1
|
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.
Collapse
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.)
| |
Collapse
|
2
|
Oh J, Han BK, Ko EY, Ko ES, Choi JS, Kim H, Park YH, Kim JY. Ring Enhancement in Non-Neoplastic Breast Tissue on MRI During Neoadjuvant Chemotherapy for Breast Cancer: Incidence and Clinical Implications. Acad Radiol 2023; 30:2931-2939. [PMID: 37045651 DOI: 10.1016/j.acra.2023.03.008] [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: 01/04/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to describe new lesions called ring enhancement in non-neoplastic breast tissue on breast magnetic resonance imaging (MRI) after neoadjuvant chemotherapy (NAC) in breast cancer patients, and to investigate the factors influencing their occurrence. MATERIALS AND METHODS We retrospectively reviewed 811 consecutive patients (mean age; 50.0 [range, 24-81] years) with breast cancer who had undergone NAC between January 2020 and December 2021, identifying cases with new ring enhancement on post-NAC MRI. We analyzed the MRI findings and identified factors that were potentially associated with ring enhancement through statistical analyses using the chi-square test, univariate and multivariate logistic regression analysis. RESULTS Forty-seven (5.8%) patients developed new ring enhancement on post-NAC MRI. The variables associated with ring enhancement were premenopausal status (p = 0.0007), younger age (p = 0.0011), high mammographic density (p = 0.0076), and high background parenchymal enhancement (BPE) on baseline MRI (p = 0.0001). Among these, high BPE was independently associated with the occurrence of ring enhancement (p = 0.0294, OR = 2.08; CI: 1.08-4.03). In a subset of high BPE patients, an association between HER2-positive cancers and ring enhancement was observed (odds ratio = 5.51 vs. 2.54). New lesion development exhibited no association with any specific NAC drug (p = 0.1676-0.7583 per drug). CONCLUSION Ring enhancement often occurs on post-NAC MRI and mostly disappears on subsequent MRI scans. High BPE on MRI was associated with this finding and HER2-positive cancers potentiated it. Knowledge of this finding can prevent unnecessary biopsies.
Collapse
Affiliation(s)
- Jiyun Oh
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea; Department of Radiology, Chung-Ang University Gwangmyeong Hospital, 110 Deokan-ro, Gwangmyeong-si, Gyeonggi-do, Korea
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Eun Y Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Eun S Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Ji S Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Haejung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yeon H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Yeon Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Xu C, Jiang M, Lin F, Zhang K, Xie H, Lv W, Ji H, Mao N. Qualitative assessments of density and background parenchymal enhancement on contrast-enhanced spectral mammography associated with breast cancer risk in high-risk women. Br J Radiol 2023:20220051. [PMID: 37227804 PMCID: PMC10392639 DOI: 10.1259/bjr.20220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To investigate the correlation between the risk of breast cancer for high-risk females and the density and background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM). METHODS Females at high-risk, without breast cancer history and received CESM from July 2016 to December 2017 were retrospectively enrolled. The longest follow-up time was 4.5 years, and patients who developed breast cancer with maximized follow-up time were classified as cancer cohort, while females who did not develop breast cancer were categorized as control cohort. These two cohorts were one-to-one matched in age, family and/or genetic history of breast cancer, menopausal status and BRCA status. The density and BPE at CESM imaging were assessed. Conditional logistic regression was applied to evaluate the relationship between imaging features and breast cancer risk. RESULTS During the follow-up interval, 90 women at high-risk without history of breast cancer were newly diagnosed. Compared with minimal BPE, increasing BPE levels were associated with the risk of breast cancer among high-risk females in a time interval of 4.5 years (mild: odds ratio [OR]=3.2, p = 0.001; moderate: OR = 4.0, p = 0.002; marked: OR = 11.2, p < 0.001). In addition, females with mild, moderate or marked BPE were four times more likely to be diagnosed with breast cancer than females with minimal BPE in a time interval of 4.5 years (OR = 4.0, p < 0.001). CONCLUSION Qualitative CESM BPE assessment may be useful in the prediction of breast cancer risk among high-risk females. ADVANCES IN KNOWLEDGE • Qualitative CESM BPE assessment may be useful in the prediction of breast cancer risk among high-risk women during the follow-up period of 4.5 years.• The significance of breast density as an independent risk factor is not fully established for high-risk women during the follow-up period of 4.5 years.
Collapse
Affiliation(s)
- Cong Xu
- Physical Examination Center, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Meiping Jiang
- Department of Ultrasound, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Fan Lin
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Kun Zhang
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Wei Lv
- Physical Examination Center, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Haixia Ji
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| |
Collapse
|
4
|
Kim J, Ko EY, Han BK, Ko ES, Choi JS, Park KW, Kim H. Comparison of the background echotexture between automated breast ultrasound and handheld breast ultrasound. Medicine (Baltimore) 2022; 101:e29547. [PMID: 35801798 PMCID: PMC9259099 DOI: 10.1097/md.0000000000029547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study aimed to compare the background echotexture (BE) between automated breast ultrasound (ABUS) and handheld breast ultrasound (HHUS) and evaluate the correlation of BE with mammographic (MG) density and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI). A total of 212 women with newly diagnosed breast cancer who had undergone preoperative ABUS, HHUS, MG, and MRI were included. Two breast radiologists blinded to the menopausal status analyzed the BE of the contralateral breasts of the patients with breast cancer in consensus. The MG density and BPE of breast MRI on the radiologic reports were compared with the BE in the ultrasound. We used the cumulative link mixed model to compare the BE and Spearman rank correlation to evaluate the association between BE with MG density and BPE. BE was more heterogeneous in ABUS than in HHUS (P < .001) and in the premenopausal group than in the postmenopausal group (P < .001). The heterogeneity of BE in the premenopausal group was higher with ABUS than with HHUS (P = .013). BE and MG density showed a moderate correlation in the postmenopausal group, but a weak correlation in the premenopausal group. BE and BPE showed moderate correlations only in the premenopausal group. ABUS showed a more heterogeneous BE, especially in the premenopausal group. Therefore, more attention is required to interpret ABUS screening in premenopausal women.
Collapse
Affiliation(s)
- Jieun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ko Woon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Haejung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Grøvik E, Hoff SR. Editorial for "Breast MRI Background Parenchymal Enhancement Categorization Using Deep Learning: Outperforming the Radiologist". J Magn Reson Imaging 2022; 56:1077-1078. [PMID: 35343010 DOI: 10.1002/jmri.28183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Endre Grøvik
- Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Alesund, Norway.,Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Alesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
6
|
Ma Y, Liu A, Zhang Y, Zhu Y, Wang Y, Zhao M, Liang Z, Qu Z, Yin L, Lu H, Ye Z. Comparison of background parenchymal enhancement (BPE) on contrast-enhanced cone-beam breast CT (CE-CBBCT) and breast MRI. Eur Radiol 2022; 32:5773-5782. [PMID: 35320411 DOI: 10.1007/s00330-022-08699-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the background parenchymal enhancement (BPE) levels on contrast-enhanced cone-beam breast CT (CE-CBBCT) and MRI, evaluate inter-reader reliability, and analyze the relationship between clinical factors and BPE level on CE-CBBCT. METHODS In this retrospective study, patients who underwent both CE-CBBCT and MRI were analyzed. BPE levels on CE-CBBCT and MRI were assessed by five specialists independently in random fashion, with a wash-out period of 4 weeks. Weighted kappa was used to analyze the agreement between CE-CBBCT and MRI, and intraclass correlation coefficient (ICC) was used to evaluate the inter-reader reliability for each modality. The association between BPE level on CE-CBBCT and clinical factors was evaluated by univariate and multivariate logistic regression. RESULTS A total of 221 patients from January 2017 to April 2021 were enrolled. CE-CBBCT showed substantial agreement (weighted kappa = 0.690) with MRI for BPE evaluation, with good degree of inter-reader reliability on both CE-CBBCT (ICC = 0.712) and MRI (ICC = 0.757). Based on majority reports, BPE levels on CE-CBBCT were lower than MRI (p < 0.001). BPE level on CE-CBBCT was significantly associated with menstrual status (odds ratio, OR = 0.125), breast density (OR = 2.308), and previously treated breast cancer (OR = 0.052) (all p < 0.05). BPE level for premenopausal patients was associated with menstrual cycle, with lower BPE level for the 2nd week of menstrual cycle (OR = 0.246). CONCLUSIONS CE-CBBCT showed substantial agreement and comparable inter-reader reliability with MRI for BPE evaluation, indicating that the corresponding BI-RADS lexicons could be used to describe BPE level on CE-CBBCT. The 2nd week of menstrual cycle timing is suggested as the optimal examination period for CE-CBBCT. KEY POINTS • CE-CBBCT showed substantial agreement and comparable inter-reader reliability with MRI for BPE evaluation. • Menstrual status, breast density, and previously treated breast cancer were associated with the BPE level on CE-CBBCT images. • The 2ndweek of the menstrual cycle is suggested as the optimal examination period for CE-CBBCT.
