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Watt GP, Thakran S, Sung JS, Jochelson MS, Lobbes MBI, Weinstein SP, Bradbury AR, Buys SS, Morris EA, Apte A, Patel P, Woods M, Liang X, Pike MC, Kontos D, Bernstein JL. Association of Breast Cancer Odds with Background Parenchymal Enhancement Quantified Using a Fully Automated Method at MRI: The IMAGINE Study. Radiology 2023; 308:e230367. [PMID: 37750771 PMCID: PMC10546291 DOI: 10.1148/radiol.230367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 09/27/2023]
Abstract
Background Background parenchymal enhancement (BPE) at breast MRI has been associated with increased breast cancer risk in several independent studies. However, variability of subjective BPE assessments have precluded its use in clinical practice. Purpose To examine the association between fully objective measures of BPE at MRI and odds of breast cancer. Materials and Methods This prospective case-control study included patients who underwent a bilateral breast MRI examination and were receiving care at one of three centers in the United States from November 2010 to July 2017. Breast volume, fibroglandular tissue (FGT) volume, and BPE were quantified using fully automated software. Fat volume was defined as breast volume minus FGT volume. BPE extent was defined as the proportion of FGT voxels with enhancement of 20% or more. Spearman rank correlation between quantitative BPE extent and Breast Imaging Reporting and Data System (BI-RADS) BPE categories assigned by an experienced board-certified breast radiologist was estimated. With use of multivariable logistic regression, breast cancer case-control status was regressed on tertiles (low, moderate, and high) of BPE, FGT volume, and fat volume, with adjustment for covariates. Results In total, 536 case participants with breast cancer (median age, 48 years [IQR, 43-55 years]) and 940 cancer-free controls (median age, 46 years [IQR, 38-55 years]) were included. BPE extent was positively associated with BI-RADS BPE (rs = 0.54; P < .001). Compared with low BPE extent (range, 2.9%-34.2%), high BPE extent (range, 50.7%-97.3%) was associated with increased odds of breast cancer (odds ratio [OR], 1.74 [95% CI: 1.23, 2.46]; P for trend = .002) in a multivariable model also including FGT volume (OR, 1.39 [95% CI: 0.97, 1.98]) and fat volume (OR, 1.46 [95% CI: 1.04, 2.06]). The association of high BPE extent with increased odds of breast cancer was similar for premenopausal and postmenopausal women (ORs, 1.75 and 1.83, respectively; interaction P = .73). Conclusion Objectively measured BPE at breast MRI is associated with increased breast cancer odds for both premenopausal and postmenopausal women. Clinical trial registration no. NCT02301767 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bokacheva in this issue.
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Affiliation(s)
- Gordon P. Watt
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Snekha Thakran
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Janice S. Sung
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Maxine S. Jochelson
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Marc B. I. Lobbes
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Susan P. Weinstein
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Angela R. Bradbury
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Saundra S. Buys
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Elizabeth A. Morris
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Aditya Apte
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Prusha Patel
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Meghan Woods
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Xiaolin Liang
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Malcolm C. Pike
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Despina Kontos
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
| | - Jonine L. Bernstein
- From the Department of Epidemiology and Biostatistics (G.P.W., P.P., M.W., X.L., M.C.P., J.L.B.), Department of Radiology (J.S.S., M.S.J.), and Department of Medical Physics (A.A.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, Perelman Center for Advanced Medicine at the University of Pennsylvania, Philadelphia, Pa (S.T., S.P.W., A.R.B., D.K.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (M.B.I.L.); Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (S.S.B.); and Department of Radiology, University of California Davis Medical Center, Davis, Calif (E.A.M.)
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Sallam H, Lenga L, Solbach C, Becker S, Vogl TJ. Correlation of background parenchymal enhancement on breast MRI with breast cancer. Clin Radiol 2023:S0009-9260(23)00218-0. [PMID: 37330320 DOI: 10.1016/j.crad.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 03/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023]
Abstract
AIM To evaluate the prognostic value of background parenchymal enhancement (BPE) in breast magnetic resonance imaging (MRI) in women referred to radiological department as a high risk for breast cancer. MATERIALS AND METHODS A retrospective, cross-sectional study included 327 consecutive patients (mean age: 60 years, age range: 30-90 years) who underwent breast MRI and tissue biopsy between 2007 and 2016. All MRI images (T1, T2, and subtraction images) were evaluated visually. The relationship of BPE with patient age, fibroglandular tissue (FGT), Breast Imaging Reporting and Data System (BIRADS) categories, presence of breast cancer, and expression of human epidermal growth factor receptor 2 (HER2), progesterone receptor (PR), oestrogen receptor (ER), and Ki67 were analysed. Furthermore, all variables were correlated with pre- and postmenopausal status. RESULTS BPE of bilateral breast showed a weak correlation with FGT (right BPE: r=-0.14, p=0.004; left BPE: r=0.16, p=0.003), a weak negative correlation with patient age (right BPE: r=-0.14, p=0.007; left BPE: r=-0.15, p=0.006), and significant correlation with HER2 (right BPE, p=0.02), left BPE with HER2 was not significant. Among the correlations between BPE and BIRADS, only between right BPE and right BIRADS was significant (p=0.031). No clear evidence of an association between breast MRI BPE and breast cancer in premenopausal and postmenopausal status was observed, and no difference was found between the right and left breasts. CONCLUSIONS The results of the present study showed no significant correlations between BPE and breast cancer. In addition, there was no significant difference between the right and left breast. Hence, BPE of MRI may not be a reliable biomarker of breast cancer development.
