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Magni V, Cozzi A, Muscogiuri G, Benedek A, Rossini G, Fanizza M, Di Giulio G, Sardanelli F. Background parenchymal enhancement on contrast-enhanced mammography: associations with breast density and patient's characteristics. LA RADIOLOGIA MEDICA 2024; 129:1303-1312. [PMID: 39060886 DOI: 10.1007/s11547-024-01860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE To evaluate if background parenchymal enhancement (BPE) on contrast-enhanced mammography (CEM), graded according to the 2022 CEM-dedicated Breast Imaging Reporting and Data System (BI-RADS) lexicon, is associated with breast density, menopausal status, and age. METHODS This bicentric retrospective analysis included CEM examinations performed for the work-up of suspicious mammographic findings. Three readers independently and blindly evaluated BPE on recombined CEM images and breast density on low-energy CEM images. Inter-reader reliability was estimated using Fleiss κ. Multivariable binary logistic regression was performed, dichotomising breast density and BPE as low (a/b BI-RADS categories, minimal/mild BPE) and high (c/d BI-RADS categories, moderate/marked BPE). RESULTS A total of 200 women (median age 56.8 years, interquartile range 50.5-65.6, 140/200 in menopause) were included. Breast density was classified as a in 27/200 patients (13.5%), as b in 110/200 (55.0%), as c in 52/200 (26.0%), and as d in 11/200 (5.5%), with moderate inter-reader reliability (κ = 0.536; 95% confidence interval [CI] 0.482-0.590). BPE was minimal in 95/200 patients (47.5%), mild in 64/200 (32.0%), moderate in 25/200 (12.5%), marked in 16/200 (8.0%), with substantial inter-reader reliability (κ = 0.634; 95% CI 0.581-0.686). At multivariable logistic regression, premenopausal status and breast density were significant positive predictors of high BPE, with adjusted odds ratios of 6.120 (95% CI 1.847-20.281, p = 0.003) and 2.416 (95% CI 1.095-5.332, p = 0.029) respectively. CONCLUSION BPE on CEM is associated with well-established breast cancer risk factors, being higher in women with higher breast density and premenopausal status.
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Affiliation(s)
- Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Giulia Muscogiuri
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Adrienn Benedek
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Gabriele Rossini
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Marianna Fanizza
- Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giuseppe Di Giulio
- Department of Breast Radiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Lega Italiana per la Lotta contro i Tumori (LILT) Milano Monza Brianza, Piazzale Paolo Gorini 22, 20133, Milan, Italy
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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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Chalfant JS, Mortazavi S, Lee-Felker SA. Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
To present recent literature regarding the assessment and clinical implications of background parenchymal enhancement on breast MRI.
Recent Findings
The qualitative assessment of BPE remains variable within the literature, as well as in clinical practice. Several different quantitative approaches have been investigated in recent years, most commonly region of interest-based and segmentation-based assessments. However, quantitative assessment has not become standard in clinical practice to date. Numerous studies have demonstrated a clear association between higher BPE and future breast cancer risk. While higher BPE does not appear to significantly impact cancer detection, it may result in a higher abnormal interpretation rate. BPE is also likely a marker of pathologic complete response after neoadjuvant chemotherapy, with decreases in BPE during and after neoadjuvant chemotherapy correlated with pCR. In contrast, pre-treatment BPE does not appear to be predictive of pCR. The association between BPE and prognosis is less clear, with heterogeneous results in the literature.
Summary
Assessment of BPE continues to evolve, with heterogeneity in approaches to both qualitative and quantitative assessment. The level of BPE has important clinical implications, with associations with future breast cancer risk and treatment response. BPE may also be an imaging marker of prognosis, but future research is needed on this topic.
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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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Nguyen AAT, Arasu VA, Strand F, Li W, Onishi N, Gibbs J, Jones EF, Joe BN, Esserman LJ, Newitt DC, Hylton NM. Comparison of Segmentation Methods in Assessing Background Parenchymal Enhancement as a Biomarker for Response to Neoadjuvant Therapy. ACTA ACUST UNITED AC 2021; 6:101-110. [PMID: 32548286 PMCID: PMC7289261 DOI: 10.18383/j.tom.2020.00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Breast parenchymal enhancement (BPE) has shown association with breast cancer risk and response to neoadjuvant treatment. However, BPE quantification is challenging, and there is no standardized segmentation method for measurement. We investigated the use of a fully automated breast fibroglandular tissue segmentation method to calculate BPE from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for use as a predictor of pathologic complete response (pCR) following neoadjuvant treatment in the I-SPY 2 TRIAL. In this trial, patients had DCE-MRI at baseline (T0), after 3 weeks of treatment (T1), after 12 weeks of treatment and between drug regimens (T2), and after completion of treatment (T3). A retrospective analysis of 2 cohorts was performed: one with 735 patients and another with a final cohort of 340 patients, meeting a high-quality benchmark for segmentation. We evaluated 3 subvolumes of interest segmented from bilateral T1-weighted axial breast DCE-MRI: full stack (all axial slices), half stack (center 50% of slices), and center 5 slices. The differences between methods were assessed, and a univariate logistic regression model was implemented to determine the predictive performance of each segmentation method. The results showed that the half stack method provided the best compromise between sampling error from too little tissue and inclusion of incorrectly segmented tissues from extreme superior and inferior regions. Our results indicate that BPE calculated using the half stack segmentation approach has potential as an early biomarker for response to treatment in the hormone receptor–negative and human epidermal growth factor receptor 2–positive subtype.