Collapse
Affiliation(s)
- Yue Ma
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Aidi Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Yuwei Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Yueqiang Zhu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Yafei Wang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Mengran Zhao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Zhiran Liang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Zhiye Qu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Lu Yin
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China.
| |
Collapse
|
7
|
Yuen S, Monzawa S, Gose A, Yanai S, Yata Y, Matsumoto H, Ichinose Y, Tashiro T, Yamagami K. Impact of background parenchymal enhancement levels on the diagnosis of contrast-enhanced digital mammography in evaluations of breast cancer: comparison with contrast-enhanced breast MRI. Breast Cancer 2022; 29:677-687. [DOI: 10.1007/s12282-022-01345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Vong S, Ronco AJ, Najafpour E, Aminololama-Shakeri S. Screening Breast MRI and the Science of Premenopausal Background Parenchymal Enhancement. JOURNAL OF BREAST IMAGING 2021; 3:407-415. [PMID: 38424792 DOI: 10.1093/jbi/wbab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 03/02/2024]
Abstract
The significance of background parenchymal enhancement (BPE) on screening and diagnostic breast MRI continues to be elucidated. Background parenchymal enhancement was initially deemed probably benign and followed or thought of as an artifact degrading the accuracy of breast cancer detection on breast MRI examinations. Subsequent research has focused on understanding the role of BPE regarding screening breast MRI. Today, there is growing evidence that a myriad of factors affect BPE, which in turn may influence patient outcomes. Additionally, BPE could represent an important risk factor for the future development of breast cancer. This article aims to describe the most up-to-date research on BPE as it relates to screening breast MRI in premenopausal women.
Collapse
Affiliation(s)
- Stephen Vong
- University of California Davis, Department of Radiology, Sacramento, CA, USA
| | - Anthony J Ronco
- University of California Davis, Department of Radiology, Sacramento, CA, USA
| | - Elham Najafpour
- University of California Davis, Department of Radiology, Sacramento, CA, USA
| | | |
Collapse
|
10
|
Yüzkan S, Cengiz D, Hekimsoy İ, Sezgin Okçu Ö, Oktay A. Diagnostic Performance of Contrast-enhanced Mammography: Comparison With MRI and Mammography. JOURNAL OF BREAST IMAGING 2021; 3:448-454. [PMID: 38424791 DOI: 10.1093/jbi/wbab028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare the diagnostic performance of contrast-enhanced mammography (CEM) with MRI and mammography (MG) based on histopathological results. METHODS In this IRB-approved study, written informed consent was obtained from all patients. Images from 40 patients (62 lesions) with suspicious findings on US between March 2018 and August 2018 were evaluated. Sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CEM, MRI, and MG were evaluated and compared within a 95% confidence interval. Maximum dimensions of lesions were measured and correlations of results were evaluated with Spearman's Rho test. RESULTS In the histopathological analysis, 66% (41/62) of lesions were malignant and 34% (21/62) of lesions were benign. Contrast-enhanced mammography, MRI, and MG had sensitivities of 100% (41/41), 100% (41/41), and 80% (33/41), respectively. The sensitivity of CEM and MRI was significantly better than that of MG (P = 0.03). The NPVs of CEM (100%, 7/7) and MRI (100%, 14/14) were statistically higher than the NPV of MG (60%, 12/20) (P = 0.03). The false-positive rates for CEM, MRI, and MG were 33% (7/21), 66% (14/21), and 42% (9/21), respectively. Contrast-enhanced mammography had a significantly lower false-positive rate than MRI (P < 0.001). Mammography had the highest false-negative rate, missing 19% (8/41) of malignant lesions. CONCLUSION Contrast-enhanced mammography has similar performance characteristics to MRI and improved performance characteristics relative to MG. In particular, CEM and MRI have similar sensitivity and NPVs and both are superior in each of these metrics to MG.
Collapse
Affiliation(s)
- Sabahattin Yüzkan
- Ege University School of Medicine, Department of Radiology, Izmir, Turkey
| | - Duygu Cengiz
- Ege University School of Medicine, Department of Radiology, Izmir, Turkey
| | - İlhan Hekimsoy
- Ege University School of Medicine, Department of Radiology, Izmir, Turkey
| | - Özlem Sezgin Okçu
- Ege University School of Medicine, Department of Radiology, Izmir, Turkey
| | - Ayşenur Oktay
- Ege University School of Medicine, Department of Radiology, Izmir, Turkey
| |
Collapse
|
11
|
de Kermadec E, Thomassin I, Daraï E, Kolanska K, Chabbert-Buffet N. [Impact of the menstrual cycle on the quality of interpretation of the MRI result in the follow-up of women at genetic risk for breast]. ACTA ACUST UNITED AC 2021; 49:923-929. [PMID: 33771738 DOI: 10.1016/j.gofs.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast MRI is used as a reference for screening breast cancer among women with a genetic high risk. Its sensitivity and specificity might decrease because of the background parenchymal enhancement. Therefore, it is recommended to plan the MRI between the 7th and the 14th day of the menstrual cycle despite of the burden of this organization. Our aim was to evaluate the interpretation (performance) of the MRI performance when it was done out of this period. METHODS We analyzed the MRI done in the Tenon Hospital among patients with a genetic high risk, without a history of breast cancer, between 2006 and 2016. We analyzed the rate of enhancement hindering the interpretation (EH) - that is to say grade III and IV -, the rate of additional explorations (MRI and biopsy), and the occurrence of interval events in 2 groups according to the programming of the examination: appropriate programming (D7-D14) and inappropriate programming (outside this period). RESULTS In total, 126 MRI were analyzed, done in a population of 62 women with a genetic predisposition to Breast Cancer (BRCA 1 or 2: 91%, others: 9%), median age was 34.5 years old. 84 were in appropriate programming and 42 were in an inappropriate one. The rate of EH was comparable between the two groups (respectively 31% and 35.7%, P=1), as well as the rate of additional explorations (respectively 31% and 45%, P=0.11). CONCLUSION Our results suggest that the programming of screening MRI could be simplified among patients with a genetic predisposition of breast cancer.
Collapse
Affiliation(s)
- E de Kermadec
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - I Thomassin
- Réseau sein a risque, AP-HP, Paris, France; Service de radiologie, centre d'imagerie de la femme, Sorbonne Université site TENON, AP-HP, Paris, France
| | - E Daraï
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - K Kolanska
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France.
| |
Collapse
|
12
|
Watt GP, Sung J, Morris EA, Buys SS, Bradbury AR, Brooks JD, Conant EF, Weinstein SP, Kontos D, Woods M, Colonna SV, Liang X, Stein MA, Pike MC, Bernstein JL. Association of breast cancer with MRI background parenchymal enhancement: the IMAGINE case-control study. Breast Cancer Res 2020; 22:138. [PMID: 33287857 PMCID: PMC7722419 DOI: 10.1186/s13058-020-01375-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
Background Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) may be associated with breast cancer risk, but previous studies of the association are equivocal and limited by incomplete blinding of BPE assessment. In this study, we evaluated the association between BPE and breast cancer based on fully blinded assessments of BPE in the unaffected breast. Methods The Imaging and Epidemiology (IMAGINE) study is a multicenter breast cancer case-control study of women receiving diagnostic, screening, or follow-up breast MRI, recruited from three comprehensive cancer centers in the USA. Cases had a first diagnosis of unilateral breast cancer and controls had no history of or current breast cancer. A single board-certified breast radiologist with 12 years’ experience, blinded to case-control status and clinical information, assessed the unaffected breast for BPE without view of the affected breast of cases (or the corresponding breast laterality of controls). The association between BPE and breast cancer was estimated by multivariable logistic regression separately for premenopausal and postmenopausal women. Results The analytic dataset included 835 cases and 963 controls. Adjusting for fibroglandular tissue (breast density), age, race/ethnicity, BMI, parity, family history of breast cancer, BRCA1/BRCA2 mutations, and other confounders, moderate/marked BPE (vs minimal/mild BPE) was associated with breast cancer among premenopausal women [odds ratio (OR) 1.49, 95% CI 1.05–2.11; p = 0.02]. Among postmenopausal women, mild/moderate/marked vs minimal BPE had a similar, but statistically non-significant, association with breast cancer (OR 1.45, 95% CI 0.92–2.27; p = 0.1). Conclusions BPE is associated with breast cancer in premenopausal women, and possibly postmenopausal women, after adjustment for breast density and confounders. Our results suggest that BPE should be evaluated alongside breast density for inclusion in models predicting breast cancer risk.