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Affiliation(s)
- H Sallam
- Department of Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - L Lenga
- Department of Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - C Solbach
- Department Gynaecology and Obstetrics, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - S Becker
- Department Gynaecology and Obstetrics, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - T J Vogl
- Department of Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Acciavatti RJ, Lee SH, Reig B, Moy L, Conant EF, Kontos D, Moon WK. Beyond Breast Density: Risk Measures for Breast Cancer in Multiple Imaging Modalities. Radiology 2023; 306:e222575. [PMID: 36749212 PMCID: PMC9968778 DOI: 10.1148/radiol.222575] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 02/08/2023]
Abstract
Breast density is an independent risk factor for breast cancer. In digital mammography and digital breast tomosynthesis, breast density is assessed visually using the four-category scale developed by the American College of Radiology Breast Imaging Reporting and Data System (5th edition as of November 2022). Epidemiologically based risk models, such as the Tyrer-Cuzick model (version 8), demonstrate superior modeling performance when mammographic density is incorporated. Beyond just density, a separate mammographic measure of breast cancer risk is parenchymal textural complexity. With advancements in radiomics and deep learning, mammographic textural patterns can be assessed quantitatively and incorporated into risk models. Other supplemental screening modalities, such as breast US and MRI, offer independent risk measures complementary to those derived from mammography. Breast US allows the two components of fibroglandular tissue (stromal and glandular) to be visualized separately in a manner that is not possible with mammography. A higher glandular component at screening breast US is associated with higher risk. With MRI, a higher background parenchymal enhancement of the fibroglandular tissue has also emerged as an imaging marker for risk assessment. Imaging markers observed at mammography, US, and MRI are powerful tools in refining breast cancer risk prediction, beyond mammographic density alone.
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Affiliation(s)
| | | | - Beatriu Reig
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
| | - Linda Moy
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
| | - Emily F. Conant
- From the Department of Radiology, University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (R.J.A., E.F.C., D.K.); Department of
Radiology, Seoul National University Hospital, Seoul, South Korea (S.H.L.,
W.K.M.); and Department of Radiology, NYU Langone Health, New York, NY (B.R.,
L.M.)
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Nguyen AAT, Onishi N, Carmona-Bozo J, Li W, Kornak J, Newitt DC, Hylton NM. Post-Processing Bias Field Inhomogeneity Correction for Assessing Background Parenchymal Enhancement on Breast MRI as a Quantitative Marker of Treatment Response. Tomography 2022; 8:891-904. [PMID: 35448706 PMCID: PMC9027600 DOI: 10.3390/tomography8020072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background parenchymal enhancement (BPE) of breast fibroglandular tissue (FGT) in dynamic contrast-enhanced breast magnetic resonance imaging (MRI) has shown an association with response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. Fully automated segmentation of FGT for BPE calculation is a challenge when image artifacts are present. Low spatial frequency intensity nonuniformity due to coil sensitivity variations is known as bias or inhomogeneity and can affect FGT segmentation and subsequent BPE measurement. In this study, we utilized the N4ITK algorithm for bias correction over a restricted bilateral breast volume and compared the contralateral FGT segmentations based on uncorrected and bias-corrected images in three MRI examinations at pre-treatment, early treatment and inter-regimen timepoints during NAC. A retrospective analysis of 2 cohorts was performed: one with 735 patients enrolled in the multi-center I-SPY 2 TRIAL and the sub-cohort of 340 patients meeting a high-quality benchmark for segmentation. Bias correction substantially increased the FGT segmentation quality for 6.3–8.0% of examinations, while it substantially decreased the quality for no examination. Our results showed improvement in segmentation quality and a small but statistically significant increase in the resulting BPE measurement after bias correction at all timepoints in both cohorts. Continuing studies are examining the effects on pCR prediction.
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Affiliation(s)
- Alex Anh-Tu Nguyen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - Natsuko Onishi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
- Correspondence: ; Tel.: +1-415-885-7511
| | - Julia Carmona-Bozo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - Wen Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA;
| | - David C. Newitt
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - Nola M. Hylton
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
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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.
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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
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Quantitative Measures of Background Parenchymal Enhancement Predict Breast Cancer Risk. AJR Am J Roentgenol 2021; 217:64-75. [PMID: 32876474 PMCID: PMC9801515 DOI: 10.2214/ajr.20.23804] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND. Higher categories of background parenchymal enhancement (BPE) increase breast cancer risk. However, current clinical BPE categorization is subjective. OBJECTIVE. Using a semiautomated segmentation algorithm, we calculated quantitative BPE measures and investigated the utility of individual features and feature pairs in significantly predicting subsequent breast cancer risk compared with radiologist-assigned BPE category. METHODS. In this retrospective case-control study, we identified 95 women at high risk of breast cancer but without a personal history of breast cancer who underwent breast MRI. Of these women, 19 subsequently developed breast cancer and were included as cases. Each case was age matched to four control patients (76 control patients total). Sociodemographic characteristics were compared between the cases and matched control patients using the Mann-Whitney U test. From each dynamic contrast-enhanced MRI examination, quantitative fibroglandular tissue and BPE measures were computed by averaging enhancing voxels above enhancement ratio thresholds (0-100%), totaling the enhancing volume above thresholds (BPE volume in cm3), and estimating the percentage of enhancing tissue above thresholds relative to total breast volume (BPE%) on each gadolinium-enhanced phase. For the 91 imaging features generated, we compared predictive performance using conditional logistic regression with 80:20 hold-out cross validation and ROC curve analysis. ROC AUC was the figure of merit. Sensitivity, specificity, PPV, and NPV were also computed. All feature pairs were exhaustively searched to identify those with the highest AUC and Youden index. A DeLong test was used to compare predictive performance (AUCs). RESULTS. Women subsequently diagnosed with breast cancer were more likely to have mild, moderate, or marked BPE (odds ratio, 3.0; 95% CI, 0.9-10.0; p = .07). According to ROC curve analysis, a BPE category threshold greater than minimal resulted in a maximized AUC (0.62) in distinguishing cases from control patients. Compared with BPE category, the first gadolinium-enhanced (phase 1) BPE% at the 30% and 40% enhancement ratio thresholds yielded significantly higher AUC values of 0.85 (p = .0007) and 0.84 (p = .0004), respectively. Feature combinations showed similar AUC values with improved sensitivity. CONCLUSION. Preliminary data indicate that quantitative BPE measures may outperform radiologist-assigned category in breast cancer risk prediction. CLINICAL IMPACT. Future risk prediction models that incorporate quantitative measures warrant additional investigation.