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Affiliation(s)
- Alex Anh-Tu Nguyen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Vignesh A Arasu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA.,Department of Radiology, Kaiser Permanente Medical Center, Vallejo, CA
| | - Fredrik Strand
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden; and
| | - Wen Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Natsuko Onishi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Jessica Gibbs
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Ella F Jones
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - David C Newitt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Nola M Hylton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
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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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de Kermadec E, Thomassin I, Daraï E, Kolanska K, Chabbert-Buffet N. [Impact of the menstrual cycle on the quality of interpretation of the MRI result in the follow-up of women at genetic risk for breast]. ACTA ACUST UNITED AC 2021; 49:923-929. [PMID: 33771738 DOI: 10.1016/j.gofs.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast MRI is used as a reference for screening breast cancer among women with a genetic high risk. Its sensitivity and specificity might decrease because of the background parenchymal enhancement. Therefore, it is recommended to plan the MRI between the 7th and the 14th day of the menstrual cycle despite of the burden of this organization. Our aim was to evaluate the interpretation (performance) of the MRI performance when it was done out of this period. METHODS We analyzed the MRI done in the Tenon Hospital among patients with a genetic high risk, without a history of breast cancer, between 2006 and 2016. We analyzed the rate of enhancement hindering the interpretation (EH) - that is to say grade III and IV -, the rate of additional explorations (MRI and biopsy), and the occurrence of interval events in 2 groups according to the programming of the examination: appropriate programming (D7-D14) and inappropriate programming (outside this period). RESULTS In total, 126 MRI were analyzed, done in a population of 62 women with a genetic predisposition to Breast Cancer (BRCA 1 or 2: 91%, others: 9%), median age was 34.5 years old. 84 were in appropriate programming and 42 were in an inappropriate one. The rate of EH was comparable between the two groups (respectively 31% and 35.7%, P=1), as well as the rate of additional explorations (respectively 31% and 45%, P=0.11). CONCLUSION Our results suggest that the programming of screening MRI could be simplified among patients with a genetic predisposition of breast cancer.
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Affiliation(s)
- E de Kermadec
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - I Thomassin
- Réseau sein a risque, AP-HP, Paris, France; Service de radiologie, centre d'imagerie de la femme, Sorbonne Université site TENON, AP-HP, Paris, France
| | - E Daraï
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - K Kolanska
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique médecine de la reproduction, centre de suivi des femmes à risque de cancer, Sorbonne Université site TENON, AP-HP, Paris, France; Réseau sein a risque, AP-HP, Paris, France.
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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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Zhang M, Sadinski M, Haddad D, Bae MS, Martinez D, Morris EA, Gibbs P, Sutton EJ. Background Parenchymal Enhancement on Breast MRI as a Prognostic Surrogate: Correlation With Breast Cancer Oncotype Dx Score. Front Oncol 2021; 10:595820. [PMID: 33614481 PMCID: PMC7890019 DOI: 10.3389/fonc.2020.595820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Breast MRI background parenchymal enhancement (BPE) can potentially serve as a prognostic marker, by possible correlation with molecular subtype. Oncotype Dx, a gene assay, is a prognostic and predictive surrogate for tumor aggressiveness and treatment response. The purpose of this study was to investigate the association between contralateral non-tumor breast magnetic resonance imaging (MRI) background parenchymal enhancement and tumor oncotype score. Methods In this retrospective study, patients with ER+ and HER2− early stage invasive ductal carcinoma who underwent preoperative breast MRI, oncotype risk scoring, and breast conservation surgery from 2008–2010 were identified. After registration, BPE from the pre and three post-contrast phases was automatically extracted using a k-means clustering algorithm. Four metrics were calculated: initial enhancement (IE) relative to the pre-contrast signal, late enhancement, overall enhancement (OE), and area under the enhancement curve (AUC). Histogram analysis was performed to determine first order metrics which were compared to oncotype risk score groups using Mann–Whitney tests and Spearman rank correlation analysis. Results This study included 80 women (mean age = 51.1 ± 10.3 years); 46 women were categorized as low risk (≤17) and 34 women were categorized as intermediate/high risk (≥18) according to Oncotype Dx. For the mean of the top 10% pixels, significant differences were noted for IE (p = 0.032), OE (p = 0.049), and AUC (p = 0.044). Using the risk score as a continuous variable, correlation analysis revealed a weak but significant correlation with the mean of the top 10% pixels for IE (r = 0.26, p = 0.02), OE (r = 0.25, p = 0.02), and AUC (r = 0.27, p = 0.02). Conclusion BPE metrics of enhancement in the non-tumor breast are associated with tumor Oncotype Dx recurrence score, suggesting that the breast microenvironment may relate to likelihood of recurrence and magnitude of chemotherapy benefit.