Collapse
Affiliation(s)
- Gordon P Watt
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., Second Floor, New York, NY, 10017, USA.
| | - Janice Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
| | - Angela R Bradbury
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Emily F Conant
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Susan P Weinstein
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Despina Kontos
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Meghan Woods
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., Second Floor, New York, NY, 10017, USA
| | - Sarah V Colonna
- Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
| | - Xiaolin Liang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., Second Floor, New York, NY, 10017, USA
| | - Matthew A Stein
- Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., Second Floor, New York, NY, 10017, USA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., Second Floor, New York, NY, 10017, USA
| |
Collapse
|
13
|
Hellgren R, Saracco A, Strand F, Eriksson M, Sundbom A, Hall P, Dickman PW. The association between breast cancer risk factors and background parenchymal enhancement at dynamic contrast-enhanced breast MRI. Acta Radiol 2020; 61:1600-1607. [PMID: 32216451 PMCID: PMC7720360 DOI: 10.1177/0284185120911583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Background parenchymal enhancement (BPE) of normal tissue at breast magnetic resonance imaging is suggested to be an independent risk factor for breast cancer. Its association with established risk factors for breast cancer is not fully investigated. Purpose To study the association between BPE and risk factors for breast cancer in a healthy, non-high-risk screening population. Material and Methods We measured BPE and mammographic density and used data from self-reported questionnaires in 214 healthy women aged 43–74 years. We estimated odds ratios for the univariable association between BPE and risk factors. We then fitted an adjusted model using logistic regression to evaluate associations between BPE (high vs. low) and risk factors, including mammographic breast density. Results The majority of women had low BPE (84%). In a multivariable model, we found statistically significant associations between BPE and age (P = 0.002) and BMI (P = 0.03). We did find a significant association between systemic progesterone medication and BPE, but due to small numbers, the results should be interpreted with caution. The adjusted odds ratio for high BPE was 3.1 among women with density D (compared to B) and 2.1 for density C (compared to B). However, the association between high BPE and density was not statistically significant. We did not find statistically significant associations with any other risk factors. Conclusion Our study confirmed the known association of BPE with age and BMI. Although our results show a higher likelihood for high BPE with increasing levels of mammographic density, the association was not statistically significant.
Collapse
Affiliation(s)
- Roxanna Hellgren
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ariel Saracco
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Fredrik Strand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Thoracic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ann Sundbom
- Department of Medical Imaging, Division of Breast Imaging, Södersjukhuset, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
14
|
Factors Associated With Background Parenchymal Enhancement on Contrast-Enhanced Mammography. AJR Am J Roentgenol 2020; 216:340-348. [PMID: 32755162 DOI: 10.2214/ajr.19.22353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to determine the relationship between background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM) and breast tissue density, menstrual status, endocrine therapy, and risk factors for breast cancer and also to evaluate interreader agreement on classification of BPE on CEM. MATERIALS AND METHODS. Five subspecialty-trained breast radiologists independently and blindly graded tissue density (with fatty tissue and scattered fibroglandular tissue classified as nondense tissue and with heterogeneously dense and extremely dense classified as dense tissue) and BPE (with minimal or mild BPE categorized as low BPE and moderate or marked BPE categorized as high BPE) on CEM examinations performed from 2014 to 2018. Electronic medical charts were reviewed for information on menstrual status, endocrine therapy, history of breast surgery, and other risk factors for breast cancer. Comparisons were performed using the Kruskal-Wallis test, Mann-Whitney test, and Spearman rank correlation. Interreader agreement was estimated using the Fleiss kappa test. RESULTS. A total of 202 patients (mean [± SD] age, 54 ± 10 years; range, 25-84 years) underwent CEM. Tissue density was categorized as fatty in two patients (1%), scattered fibroglandular in 67 patients (33%), heterogeneously dense in 117 patients (58%), and extremely dense in 16 patients (8%). Among the 202 patients, BPE was minimal in 77 (38%), mild in 80 (40%), moderate in 31 (15%), and marked in 14 (7%). Dense breasts, younger age, premenopausal status, no history of endocrine therapy, and no history of breast cancer were significantly associated with high BPE. Among premenopausal patients, no association was found between BPE and time from last menstrual period to CEM. Overall interreader agreement on BPE was moderate (κ = 0.41; 95% CI, 0.40-0.42). Interreader agreement on tissue density was substantial (κ = 0.67; 95% CI, 0.66-0.69). CONCLUSION. Women with dense breasts, premenopausal status, and younger age are more likely to have greater BPE. Targeting CEM to the last menstrual period is not indicated.
Collapse
|
15
|
Relationship Between Breast Ultrasound Background Echotexture and Magnetic Resonance Imaging Background Parenchymal Enhancement and the Effect of Hormonal Status Thereon. Ultrasound Q 2020; 36:179-191. [PMID: 32511210 DOI: 10.1097/ruq.0000000000000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We studied the relationship between breast ultrasound background echotexture (BET) and magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and whether this relationship varied with hormonal status and amount of fibroglandular tissue (FGT) on MRI. Two hundred eighty-three Korean women (52.1 years; range = 27-79 years) with newly diagnosed primary breast cancer who underwent preoperative breast ultrasound and MRI were retrospectively studied. Background echotexture, BPE, and FGT were classified into 4 categories, and age, menopausal status, menstrual cycle regularity, and menstrual cycle stage at MRI were recorded. Background echotexture and BPE relationship was assessed overall, and in menopausal, FGT, menstrual cycle regularity, and menstrual cycle stage subgroups. Background echotexture and BPE correlated in women overall, and menopausal, FGT, and menstrual cycle subgroups and those in the first half of the cycle (all P < 0.001). Background echotexture reflects BPE, regardless of menopausal status, menstrual cycle regularity, and FGT and may be a biomarker of breast cancer risk.
Collapse
|
16
|
Zhao S, Zhang X, Zhong H, Qin Y, Li Y, Song B, Huang J, Yu J. Background Parenchymal Enhancement on Contrast-Enhanced Spectral Mammography: Influence of Age, Breast Density, Menstruation Status, and Menstrual Cycle Timing. Sci Rep 2020; 10:8608. [PMID: 32451404 PMCID: PMC7248100 DOI: 10.1038/s41598-020-65526-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/04/2020] [Indexed: 02/08/2023] Open
Abstract
To evaluate the relationship of the extent and quantitative intensity of background parenchymal enhancement (BPE) on contrast-enhanced spectral mammography (CESM) with age, breast density, menstruation status, and menstrual cycle timing. This retrospective study included women who underwent CESM from July 2017 to March 2019 and who had menstruation status records. BPE category assessment was performed subjectively. BPE intensity was quantitatively measured using regions-of-interest. 208 subjects were included (150 were regular menstrual cycle and 58 were postmenopausal). The breast density was classified as category B in 11 subjects, category C in 231 subjects, and category D in 23 subjects. Subjects based on menstrual cycle timing, 24 at days 1-7, 55 at days 8-14, 48 at days 15-21, and 23 at days 22-28. Both quantitative and categorical analyses show a weak negative correlation between BPE and age in all subjects, but there was no significant correlation in premenopausal patients. Both the BPE pixel intensity value and BPE category was significantly lower in postmenopausal patients than in premenopausal patients, and there was no significant difference in breast density according to BPE. The minimum and maximum pixel values of BPE on days 8-14 of the menstrual cycle was significantly lower than those on days 15-21. There was no correlation between BPE level and menstrual cycle timing. Breast density with category D was more likely to have a lower BPE level than category C. We show here that BPE level is affected by menstruation status and menstrual cycle timing. We suggest that CESM should not be performed on days 15-21 of the menstrual cycle, but on days 8-14.