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Xu C, Yu J, Wu F, Li X, Hu D, Chen G, Wu G. High-background parenchymal enhancement in the contralateral breast is an imaging biomarker for favorable prognosis in patients with triple-negative breast cancer treated with chemotherapy. Am J Transl Res 2021; 13:4422-4436. [PMID: 34150024 PMCID: PMC8205756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to analyze the association between background parenchymal enhancement (BPE) in the contralateral breast tissue on magnetic resonance imaging (MRI) and clinicopathologic parameters in patients with unilateral breast carcinoma and to investigate its potential prognostic significance. A total of 467 patients who were pathologically confirmed to have unilateral breast cancer and underwent breast MRI were recruited to participate in this cohort study. BPE was assessed in the healthy contralateral breast. Minimal and mild levels were classified as low BPE, whereas moderate and marked levels were classified as high BPE. The effects of BPE on clinicopathologic parameters, overall survival (OS), and invasive disease-free survival (IDFS) were determined. Among the 467 patients, 327 cases were classified into the low-BPE group, whereas 140 cases were classified into the high-BPE group. The high-BPE pattern markedly correlated with age at diagnosis, menopausal status, histologic grading, and estrogen receptor status. BPE pattern did not correlate with OS and IDFS in the entire breast cancer cohort, regardless of whether adjuvant chemotherapy was received. Notably, BPE in the healthy contralateral breast on MRI is markedly related to OS and IDFS in triple-negative breast cancer (TNBC) cases who received chemotherapy. High BPE is related to chemotherapeutic benefits and can be an independent favorable prognostic factor for TNBC patients. Thus, our observations suggest that high BPE pattern can potentially be used as an imaging biomarker for relatively favorable prognosis in TNBC cases receiving chemotherapy. However, the findings need to be verified in a large-scale study.
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Affiliation(s)
- Chuanhui Xu
- Department of Radiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan UniversityShanghai, China
| | - Jinhui Yu
- Department of Radiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan UniversityShanghai, China
| | - Feifei Wu
- Department of Radiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan UniversityShanghai, China
| | - Xuemei Li
- Department of Radiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan UniversityShanghai, China
| | - Dongmin Hu
- Department of Radiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan UniversityShanghai, China
| | - Guiming Chen
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Gang Wu
- Department of Radiology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan UniversityShanghai, China
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8
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Response Predictivity to Neoadjuvant Therapies in Breast Cancer: A Qualitative Analysis of Background Parenchymal Enhancement in DCE-MRI. J Pers Med 2021; 11:jpm11040256. [PMID: 33915842 PMCID: PMC8065517 DOI: 10.3390/jpm11040256] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Background: For assessing the predictability of oncology neoadjuvant therapy results, the background parenchymal enhancement (BPE) parameter in breast magnetic resonance imaging (MRI) has acquired increased interest. This work aims to qualitatively evaluate the BPE parameter as a potential predictive marker for neoadjuvant therapy. Method: Three radiologists examined, in triple-blind modality, the MRIs of 80 patients performed before the start of chemotherapy, after three months from the start of treatment, and after surgery. They identified the portion of fibroglandular tissue (FGT) and BPE of the contralateral breast to the tumor in the basal control pre-treatment (baseline). Results: We observed a reduction of BPE classes in serial MRI checks performed during neoadjuvant therapy, as compared to baseline pre-treatment conditions, in 61.3% of patients in the intermediate step, and in 86.7% of patients in the final step. BPE reduction was significantly associated with sequential anthracyclines/taxane administration in the first cycle of neoadjuvant therapy compared to anti-HER2 containing therapies. The therapy response was also significantly related to tumor size. There were no associations with menopausal status, fibroglandular tissue (FGT) amount, age, BPE baseline, BPE in intermediate, and in the final MRI step. Conclusions: The measured variability of this parameter during therapy could predict therapy effectiveness in early stages, improving decision-making in the perspective of personalized medicine. Our preliminary results suggest that BPE may represent a predictive factor in response to neoadjuvant therapy in breast cancer, warranting future investigations in conjunction with radiomics.
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Hu N, Zhao J, Li Y, Fu Q, Zhao L, Chen H, Qin W, Yang G. Breast cancer and background parenchymal enhancement at breast magnetic resonance imaging: a meta-analysis. BMC Med Imaging 2021; 21:32. [PMID: 33607959 PMCID: PMC7893738 DOI: 10.1186/s12880-021-00566-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The background parenchymal enhancement at breast magnetic resonance imaging use to predict breast cancer attracts many searchers to draw a possible relationship. However, the results of their relationships were conflicting. This meta-analysis was performed to assess breast cancer frequency associations with background parenchymal enhancement. Methods A systematic literature search up to January 2020 was performed to detect studies recording associations between breast cancer frequency and background parenchymal enhancement. We found thirteen studies including 13,788 women at the start with 4046 breast cancer. We calculated the odds ratio (OR) and the 95% confidence intervals (CIs) between breast cancer frequency and background parenchymal enhancement by the dichotomous technique with a random or fixed-effect model. Results Women with minimal or mild background parenchymal enhancement at breast magnetic resonance imaging did not have any risk of breast cancer compared to control women (OR, 1.20; 95% CI 0.54–2.67). However, high background parenchymal enhancement at breast magnetic resonance imaging (OR, 2.66; 95% CI 1.36–5.19) and moderate (OR, 2.51; 95% CI 1.49–4.21) was associated with a significantly higher rate of breast cancer frequency compared to control women. Conclusions Our meta-analysis showed that the women with high and moderate background parenchymal enhancement at breast magnetic resonance imaging have higher risks, up to 2.66 fold, of breast cancer. We suggest that women with high or moderate background parenchymal enhancement at breast magnetic resonance imaging to be scheduled for more frequent follow-up and screening for breast cancer to avoid any complications.
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Affiliation(s)
- Na Hu
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Jinghao Zhao
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Quanshui Fu
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Linwei Zhao
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Hong Chen
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Wei Qin
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China.
| | - Guoqing Yang
- Department of Radiology, Suining Central Hospital, Suining, 629000, Sichuan, China.