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Affiliation(s)
- Michelle Zhang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Meredith Sadinski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Dana Haddad
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Radiology, Montefiore, New York, NY, United States.,Department of Radiology, Mediclinic Middle East, Dubai, United Arab Emirates.,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Min Sun Bae
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Danny Martinez
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Peter Gibbs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth J Sutton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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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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11
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Pattern Classification Approaches for Breast Cancer Identification via MRI: State-Of-The-Art and Vision for the Future. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10207201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mining algorithms for Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) of breast tissue are discussed. The algorithms are based on recent advances in multi-dimensional signal processing and aim to advance current state-of-the-art computer-aided detection and analysis of breast tumours when these are observed at various states of development. The topics discussed include image feature extraction, information fusion using radiomics, multi-parametric computer-aided classification and diagnosis using information fusion of tensorial datasets as well as Clifford algebra based classification approaches and convolutional neural network deep learning methodologies. The discussion also extends to semi-supervised deep learning and self-supervised strategies as well as generative adversarial networks and algorithms using generated confrontational learning approaches. In order to address the problem of weakly labelled tumour images, generative adversarial deep learning strategies are considered for the classification of different tumour types. The proposed data fusion approaches provide a novel Artificial Intelligence (AI) based framework for more robust image registration that can potentially advance the early identification of heterogeneous tumour types, even when the associated imaged organs are registered as separate entities embedded in more complex geometric spaces. Finally, the general structure of a high-dimensional medical imaging analysis platform that is based on multi-task detection and learning is proposed as a way forward. The proposed algorithm makes use of novel loss functions that form the building blocks for a generated confrontation learning methodology that can be used for tensorial DCE-MRI. Since some of the approaches discussed are also based on time-lapse imaging, conclusions on the rate of proliferation of the disease can be made possible. The proposed framework can potentially reduce the costs associated with the interpretation of medical images by providing automated, faster and more consistent diagnosis.
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Relationship Between Breast Ultrasound Background Echotexture and Magnetic Resonance Imaging Background Parenchymal Enhancement and the Effect of Hormonal Status Thereon. Ultrasound Q 2020; 36:179-191. [PMID: 32511210 DOI: 10.1097/ruq.0000000000000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We studied the relationship between breast ultrasound background echotexture (BET) and magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and whether this relationship varied with hormonal status and amount of fibroglandular tissue (FGT) on MRI. Two hundred eighty-three Korean women (52.1 years; range = 27-79 years) with newly diagnosed primary breast cancer who underwent preoperative breast ultrasound and MRI were retrospectively studied. Background echotexture, BPE, and FGT were classified into 4 categories, and age, menopausal status, menstrual cycle regularity, and menstrual cycle stage at MRI were recorded. Background echotexture and BPE relationship was assessed overall, and in menopausal, FGT, menstrual cycle regularity, and menstrual cycle stage subgroups. Background echotexture and BPE correlated in women overall, and menopausal, FGT, and menstrual cycle subgroups and those in the first half of the cycle (all P < 0.001). Background echotexture reflects BPE, regardless of menopausal status, menstrual cycle regularity, and FGT and may be a biomarker of breast cancer risk.
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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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Hizan NS, Hassan NHM, Haron J, Abubakar MB, Mahdi NMN, Gan SH. Tualang honey adjunct with anastrozole improve parenchyma enhancement of breast tissue in breast cancer patients: A randomized controlled trial. Integr Med Res 2018; 7:322-327. [PMID: 30591885 PMCID: PMC6303522 DOI: 10.1016/j.imr.2018.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022] Open
Abstract
Background To investigate whether the combination of anastrozole and Tualang honey (T honey) influences background parenchymal enhancement (BPE) in breast magnetic resonance imaging (MRI) of postmenopausal women with breast cancer. Methods A total of 30 patients were recruited and randomly divided into control (anastrozole 1 mg daily) and intervention (anastrozole 1 mg + T honey 20 g daily). The BPE of the contralateral breast before and six months following treatment was compared using the sign test. Results There was a decrease in BPE in 10% of the women (p = 0.317) who received only anastrozole, which resulted in a change of BPE category from moderate to mild. However, the combination of anastrozole and T honey evoked a decrease in BPE in 42% of the patients (p = 0.034). Conclusions The combination of T honey and anastrozole maybe more efficacious than anastrozole alone in decreasing breast BPE in breast cancer patients. These findings support the medicinal value of T honey as an adjuvant treatment to anastrozole.
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Affiliation(s)
- Nik Shah Hizan
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nor Hasnina Mohd Hassan
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Juhara Haron
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Murtala Bello Abubakar
- Department of Physiology, Faculty of Basic Medical Sciences, Usmanu Dan Fodiyo University, Sokoto, Nigeria
| | - Nik Munirah Nik Mahdi
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
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