Collapse
Affiliation(s)
- Shuang Zhao
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xueqin Zhang
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Huanhuan Zhong
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yun Qin
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yan Li
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Juan Huang
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China.
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, 610041, Chengdu, China.
| |
Collapse
|
17
|
Dontchos BN, Rahbar H, Partridge SC, Lehman CD, DeMartini WB. Influence of Menstrual Cycle Timing on Screening Breast MRI Background Parenchymal Enhancement and Diagnostic Performance in Premenopausal Women. JOURNAL OF BREAST IMAGING 2019; 1:205-211. [PMID: 31538142 DOI: 10.1093/jbi/wbz022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 12/12/2022]
Abstract
Purpose To assess the influence of menstrual cycle timing on background parenchymal enhancement (BPE) and performance on screening breast magnetic resonance imaging (MRI) in premenopausal women at high risk for developing breast cancer. Methods After Institutional Review Board approval, all screening breast MRIs performed from January 2007 through November 2010 in premenopausal women in whom day from last menstrual period was recorded were identified. Prospectively recorded BPE levels and Breast Imaging Reporting and Data System MRI assessments were extracted from our database. Subject outcomes were determined by using biopsy, imaging follow-up, and linkage with the regional tumor registry (minimum 12-month follow-up). Associations of BPE levels (minimal/mild versus moderate/marked) with menstrual cycle phase (follicular [day 0-15] versus luteal [day 16-35]) and week (1, 2, 3, or 4) were compared. Differences in MRI performance metrics, including abnormal interpretation rate (AIR), positive biopsy rate (PBR), cancer yield, sensitivity, and specificity, were compared between menstrual cycle phase and menstrual cycle week. Results Three-hundred twenty examinations in 244 premenopausal women met inclusion criteria with nine cancers diagnosed. BPE levels were not associated with menstrual cycle phase or week (P > 0.05). MRI performance metrics (ie, AIR, PBR, cancer yield, sensitivity, or specificity) did not differ significantly based on menstrual cycle phase or menstrual cycle week (P > 0.05). Conclusions Obtaining screening breast MRI exams during specific phases or weeks of the menstrual cycle in premenopausal women does not reliably produce MRI examinations with lower BPE levels or improved performance.
Collapse
Affiliation(s)
| | - Habib Rahbar
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Seattle, WA
| | - Savannah C Partridge
- University of Washington, Seattle Cancer Care Alliance, Department of Radiology, Seattle, WA
| | | | - Wendy B DeMartini
- Stanford University, Stanford Comprehensive Cancer Center, Stanford, CA
| |
Collapse
|
18
|
Liao GJ, Henze Bancroft LC, Strigel RM, Chitalia RD, Kontos D, Moy L, Partridge SC, Rahbar H. Background parenchymal enhancement on breast MRI: A comprehensive review. J Magn Reson Imaging 2019; 51:43-61. [PMID: 31004391 DOI: 10.1002/jmri.26762] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/22/2022] Open
Abstract
The degree of normal fibroglandular tissue that enhances on breast MRI, known as background parenchymal enhancement (BPE), was initially described as an incidental finding that could affect interpretation performance. While BPE is now established to be a physiologic phenomenon that is affected by both endogenous and exogenous hormone levels, evidence supporting the notion that BPE frequently masks breast cancers is limited. However, compelling data have emerged to suggest BPE is an independent marker of breast cancer risk and breast cancer treatment outcomes. Specifically, multiple studies have shown that elevated BPE levels, measured qualitatively or quantitatively, are associated with a greater risk of developing breast cancer. Evidence also suggests that BPE could be a predictor of neoadjuvant breast cancer treatment response and overall breast cancer treatment outcomes. These discoveries come at a time when breast cancer screening and treatment have moved toward an increased emphasis on targeted and individualized approaches, of which the identification of imaging features that can predict cancer diagnosis and treatment response is an increasingly recognized component. Historically, researchers have primarily studied quantitative tumor imaging features in pursuit of clinically useful biomarkers. However, the need to segment less well-defined areas of normal tissue for quantitative BPE measurements presents its own unique challenges. Furthermore, there is no consensus on the optimal timing on dynamic contrast-enhanced MRI for BPE quantitation. This article comprehensively reviews BPE with a particular focus on its potential to increase precision approaches to breast cancer risk assessment, diagnosis, and treatment. It also describes areas of needed future research, such as the applicability of BPE to women at average risk, the biological underpinnings of BPE, and the standardization of BPE characterization. Level of Evidence: 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:43-61.
Collapse
Affiliation(s)
- Geraldine J Liao
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Radiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | | | - Roberta M Strigel
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA.,Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Rhea D Chitalia
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Despina Kontos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda Moy
- Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Savannah C Partridge
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
19
|
Grimm LJ, Saha A, Ghate SV, Kim C, Soo MS, Yoon SC, Mazurowski MA. Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk. Acad Radiol 2019; 26:69-75. [PMID: 29602724 DOI: 10.1016/j.acra.2018.03.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 01/10/2023]
Abstract
RATIONALE AND OBJECTIVES To determine if background parenchymal enhancement (BPE) on screening breast magnetic resonance imaging (MRI) in high-risk women correlates with future cancer. MATERIALS AND METHODS All screening breast MRIs (n = 1039) in high-risk women at our institution from August 1, 2004, to July 30, 2013, were identified. Sixty-one patients who subsequently developed breast cancer were matched 1:2 by age and high-risk indication with patients who did not develop breast cancer (n = 122). Five fellowship-trained breast radiologists independently recorded the BPE. The median reader BPE for each case was calculated and compared between the cancer and control cohorts. RESULTS Cancer cohort patients were high-risk because of a history of radiation therapy (10%, 6 of 61), high-risk lesion (18%, 11 of 61), or breast cancer (30%, 18 of 61); BRCA mutation (18%, 11 of 61); or family history (25%, 15 of 61). Subsequent malignancies were invasive ductal carcinoma (64%, 39 of 61), ductal carcinoma in situ (30%, 18 of 61) and invasive lobular carcinoma (7%, 4of 61). BPE was significantly higher in the cancer cohort than in the control cohort (P = 0.01). Women with mild, moderate, or marked BPE were 2.5 times more likely to develop breast cancer than women with minimal BPE (odds ratio = 2.5, 95% confidence interval: 1.3-4.8, P = .005). There was fair interreader agreement (κ = 0.39). CONCLUSIONS High-risk women with greater than minimal BPE at screening MRI have increased risk of future breast cancer.