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Kim JJ, Kim JY. Fusion of high b-value diffusion-weighted and unenhanced T1-weighted images to diagnose invasive breast cancer: factors associated with false-negative results. Eur Radiol 2021; 31:4860-4871. [PMID: 33443601 DOI: 10.1007/s00330-020-07644-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We sought factors associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast breast magnetic resonance imaging (MRI) using fused high b-value diffusion-weighted imaging (DWI) and unenhanced T1-weighted images (T1WI). METHODS Between 2018 and 2019, 316 consecutive women (mean age, 54.6 years) with invasive breast cancer who underwent preoperative breast MRI, including fused high b-value DWI and unenhanced T1WI, were retrospectively evaluated. Malignancy confidence ratings of the most suspicious breast lesions evident on fused DWI were derived by two radiologists using a 6-point Likert-type scale. Both clinicopathological and imaging features were analyzed. Multivariate regression analysis was performed to identify factors associated with false-negative DWI results in the diagnosis of invasive breast cancer. RESULTS Of the 316 breast cancers, fused DWI yielded 289 (91.5%) true-positive and 27 (8.5%) false-negative results. Multivariate analysis showed that small tumor size (≤ 1 cm) (odds ratio [OR], 5.95; 95% confidence interval [CI], 2.11, 16.81; p = 0.001), presence of calcifications in the tumor (OR, 3.41; 95% CI, 1.27, 9.15; p = 0.015), and a moderate/marked background diffusion signal (ORs, 4.23 and 19.18; 95% CI, 1.31, 13.67 and 6.51, 56.46; p = 0.016 and p < 0.001, respectively) were significantly associated with false-negative results. In subgroup analysis of 141 screening-detected cancers, a marked background diffusion signal (OR, 7.94; 95% CI, 2.30, 27.35; p = 0.001) remained significantly associated with false-negative results in the multivariate analysis. CONCLUSIONS In addition to histopathological features, a higher background diffusion signal was associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast MRI using fused high b-value DWI and unenhanced T1WI. KEY POINTS • Subcentimeter tumors and presence of calcifications in the tumor are associated with false-negative diffusion-weighted imaging results in the diagnosis of invasive breast cancer. • A higher degree of background diffusion signal may lead to false-negative interpretation of diffusion-weighted imaging in patients with invasive breast cancer.
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Affiliation(s)
- Jin Joo Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea.
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11
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van der Velden BH, van Rijssel MJ, Lena B, Philippens ME, Loo CE, Ragusi MA, Elias SG, Sutton EJ, Morris EA, Bartels LW, Gilhuijs KG. Harmonization of Quantitative Parenchymal Enhancement in T 1 -Weighted Breast MRI. J Magn Reson Imaging 2020; 52:1374-1382. [PMID: 32491246 PMCID: PMC7687185 DOI: 10.1002/jmri.27244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Differences in imaging parameters influence computer-extracted parenchymal enhancement measures from breast MRI. PURPOSE To investigate the effect of differences in dynamic contrast-enhanced MRI acquisition parameter settings on quantitative parenchymal enhancement of the breast, and to evaluate harmonization of contrast-enhancement values with respect to flip angle and repetition time. STUDY TYPE Retrospective. PHANTOM/POPULATIONS We modeled parenchymal enhancement using simulations, a phantom, and two cohorts (N = 398 and N = 302) from independent cancer centers. SEQUENCE FIELD/STRENGTH 1.5T dynamic contrast-enhanced T1 -weighted spoiled gradient echo MRI. Vendors: Philips, Siemens, General Electric Medical Systems. ASSESSMENT We assessed harmonization of parenchymal enhancement in simulations and phantom by varying the MR parameters that influence the amount of T1 -weighting: flip angle (8°-25°) and repetition time (4-12 msec). We calculated the median and interquartile range (IQR) of the enhancement values before and after harmonization. In vivo, we assessed overlap of quantitative parenchymal enhancement in the cohorts before and after harmonization using kernel density estimations. Cohort 1 was scanned with flip angle 20° and repetition time 8 msec; cohort 2 with flip angle 10° and repetition time 6 msec. STATISTICAL TESTS Paired Wilcoxon signed-rank-test of bootstrapped kernel density estimations. RESULTS Before harmonization, simulated enhancement values had a median (IQR) of 0.46 (0.34-0.49). After harmonization, the IQR was reduced: median (IQR): 0.44 (0.44-0.45). In the phantom, the IQR also decreased, median (IQR): 0.96 (0.59-1.22) before harmonization, 0.96 (0.91-1.02) after harmonization. Harmonization yielded significantly (P < 0.001) better overlap in parenchymal enhancement between the cohorts: median (IQR) was 0.46 (0.37-0.58) for cohort 1 vs. 0.37 (0.30-0.44) for cohort 2 before harmonization (57% overlap); and 0.35 (0.28-0.43) vs. .0.37 (0.30-0.44) after harmonization (85% overlap). DATA CONCLUSION The proposed practical harmonization method enables an accurate comparison between patients scanned with differences in imaging parameters. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 4.
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Affiliation(s)
- Bas H.M. van der Velden
- Image Sciences InstituteUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Michael J. van Rijssel
- Image Sciences InstituteUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Beatrice Lena
- Image Sciences InstituteUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Marielle E.P. Philippens
- Department of RadiotherapyUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Claudette E. Loo
- Department of RadiologyThe Netherlands Cancer Institute – Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
| | - Max A.A. Ragusi
- Image Sciences InstituteUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Sjoerd G. Elias
- Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Elizabeth J. Sutton
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Elizabeth A. Morris
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Lambertus W. Bartels
- Image Sciences InstituteUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Kenneth G.A. Gilhuijs
- Image Sciences InstituteUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
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12
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Zhang H, Guo L, Tao W, Zhang J, Zhu Y, Abdelrahim MEA, Bai G. Possible Breast Cancer Risk Related to Background Parenchymal Enhancement at Breast MRI: A Meta-Analysis Study. Nutr Cancer 2020; 73:1371-1377. [PMID: 32700575 DOI: 10.1080/01635581.2020.1795211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The higher level of background parenchymal enhancement (BPE) at breast magnetic resonance imaging (MRI) has drawn considerable attention in the early detection and prediction of breast cancer. It has been reported that there is a possible relationship between the level of BPE at breast MRI and the presence of breast cancer. This meta-analysis was performed to evaluate this relationship. METHODS Through a systematic literature search up to December 2019, 12 studies with 9541 females, 3870 of them were breast cancer. They were identified reporting relationships between breast cancer and BPE at breast MRI with its different categories (10 related to minimal or mild BPE, eight related to moderate BPE and nine related to high BPE). Odd ratio(OR) with 95% confidence intervals (CIs) was calculated comparing breast cancer prevalence and BPE at breast MRI using dichotomous method with a random or fixed effect model. RESULTS Females with high (OR, 2.93; 95% CI, 1.24-6.88) and moderate (OR, 2.89; 95% CI, 1.51-5.52) BPE at breast MRI was related with high odds to breast cancer compared to control females. However, females with minimal or mild BPE at breast MRI (OR, 1.33; 95% CI, 0.56-3.17) did not have such risk on breast cancer. The impact of BPE on breast cancer may have a great influence as a tool for improving early detection and prevention of breast cancer. CONCLUSIONS Based on this meta-analysis, females with high or moderate BPE at breast MRI may have an independent relationship with the risk of breast cancer. This relationship forces us to recommend follow up with those with high or moderate BPE at breast MRI to avoid any complication.
