseline demographics. The Wilcoxon rank sum test and one-way analysis of variance were used for differential responses to therapy. RESULTS Patients with similar pre-NAT mean BPE30, median BAT and mean AUC30 in the ipsi- and contralateral normal parenchyma were more likely to achieve pCR following NAT (p < 0.02). Patients classified as having residual cancer burden (RCB) II after NAT showed higher post-NAT tSE30 and tumor AUC30 and higher post-NAT MaxSlope in ipsilateral normal parenchyma compared to those classified as RCB I or pCR (p < 0.05). CONCLUSION Bilateral asymmetry in normal parenchyma could predict treatment outcome prior to NAT. Post-NAT tumor kinetics could evaluate the aggressiveness of residual tumor.
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Affiliation(s)
- Zhen Ren
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Federico D Pineda
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Frederick M Howard
- Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Elle Hill
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Teodora Szasz
- Research Computing Center, The University of Chicago, Chicago, Illinois
| | - Rabia Safi
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Milica Medved
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Rita Nanda
- Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Thomas E Yankeelov
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas; Department of Diagnostic Medicine, The University of Texas at Austin, Austin, Texas; Department of Oncology, The University of Texas at Austin, Austin, Texas; Institute for Computational and Engineering Sciences, The University of Texas at Austin, Austin, Texas; Livestrong Cancer Institutes, The University of Texas at Austin, Austin, Texas; Department of Imaging Physics, MD Anderson Cancer Center, Houston, Texas
| | - Hiroyuki Abe
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637
| | - Gregory S Karczmar
- Department of Radiology, The University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637.
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Rella R, Bufi E, Belli P, Scrofani AR, Petta F, Borghetti A, Marazzi F, Valentini V, Manfredi R. Association between contralateral background parenchymal enhancement on MRI and outcome in patients with unilateral invasive breast cancer breast receiving neoadjuvant chemotherapy. Diagn Interv Imaging 2022; 103:486-494. [DOI: 10.1016/j.diii.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
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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: 16] [Impact Index Per Article: 5.3] [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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Chalfant JS, Mortazavi S, Lee-Felker SA. Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
To present recent literature regarding the assessment and clinical implications of background parenchymal enhancement on breast MRI.
Recent Findings
The qualitative assessment of BPE remains variable within the literature, as well as in clinical practice. Several different quantitative approaches have been investigated in recent years, most commonly region of interest-based and segmentation-based assessments. However, quantitative assessment has not become standard in clinical practice to date. Numerous studies have demonstrated a clear association between higher BPE and future breast cancer risk. While higher BPE does not appear to significantly impact cancer detection, it may result in a higher abnormal interpretation rate. BPE is also likely a marker of pathologic complete response after neoadjuvant chemotherapy, with decreases in BPE during and after neoadjuvant chemotherapy correlated with pCR. In contrast, pre-treatment BPE does not appear to be predictive of pCR. The association between BPE and prognosis is less clear, with heterogeneous results in the literature.
Summary
Assessment of BPE continues to evolve, with heterogeneity in approaches to both qualitative and quantitative assessment. The level of BPE has important clinical implications, with associations with future breast cancer risk and treatment response. BPE may also be an imaging marker of prognosis, but future research is needed on this topic.
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Response Predictivity to Neoadjuvant Therapies in Breast Cancer: A Qualitative Analysis of Background Parenchymal Enhancement in DCE-MRI. J Pers Med 2021; 11:jpm11040256. [PMID: 33915842 PMCID: PMC8065517 DOI: 10.3390/jpm11040256] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Background: For assessing the predictability of oncology neoadjuvant therapy results, the background parenchymal enhancement (BPE) parameter in breast magnetic resonance imaging (MRI) has acquired increased interest. This work aims to qualitatively evaluate the BPE parameter as a potential predictive marker for neoadjuvant therapy. Method: Three radiologists examined, in triple-blind modality, the MRIs of 80 patients performed before the start of chemotherapy, after three months from the start of treatment, and after surgery. They identified the portion of fibroglandular tissue (FGT) and BPE of the contralateral breast to the tumor in the basal control pre-treatment (baseline). Results: We observed a reduction of BPE classes in serial MRI checks performed during neoadjuvant therapy, as compared to baseline pre-treatment conditions, in 61.3% of patients in the intermediate step, and in 86.7% of patients in the final step. BPE reduction was significantly associated with sequential anthracyclines/taxane administration in the first cycle of neoadjuvant therapy compared to anti-HER2 containing therapies. The therapy response was also significantly related to tumor size. There were no associations with menopausal status, fibroglandular tissue (FGT) amount, age, BPE baseline, BPE in intermediate, and in the final MRI step. Conclusions: The measured variability of this parameter during therapy could predict therapy effectiveness in early stages, improving decision-making in the perspective of personalized medicine. Our preliminary results suggest that BPE may represent a predictive factor in response to neoadjuvant therapy in breast cancer, warranting future investigations in conjunction with radiomics.
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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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