Collapse
Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
| | - Ashirbani Saha
- Carl E. Ravin Advanced Imaging Laboratories, Duke University Hock Plaza, Durham, North Carolina
| | - Sujata V Ghate
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Connie Kim
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Sora C Yoon
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710
| | - Maciej A Mazurowski
- Carl E. Ravin Advanced Imaging Laboratories, Duke University Hock Plaza, Durham, North Carolina
| |
Collapse
|
20
|
Kamitani T, Yabuuchi H, Kanemaki Y, Tozaki M, Sonomura T, Mizukoshi W, Nakata W, Shimono T, Urano M, Yamano T, Kato F, Kuchiki M, Shiragami N, Yanagita H, Katsuda E, Kataoka M, Yamaguchi K, Horikoshi T, Gomi T, Nozaki M, Shiotani M, Amano M, Saigusa H, Sadaoka S, Kamiya H, Kubo M, Yamashita N, Yamamoto H, Honda H. Effects of menstrual cycle on background parenchymal enhancement and detectability of breast cancer on dynamic contrast-enhanced breast MRI: A multicenter study of an Asian population. Eur J Radiol 2019; 110:130-135. [DOI: 10.1016/j.ejrad.2018.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/31/2018] [Accepted: 11/21/2018] [Indexed: 11/30/2022]
|
21
|
Di Leo G, Ioan I, Luciani ML, Midulla C, Podo F, Sardanelli F, Pediconi F. Changes in total choline concentration in the breast of healthy fertile young women in relation to menstrual cycle or use of oral contraceptives: a 3-T 1H-MRS study. Eur Radiol Exp 2018; 2:43. [PMID: 30560497 PMCID: PMC6297122 DOI: 10.1186/s41747-018-0075-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/26/2018] [Indexed: 02/03/2023] Open
Abstract
Background To evaluate changes in total choline (tCho) absolute concentration ([tCho]) in the breast of healthy fertile women in relation to menstrual cycle (MC) or use of oral contraceptives (OC). Methods After institutional review board approval, we prospectively evaluated 40 healthy fertile volunteers: 20 with physiological MC, aged 28 ± 3 years (mean ± standard deviation; nOC group); 20 using OC, aged 26 ± 3 years (OC group). Hormonal assays and water-suppressed single-voxel 3-T proton magnetic resonance spectroscopy (1H-MRS) were performed on MC days 7, 14, and 21 in the nOC group and only on MC day 14 in the OC group. [tCho] was measured versus an external phantom. Mann-Whitney U test and Spearman coefficient were used; data are given as median and interquartile interval. Results All spectra had good quality. In the nOC group, [tCho] (mM) did not change significantly during MC: 0.8 (0.3–2.4) on day 7, 0.9 (0.4–1.2) on day 14, and 0.4 (0.2–0.8) on day 21 (p = 0.963). In the OC group, [tCho] was 0.7 (0.2–1.7) mM. The between-groups difference was not significant on all days (p ≥ 0.411). All hormones except prolactin changed during MC (p ≤ 0.024). In the OC group, [tCho] showed a borderline correlation with estradiol (r = 0.458, p = 0.056), but no correlation with other hormones (p ≥ 0.128). In the nOC group, [tCho] negatively correlated with prolactin (r = -0.587, p = 0.006) on day 7; positive correlation was found with estradiol on day 14 (r = 0.679, p = 0.001). Conclusions A tCho peak can be detected in the normal mammary gland using 3-T 1H-MRS. The [tCho] in healthy volunteers was 0.4–0.9 mM, constant over the MC and independent of OC use.
Collapse
Affiliation(s)
- Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Ileana Ioan
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Maria Laura Luciani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cecilia Midulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Franca Podo
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
22
|
Wöckel A, Festl J, Stüber T, Brust K, Stangl S, Heuschmann PU, Albert US, Budach W, Follmann M, Janni W, Kopp I, Kreienberg R, Kühn T, Langer T, Nothacker M, Scharl A, Schreer I, Link H, Engel J, Fehm T, Weis J, Welt A, Steckelberg A, Feyer P, König K, Hahne A, Kreipe HH, Knoefel WT, Denkinger M, Brucker S, Lüftner D, Kubisch C, Gerlach C, Lebeau A, Siedentopf F, Petersen C, Bartsch HH, Schulz-Wendtland R, Hahn M, Hanf V, Müller-Schimpfle M, Henscher U, Roncarati R, Katalinic A, Heitmann C, Honegger C, Paradies K, Bjelic-Radisic V, Degenhardt F, Wenz F, Rick O, Hölzel D, Zaiss M, Kemper G, Budach V, Denkert C, Gerber B, Tesch H, Hirsmüller S, Sinn HP, Dunst J, Münstedt K, Bick U, Fallenberg E, Tholen R, Hung R, Baumann F, Beckmann MW, Blohmer J, Fasching PA, Lux MP, Harbeck N, Hadji P, Hauner H, Heywang-Köbrunner S, Huober J, Hübner J, Jackisch C, Loibl S, Lück HJ, von Minckwitz G, Möbus V, Müller V, Nöthlings U, Schmidt M, Schmutzler R, Schneeweiss A, Schütz F, Stickeler E, Thomssen C, Untch M, Wesselmann S, Bücker A, Krockenberger M. Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 1 with Recommendations for the Screening, Diagnosis and Therapy of Breast Cancer. Geburtshilfe Frauenheilkd 2018; 78:927-948. [PMID: 30369626 PMCID: PMC6202580 DOI: 10.1055/a-0646-4522] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Methods The process of updating the S3 guideline dating from 2012 was based on the adaptation of identified source guidelines which were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and the results of a systematic search of literature databases and the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point to develop recommendations and statements which were modified and graded in a structured consensus procedure. Recommendations Part 1 of this short version of the guideline presents recommendations for the screening, diagnosis and follow-up care of breast cancer. The importance of mammography for screening is confirmed in this updated version of the guideline and forms the basis for all screening. In addition to the conventional methods used to diagnose breast cancer, computed tomography (CT) is recommended for staging in women with a higher risk of recurrence. The follow-up concept includes suggested intervals between physical, ultrasound and mammography examinations, additional high-tech diagnostic procedures, and the determination of tumor markers for the evaluation of metastatic disease.
Collapse
Affiliation(s)
- Achim Wöckel
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Jasmin Festl
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Tanja Stüber
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Katharina Brust
- Universitätsfrauenklinik Würzburg, Universität Würzburg, Würzburg, Germany
| | - Stephanie Stangl
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | - Peter U. Heuschmann
- Institut für Klinische Epidemiologie und Biometrie (IKE-B), Universität Würzburg, Würzburg, Germany
| | | | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | - Ina Kopp
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | | | - Thorsten Kühn
- Frauenklinik, Klinikum Esslingen, Esslingen, Germany
| | - Thomas Langer
- Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Anton Scharl
- Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany
| | | | - Hartmut Link
- Praxis für Hämatologie und Onkologie, Kaiserslautern, Germany
| | - Jutta Engel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Tanja Fehm
- Universitätsfrauenklinik Düsseldorf, Düsseldorf, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Anja Welt
- Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Germany
| | | | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum, Neukölln Berlin, Germany
| | - Klaus König
- Berufsverband der Frauenärzte, Steinbach, Germany
| | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfram Trudo Knoefel
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - Sara Brucker
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Benjamin Franklin, Universitätsklinikum Charité, Berlin, Germany
| | - Christian Kubisch
- Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Gerlach
- III. Medizinische Klinik und Poliklinik, uct, Interdisziplinäre Abteilung für Palliativmedizin, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Germany
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Cordula Petersen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Markus Hahn
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | | | | | - Renza Roncarati
- Frauenselbsthilfe nach Krebs – Bundesverband e. V., Bonn, Germany
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Christoph Heitmann
- Ästhetisch plastische und rekonstruktive Chirurgie, Camparihaus München, München, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Vesna Bjelic-Radisic
- Universitätsfrauenklinik, Abteilung für Gynäkologie, Medizinische Universität Graz, Graz, Austria
| | - Friedrich Degenhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frederik Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe Bad Wildungen, Bad Wildungen, Germany
| | - Dieter Hölzel
- Tumorregister München, Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
| | - Matthias Zaiss
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg, Germany
| | | | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Denkert
- Institut für Pathologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Hans Tesch
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | - Hans-Peter Sinn
- Pathologisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karsten Münstedt
- Frauenklinik Offenburg, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Ulrich Bick
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Eva Fallenberg
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Roswita Hung
- Frauenselbsthilfe nach Krebs, Wolfsburg, Germany
| | - Freerk Baumann
- Centrum für Integrierte Onkologie Köln, Uniklinik Köln, Köln, Germany
| | - Matthias W. Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens Blohmer
- Klinik für Gynäkologie incl. Brustzentrum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Peter A. Fasching
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P. Lux
- Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik, Universität München (LMU), München, Germany
| | - Peyman Hadji
- Klinik für Gynäkologie und Geburtshilfe, Krankenhaus Nordwest, Frankfurt, Germany
| | - Hans Hauner
- Lehrstuhl für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | | | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | | | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Nöthlings
- Institut für Ernährungs- und Lebensmittelwissenschaften, Rheinische Friedrich-Wilhelms Universität Bonn, Bonn, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Rita Schmutzler
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Geburtshilfe und Gynäkologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | | | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie am UKS, Universität des Saarlandes, Homburg, Germany
| | | |
Collapse
|
23
|
Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat 2018; 172:487-496. [PMID: 30140962 DOI: 10.1007/s10549-018-4916-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Breast fibroglandular tissue (FGT), as visualized on a mammogram (mammographic density, MD), is one of the strongest known risk factors for breast cancer. FGT is also visible on breast MRI, and increased background parenchymal enhancement (BPE) in the FGT has been identified as potentially a major breast cancer risk factor. The aim of this exploratory study was to examine the biologic basis of BPE. METHODS We examined the unaffected contra-lateral breast of 80 breast cancer patients undergoing a prophylactic mastectomy before any treatment other than surgery of their breast cancer. BPE was classified on the BI-RADS scale (minimal/mild/moderate/marked). Slides were stained for microvessel density (MVD), CD34 (another measure of endothelial density), glandular tissue within the FGT and VEGF. Spearman correlations were used to evaluate the associations between BPE and these pathologic variables. RESULTS In pre-menopausal patients, BPE was highly correlated with MVD, CD34 and glandular concentration within the FGT, and the pathologic variables were themselves highly correlated. The expression of VEGF was effectively confined to terminal duct lobular unit (TDLU) epithelium. The same relationships of the four pathologic variables with BPE were seen in post-menopausal patients, but the relationships were much weaker and not statistically significant. CONCLUSION The strong correlation of BPE and MVD together with the high correlation of MVD with glandular concentration seen in pre-menopausal patients indicates that increased breast cancer risk associated with BPE in pre-menopausal women is likely to result from its association with increased concentration of glandular tissue in the FGT. The effective confinement of VEGF expression to the TDLUs shows that the signal for MVD growth arises directly from the glandular tissue. Further studies are needed to understand the basis of BPE in post-menopausal women.