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Affiliation(s)
- Hui Zhang
- Medical Imaging Department, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, P.R. China
| | - Lili Guo
- Medical Imaging Department, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, P.R. China
| | - Weijing Tao
- Medical Imaging Department, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, P.R. China
| | - Jiandong Zhang
- Medical Imaging Department, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, P.R. China
| | - Yan Zhu
- Medical Imaging Department, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, P.R. China
| | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Genji Bai
- Medical Imaging Department, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, P.R. China
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Automatic Breast and Fibroglandular Tissue Segmentation in Breast MRI Using Deep Learning by a Fully-Convolutional Residual Neural Network U-Net. Acad Radiol 2019; 26:1526-1535. [PMID: 30713130 DOI: 10.1016/j.acra.2019.01.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/03/2019] [Accepted: 01/13/2019] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES Breast segmentation using the U-net architecture was implemented and tested in independent validation datasets to quantify fibroglandular tissue volume in breast MRI. MATERIALS AND METHODS Two datasets were used. The training set was MRI of 286 patients with unilateral breast cancer. The segmentation was done on the contralateral normal breasts. The ground truth for the breast and fibroglandular tissue (FGT) was obtained by using a template-based segmentation method. The U-net deep learning algorithm was implemented to analyze the training set, and the final model was obtained using 10-fold cross-validation. The independent validation set was MRI of 28 normal volunteers acquired using four different MR scanners. Dice Similarity Coefficient (DSC), voxel-based accuracy, and Pearson's correlation were used to evaluate the performance. RESULTS For the 10-fold cross-validation in the initial training set of 286 patients, the DSC range was 0.83-0.98 (mean 0.95 ± 0.02) for breast and 0.73-0.97 (mean 0.91 ± 0.03) for FGT; and the accuracy range was 0.92-0.99 (mean 0.98 ± 0.01) for breast and 0.87-0.99 (mean 0.97 ± 0.01) for FGT. For the entire 224 testing breasts of the 28 normal volunteers in the validation datasets, the mean DSC was 0.86 ± 0.05 for breast, 0.83 ± 0.06 for FGT; and the mean accuracy was 0.94 ± 0.03 for breast and 0.93 ± 0.04 for FGT. The testing results for MRI acquired using four different scanners were comparable. CONCLUSION Deep learning based on the U-net algorithm can achieve accurate segmentation results for the breast and FGT on MRI. It may provide a reliable and efficient method to process large number of MR images for quantitative analysis of breast density.
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Li J, Mo Y, He B, Gao Q, Luo C, Peng C, Zhao W, Ma Y, Yang Y. Association between MRI background parenchymal enhancement and lymphovascular invasion and estrogen receptor status in invasive breast cancer. Br J Radiol 2019; 92:20190417. [PMID: 31398071 PMCID: PMC6849688 DOI: 10.1259/bjr.20190417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: In magnetic resonance imaging (MRI), background parenchymal enhancement (BPE) is associated with breast cancer risk, but the associations between BPE and clinical characteristics and histological features are unknown. This study aimed to investigate the association between BPE and clinical characteristics (including age, menopausal status, and tumor histological characteristics) in patients with invasive breast cancer. Methods: This was a retrospective study of 163 patients with invasive breast cancer (164 lesions, 1 patient had bilateral cancer) confirmed by surgery and pathological examination, treated between January 2014 and December 2016 at our university (Kunming Medical University). The patients were divided into two groups: extremely minimal and mild enhancement (low BPE group, n = 78) vs moderate and marked enhancement (high BPE group, n = 86). Results: Compared with the low BPE group, the high BPE group showed higher frequencies of patients < 50 years of age (88% vs 38%, p < 0.0001), premenopausal (87% vs 29%, p < 0.0001), T1 staging (35% vs 15%, p = 0.027), Grade II (57% vs 37%, p = 0.03), lymphovascular invasion (83% vs 13%, p < 0.0001), and positive estrogen receptor (ER) (79% vs 42%, p < 0.0001). The Spearman correlation coefficients (r) between BPE and age, menopausal status, lymphovascular invasion, and ER status were −0.521 (p < 0.0001), –0.588 (p < 0.0001), 0.697 (p < 0.0001), and 0.377 (p < 0.0001), respectively. Conclusion: BPE is negatively associated with age and menopausal status, and is positively associated with lymphovascular invasion and positive ER status. Advances in knowledge: BPE is not correlated with T staging and histological classification in patients with invasive breast cancer.
