Background parenchymal enhancement: behavior during neoadjuvant chemotherapy for breast cancer and relationship with a pathological complete response

Abstract

Objective: To evaluate background parenchymal enhancement (BPE) and its characteristics, as well as its behavior before and after neoadjuvant chemotherapy (NAC), in both breasts of patients with unilateral breast cancer. Materials and Methods: This was a retrospective, cross-sectional observational study involving a consecutive sample of women with invasive breast cancer who underwent breast magnetic resonance imaging (MRI) between July 2007 and July 2017, as well as undergoing dynamic contrast-enhanced MRI before and after NAC. In both breasts, we evaluated the BPE in accordance with the Breast Imaging Reporting and Data System. We applied logistic regression analysis, and values of p < 0.05 were considered significant. Results: We evaluated 150 women. The mean age was 45.2 years (range, 20-74 years). The variables correlating independently with a high pre-NAC BPE, in the affected and contralateral breasts, were being under 50 years of age (odds ratio [OR] = 6.55; 95% confidence interval [95% CI]: 2.32-18.46, for both breasts) and a post-NAC BPE reduction (OR = 17.75; 95% CI: 4.94-63.73 and OR = 18.47; 95% CI: 5.19-66.49, respectively). Conclusion: Patients with invasive unilateral breast cancer who have a high pre-NAC BPE in both breasts tend to be under 50 years of age and to show a post-NAC reduction in BPE.

Response Predictivity to Neoadjuvant Therapies in Breast Cancer: A Qualitative Analysis of Background Parenchymal Enhancement in DCE-MRI

“…The relatively low sample size in the various categories represents our study limitation, even though it is in line with other published works [ 26 , 42 ]…”

“…The relatively low sample size in the various categories represents our study limitation, even though it is in line with other published works [26,42] A second limit may be the retrospective nature of the study. From having analyzed only two MRI steps in a significant proportion of the sample, this limit could eventually be considered apparent since the most significant changes in BPE occurred in the first treatment phase, as reported in the literature [22][23][24]30].…”

“…According to some previous studies, BPE is considered to be a potential predictor of response to neoadjuvant therapy [ 22 , 23 , 24 , 25 , 26 ]. In particular, the reduction in BPE intensity over time, measured by MRI in the disease-free breast, depends on the menopausal status and appears to be more associated with pCR than NAC.…”

“…However, it could also be related to ovarian suppression caused by chemotherapy and to the better vascularization and vasal permeability of certain types of breasts. This type of assessment is still being studied; particularly, the information concerning pre-treatment BPE intensity [ 4 , 6 , 22 , 26 , 27 , 28 , 29 , 30 ] appears to be controversial. For the reasons mentioned above, BPE is considered an interesting diagnostic and prognostic indicator in breast oncology, yet some aspects are still not fully defined and are deserving of further studies.…”

Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer

“…In recent years, it has also been suggested to use background parenchymal enhancement (BPE) in the assessment of responses to NAC, which describes the enhancement of the normal breast tissue related to physiological vascularization. La Forgia et al, indicated that BPE is an important aspect that conditions the diagnosis and that it is a potential predictive factor in the response to neoadjuvant cancer therapies in graphic contrast examinations, as already confirmed in MRI and CESM examinations [ 46 , 47 , 48 ].…”