Collapse
|
24
|
Grubstein A, Rapson Y, Benzaquen O, Rozenblatt S, Gadiel I, Atar E, Yerushalmi R, Cohen MJ. Comparison of background parenchymal enhancement and fibroglandular density at breast magnetic resonance imaging between BRCA gene mutation carriers and non-carriers. Clin Imaging 2018; 51:347-351. [PMID: 29982132 DOI: 10.1016/j.clinimag.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/24/2018] [Accepted: 06/11/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE High background parenchymal enhancement and amount of fibroglandular tissue on breast magnetic resonance imaging are related to increased breast cancer risk. This study sought to compare these parameters between BRCA mutation carriers and non-carriers and to evaluate the potential implications of the findings for short term follow-up. MATERIALS AND METHODS Magnetic resonance imaging studies of known BRCA mutation carriers, were compared to age-matched non-carrier studies performed in the same center during the same period. The groups were compared for qualitative background parenchymal enhancement and amount of fibroglandular tissue using the Breast Imaging Reporting and Data System (BI-RADS). RESULTS Breast parenchymal enhancement was high in up to one-third of the cohort: 22% of carriers and 33% of controls (p = 0.013). These results were sustained on separate analysis of menstrual-cycle-timed examinations. Amount of fibroglandular tissue was high in most cases: 62% of carriers and 75% of controls (p = 0.004). A BI-RADS final assessment score of 3 was more common in patients with high parenchymal enhancement, especially controls. CONCLUSION BRCA mutation carriers demonstrated lower levels of breast parenchymal enhancement and amount of fibroglandular tissue than age-matched non-carriers. These differences are probably influenced by hormonal status, as well as highlight different risks in distinctive subgroups of breast cancer (hormone-enriched, mutation-associated defective DNA damage repair), affecting considerations of preventive medical treatment. Differences in the indications for imaging between the carrier and non-carrier groups (screening for mutations and breast cancer evaluation, respectively) probably accounted for the higher rate of BI-RADS 3 in the control group.
Collapse
Affiliation(s)
- Ahuva Grubstein
- Department of Imaging, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Yael Rapson
- Department of Imaging, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Oshra Benzaquen
- Department of Imaging, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Shira Rozenblatt
- Department of Imaging, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Itay Gadiel
- Department of Imaging, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Eli Atar
- Department of Imaging, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Rinat Yerushalmi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva 4941492, Israel.
| | | |
Collapse
|
25
|
Alikhassi A, Miratashi Yazdi SN, Akbari H, Kia SA, Baikpour M. Correlation Between Mammographic Breast Density, Breast Tissue Type in Ultrasonography, Fibroglandular Tissue, and Background Parenchymal Enhancement in Magnetic Resonance Imaging. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223418771971. [PMID: 29706765 PMCID: PMC5912268 DOI: 10.1177/1178223418771971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/18/2018] [Indexed: 11/16/2022]
Abstract
Objective Breast cancer is the most common malignancy in the female population, and imaging studies play a critical role for its early detection. Mammographic breast density (MBD) is one of the markers used to predict the risk stratification of breast cancer in patients. We aimed to assess the correlations among MBD, ultrasound breast composition (USBC), fibroglandular tissue (FGT), and the amount of background parenchymal enhancement (BPE) in magnetic resonance imaging, after considering the subjects' menopausal status. Methods In this retrospective cross-sectional study, the medical records' archives in a tertiary referral hospital were reviewed. Data including age, menopausal status, their mammograms, and ultrasound assessments were extracted from their records. All of their imaging studies were reviewed, and MBD, USBC, FGT, and BPE were determined, recorded, and entered into SPSS software for analysis. Results A total of 121 women (mean age = 42.7 ± 11.0 years) were included, of which 35 out of 115 (30.4%) had reached menopause. Using the Jonckheere-Terpstra test for evaluating the trends among above mentioned 4 radiologic characteristics in the total sample population, a significant positive relation was found between each of these paired variables: (1) USBC-MBD (P = .006), (2) FGT-MBD (P = .001), (3) USBC-BPE (P = .046), (4) USBC-FGT (P = .036), and (5) BPE-FGT (P < .001). These trends were not found to be significant among premenopausal subjects. Conclusions Considering the trends between different measures of breast density in the 3 radiologic modalities, these factors can be used interchangeably in certain settings.
Collapse
Affiliation(s)
- Afsaneh Alikhassi
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hedieh Akbari
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sona Akbari Kia
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Baikpour
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
26
|
Brooks JD, Sung JS, Pike MC, Orlow I, Stanczyk FZ, Bernstein JL, Morris EA. MRI background parenchymal enhancement, breast density and serum hormones in postmenopausal women. Int J Cancer 2018. [PMID: 29524207 PMCID: PMC6041161 DOI: 10.1002/ijc.31370] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background parenchymal enhancement (BPE) is the degree to which normal breast tissue enhances on contrast-enhanced magnetic resonance imaging (MRI). MRI-density is a volumetric measure of breast density that is highly correlated with mammographic density, an established breast cancer risk factor. Endogenous estrogen concentrations are positively associated with postmenopausal breast cancer risk and BPE has been shown to be sensitive to hormonal exposures. The objective of our study was to examine the relationship between BPE and MRI-density and serum hormone concentrations in postmenopausal women. This was a study of cancer-free postmenopausal women undergoing contrast-enhanced breast MRI (N = 118). At the time of MRI all women completed a self-administered questionnaire and blood samples were collected for hormone analyses. Serum concentrations of estrone (E1), estradiol (E2) and bioavailable E2 were examined by category of BPE and MRI-density. Compared to women with "minimal" BPE, those who had "marked" BPE had significantly higher serum concentrations of E1, E2 and bioavailable E2 (90% increase, ptrend across all categories = 0.001; 150% increase, ptrend = 0.001; and 158% increase, ptrend = 0.001, respectively). These associations were only affected to a minor extent by adjustment for BMI and other variables. After adjustment for BMI, no significant associations between MRI-density and serum E1, E2 and bioavailable E2 were observed. Serum estrogen concentrations were significantly positively associated with BPE. Our study provides further evidence of the hormone-sensitive nature of BPE, indicating a potential role for BPE as an imaging marker of endogenous and exogenous hormonal exposures in the breast.