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Affiliation(s)
- Jun Li
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yin Mo
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Bo He
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Qian Gao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Chunyan Luo
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Chao Peng
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Wei Zhao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Yun Ma
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
| | - Ying Yang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, China
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15
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Cai D, Lin T, Jiang K, Sun Z. Diagnostic value of MRI combined with ultrasound for lymph node metastasis in breast cancer: Protocol for a meta-analysis. Medicine (Baltimore) 2019; 98:e16528. [PMID: 31348268 PMCID: PMC6709118 DOI: 10.1097/md.0000000000016528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of breast cancer are important to prevent fatal tumor progression. Axillary lymph node (ALN) status is the most significant prognostic factor for diagnosing overall survival in breast cancer patients. Axillary lymph node dissection (ALND) is regarded as the reference standard for determining ALN status. However, ALND is an invasive therapy with high morbidity and complications such as lymphedema, seroma and nerve injury. Comparatively, magnetic resonance imaging (MRI) and ultrasound are noninvasive and non-radiative techniques that are common imaging methods to diagnose breast cancer lymph node metastasis. Many studies have investigated the diagnostic value of MRI combined with ultrasound for breast cancer ALN metastasis, but the evidence has been insufficient to apply these modalities when diagnosing new patients. METHODS We will search electronic databases including PubMed, EMbase, The Cochrane Library, Chinese Biomedical Database, WangFang Database, and China National Knowledge Infrastructure. The language of studies is limited in English or Chinese. The final search includes articles published in June, 2018. Stata 14.0 software will be used for all statistical analyses, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) will be utilized to evaluate the quality of the included studies. Meta-regression and subgroup analyses will be performed to explore heterogeneity, which will be derived from the different countries of origin of the included studies. Deeks' funnel plot asymmetry test will be demonstrated the inexistence of publication bias. RESULT This study will provide a rational synthesis of current evidences for magnetic resonance imaging combined with ultrasound for breast cancer. CONCLUSION The conclusion of this study will provide evidence for the diagnostic value of MRI combined with ultrasound for lymph node metastasis in breast cancer. REGISTRATION PROS-PERO CRD42019134474.
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Affiliation(s)
- Dechun Cai
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Tong Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kailin Jiang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhizhong Sun
- Guangzhou University of Chinese Medicine, Guangzhou, China
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16
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Thompson CM, Mallawaarachchi I, Dwivedi DK, Ayyappan AP, Shokar NK, Lakshmanaswamy R, Dwivedi AK. The Association of Background Parenchymal Enhancement at Breast MRI with Breast Cancer: A Systematic Review and Meta-Analysis. Radiology 2019; 292:552-561. [PMID: 31237494 DOI: 10.1148/radiol.2019182441] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BackgroundThe higher level of background parenchymal enhancement (BPE) at breast MRI has the potential for early detection and prediction of the risk of breast cancer. However, conflicting findings have been reported about the association between the level of BPE at breast MRI and the presence of breast cancer.PurposeTo evaluate the association between qualitative and quantitative BPE at dynamic contrast material-enhanced MRI and breast cancer among populations with average risk and high risk separately.Materials and MethodsA retrospective meta-analysis of observational studies comparing either qualitative or quantitative assessments of BPE in women with and women without breast cancer was performed for studies published through July 2018. Pooled odds ratios (ORs) or standardized mean differences and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. The heterogeneity across the studies was measured by using the statistic I 2. Sensitivity analyses were conducted to test this association according to different study characteristics. P values less than or equal to 5% were considered to indicate statistically significant results.ResultsEighteen studies comprising 1910 women with breast cancer and 2541 control participants were included in the analysis. Among women with high risk, at least moderate BPE (OR, 1.6; 95% CI: 1.0, 2.6; P = .04) or at least mild BPE (OR, 2.1; 95% CI: 1.5, 3.0; P < .001) was associated with higher odds of breast cancer. Furthermore, women with breast cancer showed a higher average BPE percentage compared with control participants with high risk (standardized mean difference, 0.5; 95% CI: 0.2, 0.9; P = .001). No association was observed between at least mild BPE level (P = .15) or at least moderate BPE level (P = .38) and the presence of breast cancer among the population with average risk.ConclusionA higher level of background parenchymal enhancement measured at breast MRI is associated with the presence of breast cancer in women with high risk, but not in women with average risk.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Mann and Pinker in this issue.
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Affiliation(s)
- Christopher M Thompson
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Indika Mallawaarachchi
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Durgesh K Dwivedi
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Anoop P Ayyappan
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Navkiran K Shokar
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Rajkumar Lakshmanaswamy
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
| | - Alok K Dwivedi
- From the Graduate School of Biomedical Sciences (C.M.T., R.L.), Office of Research Resources, Biostatistics and Epidemiology Consulting Laboratory (I.M.), Department of Radiology, Paul L. Foster School of Medicine (A.P.A.), Department of Family Medicine, Paul L. Foster School of Medicine (N.K.S.), and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine (A.K.D.), Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, Tex 79905; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.K.D.); and Department of Radiodiagnosis, King George's Medical University, Lucknow, India (D.K.D.)
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17
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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.
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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
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18
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Saha A, Grimm LJ, Ghate SV, Kim CE, Soo MS, Yoon SC, Mazurowski MA. Machine learning-based prediction of future breast cancer using algorithmically measured background parenchymal enhancement on high-risk screening MRI. J Magn Reson Imaging 2019; 50:456-464. [PMID: 30648316 DOI: 10.1002/jmri.26636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Preliminary work has demonstrated that background parenchymal enhancement (BPE) assessed by radiologists is predictive of future breast cancer in women undergoing high-risk screening MRI. Algorithmically assessed measures of BPE offer a more precise and reproducible means of measuring BPE than human readers and thus might improve the predictive performance of future cancer development. PURPOSE To determine if algorithmically extracted imaging features of BPE on screening breast MRI in high-risk women are associated with subsequent development of cancer. STUDY TYPE Case-control study. POPULATION In all, 133 women at high risk for developing breast cancer; 46 of these patients developed breast cancer subsequently over a follow-up period of 2 years. FIELD STRENGTH/SEQUENCE 5 T or 3.0 T T1 -weighted precontrast fat-saturated and nonfat-saturated sequences and postcontrast nonfat-saturated sequences. ASSESSMENT Automatic features of BPE were extracted with a computer algorithm. Subjective BPE scores from five breast radiologists (blinded to clinical outcomes) were also available. STATISTICAL TESTS Leave-one-out crossvalidation for a multivariate logistic regression model developed using the automatic features and receiver operating characteristic (ROC) analysis were performed to calculate the area under the curve (AUC). Comparison of automatic features and subjective features was performed using a generalized regression model and the P-value was obtained. Odds ratios for automatic and subjective features were compared. RESULTS The multivariate model discriminated patients who developed cancer from the patients who did not, with an AUC of 0.70 (95% confidence interval: 0.60-0.79, P < 0.001). The imaging features remained independently predictive of subsequent development of cancer (P < 0.003) when compared with the subjective BPE assessment of the readers. DATA CONCLUSION Automatically extracted BPE measurements may potentially be used to further stratify risk in patients undergoing high-risk screening MRI. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:456-464.