Collapse
Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Janice S Sung
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jonine L Bernstein
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
27
|
Ko KH, Jung HK, Kim I. Analysis of background parenchymal echogenicity on breast ultrasound: Correlation with mammographic breast density and background parenchymal enhancement on magnetic resonance imaging. Medicine (Baltimore) 2017; 96:e7850. [PMID: 28816987 PMCID: PMC5571724 DOI: 10.1097/md.0000000000007850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to analyze the background parenchymal echotexture (BP echo) on breast ultrasound in detail and to evaluate the relation BP echo with menopausal status. In addition, we correlated BP echo with mammographic breast density (MGD) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI).The institutional review board of our hospital approved this retrospective study, and the requirement of informed consent was waived. We studied 138 women (mean age 51.6 years, range from 26 to 79 years) with newly diagnosed invasive breast cancer, who had performed preoperative mammography, ultrasound, and MR from June 2013 to June 2015. BP echo was classified as homogeneous and heterogeneous according to the BI-RADS US lexicon. MGD was described into fatty, scattered, heterogeneously dense, and extremely dense. BPE was categorized as minimal, mild, moderate, and marked. The relationship between the BP echo and menopausal status was investigated. Associations between the degree of BP echo with MGD grades and BPE grades were also evaluated.Of the 138 women, 74 (54%) were premenopausal and 64 (46%) were postmenopausal. Premenopausal women were more likely to have heterogeneous BP echo (60/74, 81%) compared with postmenopausal women (10/64, 16%) (P = .000). BP echo showed significant correlation with BPE in both premenopausal and postmenopausal women (P = .000). However, MGD showed no significant correlation with BP echo or BPE, regardless of menopausal states. In the postmenopausal group, 70% women (21/30) with dense MGD showed homogeneous BP echo and 77% women (23/30) with dense MGD showed nondense BPE.In conclusion, we demonstrated that the BP echo was influenced by menopausal status. Our data support the concept that BP echo is influenced by breast hormonal changes. Because there was a significant association between BP echo and BPE in pre- and post-menopausal women, the BP echo might be a good predictor for BPE.
Collapse
|
28
|
Lim Y, Ko ES, Han BK, Ko EY, Choi JS, Lee JE, Lee SK. Background parenchymal enhancement on breast MRI: association with recurrence-free survival in patients with newly diagnosed invasive breast cancer. Breast Cancer Res Treat 2017; 163:573-586. [DOI: 10.1007/s10549-017-4217-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/21/2017] [Indexed: 01/19/2023]
|
29
|
Bignotti B, Signori A, Valdora F, Rossi F, Calabrese M, Durando M, Mariscotto G, Tagliafico A. Evaluation of background parenchymal enhancement on breast MRI: a systematic review. Br J Radiol 2016; 90:20160542. [PMID: 27925480 DOI: 10.1259/bjr.20160542] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To perform a systematic review of the methods used for background parenchymal enhancement (BPE) evaluation on breast MRI. METHODS Studies dealing with BPE assessment on breast MRI were retrieved from major medical libraries independently by four reviewers up to 6 October 2015. The keywords used for database searching are "background parenchymal enhancement", "parenchymal enhancement", "MRI" and "breast". The studies were included if qualitative and/or quantitative methods for BPE assessment were described. RESULTS Of the 420 studies identified, a total of 52 articles were included in the systematic review. 28 studies performed only a qualitative assessment of BPE, 13 studies performed only a quantitative assessment and 11 studies performed both qualitative and quantitative assessments. A wide heterogeneity was found in the MRI sequences and in the quantitative methods used for BPE assessment. CONCLUSION A wide variability exists in the quantitative evaluation of BPE on breast MRI. More studies focused on a reliable and comparable method for quantitative BPE assessment are needed. Advances in knowledge: More studies focused on a quantitative BPE assessment are needed.
Collapse
Affiliation(s)
- Bianca Bignotti
- 2 Department of Health Sciences, Institute of Statistics, University of Genoa, Genoa, Italy
| | - Alessio Signori
- 3 Department of Experimental Medicine, Institute of Anatomy, University of Genoa, Genoa, Italy
| | | | - Federica Rossi
- 1 Department of Health Sciences, University of Genova, Genoa, Italy
| | - Massimo Calabrese
- 5 IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Manuela Durando
- 6 Department of Diagnostic Imaging and Radiotherapy, AOU Città della Salute e della Scienza of Turin, Breast Imaging Service, Division of Radiology, University of Turin, Turin, Italy
| | - Giovanna Mariscotto
- 6 Department of Diagnostic Imaging and Radiotherapy, AOU Città della Salute e della Scienza of Turin, Breast Imaging Service, Division of Radiology, University of Turin, Turin, Italy
| | - Alberto Tagliafico
- 3 Department of Experimental Medicine, Institute of Anatomy, University of Genoa, Genoa, Italy.,5 IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| |
Collapse
|
30
|
Seithe T, Braun J, Wolf M, Vahldiek J, Wolny D, Auer J, Pociej J, Heine O, Hamm B, de Bucourt M. Diagnostic efficacy and safety of gadoteric acid MR mammography in 1537 patients. Eur J Radiol 2016; 85:2281-2287. [PMID: 27842678 DOI: 10.1016/j.ejrad.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To perform a large-scale multicenter post-marketing surveillance study for analyzing diagnostic effectiveness and safety of intravenous (IV) gadoteric acid (Dotarem®) in magnetic resonance (MR) mammography under daily practice conditions. MATERIALS AND METHODS Patients underwent high-resolution MR mammography with gadoteric acid in 15 German centers. Radiologists used a standardized questionnaire to report data including patient demographics and medical history, characteristics of MR examination and results in terms of diagnosis and safety for the patient. RESULTS A total of 1537 patients were examined. In 99.2% of all patients, a diagnosis was established. In 91.6% of all patients, image quality was excellent or good. Histopathological examinations were performed for 232 of 1537 patients (15.1%) with invasive ductal carcinoma being the most frequent diagnosis (109 patients, 47.0%). Based on histopathology as the standard of reference, IV gadoteric acid-enhanced MR mammography confirmed diagnoses of invasive ductal carcinoma in 93.5% of the patients. Adverse drug reactions occurred in 5 of 1537 patients (0.3%) and were classified as serious in one case (tachycardia, dysphagia, urticaria, rash). All patients with adverse drug reactions fully recovered after the examination. CONCLUSION This noninterventional surveillance study shows IV gadoteric acid to be a safe and effective contrast agent for use in MR mammography.
Collapse
Affiliation(s)
- Tim Seithe
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Joachim Braun
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Michael Wolf
- Michael Wolf Information Systems, Viktoriastr. 26, 66346 Püttlingen, Germany
| | - Janis Vahldiek
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Dajana Wolny
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Jonas Auer
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Joanna Pociej
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | - Oliver Heine
- Guerbet GmbH, Otto-Vogler-Str. 11, 65843 Sulzbach, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine, Berlin, Germany
| | | |
Collapse
|
31
|
Sogani J, Morris EA, Kaplan JB, D'Alessio D, Goldman D, Moskowitz CS, Jochelson MS. Comparison of Background Parenchymal Enhancement at Contrast-enhanced Spectral Mammography and Breast MR Imaging. Radiology 2016; 282:63-73. [PMID: 27379544 DOI: 10.1148/radiol.2016160284] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose To assess the extent of background parenchymal enhancement (BPE) at contrast material-enhanced (CE) spectral mammography and breast magnetic resonance (MR) imaging, to evaluate interreader agreement in BPE assessment, and to examine the relationships between clinical factors and BPE. Materials and Methods This was a retrospective, institutional review board-approved, HIPAA-compliant study. Two hundred seventy-eight women from 25 to 76 years of age with increased breast cancer risk who underwent CE spectral mammography and MR imaging for screening or staging from 2010 through 2014 were included. Three readers independently rated BPE on CE spectral mammographic and MR images with the ordinal scale: minimal, mild, moderate, or marked. To assess pairwise agreement between BPE levels on CE spectral mammographic and MR images and among readers, weighted κ coefficients with quadratic weights were calculated. For overall agreement, mean κ values and bootstrapped 95% confidence intervals were calculated. The univariate and multivariate associations between BPE and clinical factors were examined by using generalized estimating equations separately for CE spectral mammography and MR imaging. Results Most women had minimal or mild BPE at both CE spectral mammography (68%-76%) and MR imaging (69%-76%). Between CE spectral mammography and MR imaging, the intrareader agreement ranged from moderate to substantial (κ = 0.55-0.67). Overall agreement on BPE levels between CE spectral mammography and MR imaging and among readers was substantial (κ = 0.66; 95% confidence interval: 0.61, 0.70). With both modalities, BPE demonstrated significant association with menopausal status, prior breast radiation therapy, hormonal treatment, breast density on CE spectral mammographic images, and amount of fibroglandular tissue on MR images (P < .001 for all). Conclusion There was substantial agreement between readers for BPE detected on CE spectral mammographic and MR images. © RSNA, 2016.