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Affiliation(s)
- Ashirbani Saha
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lars J Grimm
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sujata V Ghate
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Connie E Kim
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mary S Soo
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sora C Yoon
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Electrical and Computer Eng., Duke University, Durham, North Carolina, USA.,Duke University Medical Physics Program, Durham, North Carolina, USA
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19
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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.
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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
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20
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Bicchierai G, Nori J, De Benedetto D, Boeri C, Vanzi E, Bianchi S, Kaur Gill M, Cirone D, Miele V. Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results. TUMORI JOURNAL 2018; 105:378-387. [PMID: 30558495 DOI: 10.1177/0300891618816212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB). METHODS The local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41-77 years were included in our study. All patients underwent CESM 2-3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings. RESULTS The sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451-.696), for categorization of BPE from moderate to substantial (κ = .562-.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346-.459). CONCLUSION In cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | | | - Donatello Cirone
- General Management Staff, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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21
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Bermot C, Saint-Martin C, Malhaire C, Sebbag-Sfez D, Mouret-Fourme E, Carton M, Thibault FE. Background parenchymal enhancement and fibroglandular tissue on breast MRI in women with high genetic risk: Are changes before and after risk-reducing salpingo-oophorectomy associated with breast cancer risk? Eur J Radiol 2018; 109:171-177. [PMID: 30527300 DOI: 10.1016/j.ejrad.2018.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/25/2018] [Accepted: 10/30/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Parenchymal enhancement and fibroglandular tissue on breast MRI in women with high genetic risk: are changes before and after risk-reducing salpingo-oophorectomy associated with breast cancer risk? OBJECTIVE To evaluate changes in the level of background parenchymal enhancement (BPE) and amount of fibroglandular tissue (FGT) on breast MRI before and after risk-reducing oophorectomy (RRSO), and to determine whether these changes correlate with ultimate breast cancer risk. MATERIALS AND METHODS The cohort included 146 women with high genetic risk who had undergone pre- and post-RRSO breast MRI. BPE level and FGT amount were retrospectively graded according to BI-RADS classification. Initial values and changes were compared in women with or without later breast cancer after RRSO. Hazard ratios (HR) were estimated using Cox univariate models. RESULTS Patients with initial moderate (BI-RADS C category) BPE had a higher risk of subsequent breast cancer of HR = 3.9 (95% CI [1.1-14.3]; p = 0.04) compared to patients with initial minimal (BI-RADS A) BPE. A categorical BPE decrease after RRSO, versus no change, was associated with a higher cancer risk (HR 2.2, 95% CI [1.04-4.8]; p = 0.04). Initially dense (BI-RADS 3 category) FGT correlated with an increased cancer risk compared to fatty (BI-RADS 1 category) parenchyma (HR 8.3, 95% CI [1.1-64]; p = 0.04). After RRSO, there was a trend for higher cancer risk related to a categorical FGT decrease (HR 2.3, 95% CI [0.9-35.4]; p = 0.06). CONCLUSION Patients in whom BPE decreases after RRSO might be at higher risk of subsequent breast cancer compared to patients with stable BPE. This finding is consistent with the concept of increased risk associated with high initial BPE, which could be of higher clinical relevance than post-RRSO BPE reduction. A similar trend was observed with high initial FGT.
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Affiliation(s)
- Cécile Bermot
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France.
| | - Caroline Saint-Martin
- Institut Curie, PSL Research University, DRCI, Biométrie, 35 Rue Dailly, F-92210, Saint-Cloud, France.
| | - Caroline Malhaire
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France
| | - Delphine Sebbag-Sfez
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France.
| | | | - Matthieu Carton
- Institut Curie, PSL Research University, DRCI, Biométrie, 35 Rue Dailly, F-92210, Saint-Cloud, France.
| | - Fabienne E Thibault
- Institut Curie, Département d'Imagerie Médicale, 26 rue d'Ulm, F-75005 Paris, France.
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Xu T, Zhang L, Xu H, Kang S, Xu Y, Luo X, Hua T, Tang G. Prediction of low-risk breast cancer using quantitative DCE-MRI and its pathological basis. Oncotarget 2017; 8:114360-114370. [PMID: 29371992 PMCID: PMC5768409 DOI: 10.18632/oncotarget.22267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/26/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose This study aimed to evaluate the difference of mass in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) characteristics between low-risk and non-low-risk breast cancers and to explore the possible pathological basis. Materials and Methods Approval from the institutional review board and informed consent were acquired for this study. The MR images of 104 patients with pathologically proven breast cancer (104 lesions) were prospectively analyzed. All of included patients were Chinese woman. The DCE-MRI morphologic findings, apparent diffusion coefficient (ADC) values, quantitative DCE-MRI parameters, and pathological biomarkers between the two subtypes of breast cancer were compared. The quantitative DCE-MRI parameters and ADC values were added to the morphologic features in multivariate models to evaluate diagnostic performance in predicting low-risk breast cancer. The values were further subjected to the receiver operating characteristic (ROC) curve analysis. Results Low-risk tumors showed significantly lower Ktrans and Kepvalues (t = 2.065, P = 0.043 and t = 3.548, P = 0.001, respectively) and higher ADC value (t = 4.713, P = 0.000) than non-low-risk breast cancers. Our results revealed no significant differences in clinic data and conventional imaging findings between the two breast cancer subtypes. Adding the quantitative DCE-MRI parameters and ADC values to conventional MRI improved the diagnostic performance of MRI: The area under the ROC improved from 0.63 to 0.91. Low-risk breast cancers showed significantly lower matrix metalloproteinase (MMP)-2 expression (P = 0.000), lower MMP-9 expression (P = 0.001), and lower microvessel density (MVD) values (P = 0.008) compared with non-low-risk breast cancers. Ktrans and Kep values were positively correlated with pathological biomarkers. The ADC value showed a significant inverse correlation with pathological biomarkers. Conclusions The prediction parameter using Ktrans, Kep, and ADC obtained on DCE-MRI and diffusion-weighted imaging could facilitate the identification of low-risk breast cancers. Decreased biological factors, including MVD, vascular endothelial growth factor, MMP-2, and MMP-9, may explain the possible pathological basis.
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Affiliation(s)
- Tingting Xu
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Lin Zhang
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Hong Xu
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Sifeng Kang
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yali Xu
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiaoyu Luo
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Ting Hua
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Guangyu Tang
- Department of Radiology, Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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23
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You C, Peng W, Zhi W, He M, Liu G, Xie L, Jiang L, Hu X, Shen X, Gu Y. Association Between Background Parenchymal Enhancement and Pathologic Complete Remission Throughout the Neoadjuvant Chemotherapy in Breast Cancer Patients. Transl Oncol 2017; 10:786-792. [PMID: 28806712 PMCID: PMC5554960 DOI: 10.1016/j.tranon.2017.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To retrospectively investigate the quantitative background parenchymal enhancement (BPE) of the contralateral normal breast in patients with unilateral invasive breast cancer throughout multiple monitoring points of neoadjuvant chemotherapy (NAC) and to further determine whether BPE is associated with tumor response, especially at the early stage of NAC. MATERIALS AND METHODS A total of 90 patients with unilateral breast cancer who then received six or eight cycles of NAC before surgery were analyzed retrospectively. BPE was measured in dynamic contrast-enhanced MRI at baseline and after 2nd, 4th, and 6th NAC, respectively. Correlation between BPE and tumor size was analyzed, and the association between pathologic complete remission (pCR) and BPE was also analyzed. RESULTS The BPE of contralateral normal breast showed a constant reduction throughout NAC therapy regardless of the menopausal status (P<.001 in all). Both the BPEs and the changes of BPE in each of the three monitoring points were significantly correlated with those in tumor size (P<.05 in all), and the reduction of BPE after 2nd NAC had the largest diagnostic value for pCR (AUC=0.726, P<.001), particularly in hormonal receptor (HR)-negative patients (OR=0.243, 95%CI=0.083 to 0.706, P=.009). CONCLUSION The BPE of contralateral normal breast had a constant decreased tendency similar to the change of tumor size in NAC. Reduction of BPE at the early stage of NAC was positively associated with pCR, especially in HR-negative status.
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Affiliation(s)
- Chao You
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Weijun Peng
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Wenxiang Zhi
- Department of Ultrasound, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Min He
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Guangyu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Li Xie
- Statistical Office, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Luan Jiang
- Center for Advanced Medical Imaging Technology, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, PR China
| | - Xiaoxin Hu
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - Xuxia Shen
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University Shanghai, PR China
| | - Yajia Gu
- Department of Radiology, Fudan University Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China.
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24
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MRI surveillance for women with dense breasts and a previous breast cancer and/or high risk lesion. Breast 2017; 34:77-82. [DOI: 10.1016/j.breast.2017.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/10/2017] [Accepted: 04/15/2017] [Indexed: 11/20/2022] Open
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25
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Yu C, Luan Y, Wang Z, Zhao J, Xu C. Suppression of TAFI by siRNA inhibits invasion and migration of breast cancer cells. Mol Med Rep 2017; 16:3469-3474. [PMID: 28765963 DOI: 10.3892/mmr.2017.7031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/25/2017] [Indexed: 11/06/2022] Open
Abstract
Human thrombin activatable fibrinolysis inhibitor (TAFI), also known as carboxypeptidase B2 (CPB2), is a procarboxypeptidase enzyme. The purpose of the present study was to observe the expression of TAFI in breast cancer (BC) and breast cancer cell (BCC) lines and to investigate the effect of TAFI suppression by small interfering (si)RNA gene silencing on invasion and migration of BCC lines. A significant increase in TAFI level was identified by immunohistochemical analysis in BC tissues compared with normal breast tissues. TAFI suppression also inhibited cell viability, invasion and migration ability as demonstrated by MTT, Transwell chamber, and wound scratch assays, respectively (P<0.05). The data suggested that suppression of TAFI by siRNA inhibits invasion and migration of breast cancer cells and that TAFI may be a new target for breast cancer therapy.
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Affiliation(s)
- Chao Yu
- Department of Laboratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Yun Luan
- Central Laboratory, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Zejun Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Jingjie Zhao
- Department of Laboratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Chengwei Xu
- Department of Laboratory Medicine, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
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26
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Jiang L, Hu X, Xiao Q, Gu Y, Li Q. Fully automated segmentation of whole breast using dynamic programming in dynamic contrast enhanced MR images. Med Phys 2017; 44:2400-2414. [DOI: 10.1002/mp.12254] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/14/2017] [Accepted: 03/25/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Luan Jiang
- Center for Advanced Medical Imaging Technology; Division of Life Sciences; Shanghai Advanced Research Institute; Chinese Academy of Sciences; No. 99 Haike Road Shanghai 201210 China
- Cooperate Research Center; Shanghai United Imaging Healthcare Co., Ltd.; No. 2258 Chengbei Road Shanghai 201807 China
| | - Xiaoxin Hu
- Department of Radiology; Shanghai Cancer Hospital of FuDan University; No. 270 DongAn Road Shanghai 200032 China
| | - Qin Xiao
- Department of Radiology; Shanghai Cancer Hospital of FuDan University; No. 270 DongAn Road Shanghai 200032 China
| | - Yajia Gu
- Department of Radiology; Shanghai Cancer Hospital of FuDan University; No. 270 DongAn Road Shanghai 200032 China
| | - Qiang Li
- Center for Advanced Medical Imaging Technology; Division of Life Sciences; Shanghai Advanced Research Institute; Chinese Academy of Sciences; No. 99 Haike Road Shanghai 201210 China
- Cooperate Research Center; Shanghai United Imaging Healthcare Co., Ltd.; No. 2258 Chengbei Road Shanghai 201807 China
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