Collapse
Affiliation(s)
- Julie Sogani
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Elizabeth A Morris
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Jennifer B Kaplan
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Donna D'Alessio
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Debra Goldman
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Chaya S Moskowitz
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Maxine S Jochelson
- From the Departments of Radiology (J.S., J.B.K., D.D., M.S.J.), Breast Imaging (E.A.M.), and Epidemiology and Biostatistics (D.G., C.S.M.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| |
Collapse
|
32
|
Wang J, Wang MY, Kuo WH, Chen KL, Shih TTF. Proton MR spectroscopy of normal breasts: Association of risk factors for breast cancer with water and lipid composition of the breast. Magn Reson Imaging 2016; 34:524-8. [DOI: 10.1016/j.mri.2015.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
|
33
|
Lewin AA, Gene Kim S, Babb JS, Melsaether AN, McKellop J, Moccaldi M, Klautau Leite AP, Moy L. Assessment of Background Parenchymal Enhancement and Lesion Kinetics in Breast MRI of BRCA 1/2 Mutation Carriers Compared to Matched Controls Using Quantitative Kinetic Analysis. Acad Radiol 2016; 23:358-67. [PMID: 26774741 DOI: 10.1016/j.acra.2015.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate whether quantitative kinetic analysis of lesions and background parenchyma in breast magnetic resonance imaging can elucidate differences between BRCA carriers and sporadic controls with high risk for breast cancer. MATERIALS AND METHODS Fifty-nine BRCA and 59 control cases (49 benign, 10 malignant) were examined in this study. Principal component analysis was applied for quantitative analysis of dynamic signal in background parenchyma (B) and lesion (L) in terms of initial enhancement ratio (IER) and delayed enhancement ratio (DER). RESULTS Control B-IER, B-DER, L-IER, and L-DER were higher than BRCA cases in all women and in women with benign lesions; statistically significant differences in B-IER and B-DER (all women: P = 0.02 and P = 0.02, respectively; benign only: P = 0.005 and P = 0.005, respectively). In the control cohort, B-IER and B-DER were higher in the premenopausal women than in the postmenopausal women (P = 0.013 and 0.003, respectively), but not in the BRCA cohort; this led to significant differences in B-IER and B-DER between the control and the BRCA groups in the premenopausal women (P = 0.01 and 0.01, respectively) but not in the postmenopausal women. CONCLUSION Results suggest possible differences in the vascular properties of background parenchyma between BRCA carriers and noncarriers and its association with menopausal status.
Collapse
|
34
|
|
35
|
van der Velden BHM, Dmitriev I, Loo CE, Pijnappel RM, Gilhuijs KGA. Association between Parenchymal Enhancement of the Contralateral Breast in Dynamic Contrast-enhanced MR Imaging and Outcome of Patients with Unilateral Invasive Breast Cancer. Radiology 2015; 276:675-85. [DOI: 10.1148/radiol.15142192] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
36
|
Kim JY, Kim SH, Kim YJ, Kang BJ, An YY, Lee AW, Song BJ, Park YS, Lee HB. Enhancement parameters on dynamic contrast enhanced breast MRI: do they correlate with prognostic factors and subtypes of breast cancers? Magn Reson Imaging 2015; 33:72-80. [DOI: 10.1016/j.mri.2014.08.034] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/10/2014] [Indexed: 01/04/2023]
|
37
|
Comparison of Gadoteric Acid and Gadobutrol for Detection as Well as Morphologic and Dynamic Characterization of Lesions on Breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Invest Radiol 2014; 49:474-84. [DOI: 10.1097/rli.0000000000000039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Diffusion-weighted MRI: association between patient characteristics and apparent diffusion coefficients of normal breast fibroglandular tissue at 3 T. AJR Am J Roentgenol 2014; 202:W496-502. [PMID: 24758685 DOI: 10.2214/ajr.13.11159] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study is to assess associations between patient characteristics and apparent diffusion coefficient (ADC) values of normal breast fibroglandular tissue on diffusion-weighted imaging (DWI) at 3 T. MATERIALS AND METHODS The retrospective study included 103 women with negative bilateral findings on 3-T breast MRI examinations (BI-RADS category 1). DWI was acquired during clinical breast MRI scans using b = 0 and b = 800 s/mm(2). Mean ADC of normal breast fibroglandular tissue was calculated for each breast using a semiautomated software tool in which parenchyma pixels were selected by interactive thresholding of the b = 0 s/mm(2) image to exclude fat. Intrasubject right- and left-breast ADC values were compared and averaged together to evaluate the association of mean breast ADC with age, mammographic breast density, and background parenchymal enhancement. RESULTS Overall mean ± SD breast ADC was 1.62 ± 0.30 × 10(-3) mm(2)/s. Intrasubject right- and left-breast ADC measurements were highly correlated (R(2) = 0.89; p < 0.0001). Increased breast density was strongly associated with increased ADC (p ≤ 0.0001). Age and background parenchymal enhancement were not associated with ADC. CONCLUSION Normal breast parenchymal ADC values increase with mammographic density but are independent of age and background parenchymal enhancement. Because breast malignancies have been shown to have low ADC values, DWI may be particularly valuable in women with dense breasts owing to greater contrast between lesion and normal tissue.
Collapse
|
39
|
Nissan N, Furman-Haran E, Shapiro-Feinberg M, Grobgeld D, Degani H. Diffusion-tensor MR imaging of the breast: hormonal regulation. Radiology 2014; 271:672-80. [PMID: 24533873 DOI: 10.1148/radiol.14132084] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the parameters obtained with magnetic resonance (MR) diffusion-tensor imaging (DTI) of the breast throughout the menstrual cycle phases, during lactation, and after menopause, with and without hormone replacement therapy (HRT). MATERIALS AND METHODS All protocols were approved by the internal review board, and signed informed consent was obtained from all participants. Forty-five healthy volunteers underwent imaging by using T2-weighted and DTI MR sequences at 3 T. Premenopausal volunteers (n = 16) underwent imaging weekly, four times during one menstrual cycle. Postmenopausal volunteers (n = 19) and lactating volunteers (n = 10) underwent imaging once. The principal diffusion coefficients (λ1, λ2, and λ3), apparent diffusion coefficient (ADC), fractional anisotropy (FA), and maximal anisotropy (λ1-λ3) were calculated pixel by pixel for the fibroglandular tissue in the entire breast. RESULTS In all premenopausal volunteers, the DTI parameters exhibited high repeatability, remaining almost equal along the menstrual cycle, with a low mean within-subject coefficient of variance of λ1, λ2, λ3, and ADC (1%-2% for all) and FA (5%), as well as a high intraclass correlation of 0.92-0.98. The diffusion coefficients were significantly lower (a) in the group without HRT use as compared with the group with HRT use (P < .01) and premenopausal volunteers (P < .01) and (b) in the lactating volunteers as compared with the premenopausal volunteers (P < .005). No significant differences in DTI parameters were found between premenopausal volunteers free of oral contraceptives and those who used oral contraceptives (P = .28-0.82) and between premenopausal volunteers and postmenopausal volunteers who used HRT (P = .31-0.93). CONCLUSION DTI parameters are not sensitive to menstrual cycle changes, while menopause, long-term HRT, and presence of milk in lactating women affected the DTI parameters. Therefore, the timing for performing breast DTI is not restricted throughout the menstrual cycle, whereas the modulations in diffusion parameters due to HRT and lactation should be taken into account in DTI evaluation.
Collapse
Affiliation(s)
- Noam Nissan
- From the Department of Biological Regulation (N.N., D.G., H.D.) and Unit of Biological Services (E.F.H.), Weizmann Institute of Science, PO Box 26, Rehovot 76100, Israel; and Department of Radiology, Meir Medical Center, Kfar Saba, Israel (M.S.F.)
| | | | | | | | | |
Collapse
|