Evaluation of association between degree of background parenchymal enhancement on MRI and breast cancer subtype

Ha, Richard; Mango, Victoria L.; Al-Khalili, Rend; Mema, Eralda; Friedlander, Lauren; Desperito, Elise; Wynn, Ralph

doi:10.1016/j.clinimag.2018.05.008

Cited by 11 publications

(8 citation statements)

References 41 publications

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“…We also found that the hormone Table 4 The association between BPE and tumor characteristics among women with breast cancer in the IMAGINE study Considered positive if positive for estrogen or progesterone receptors receptor status of tumors was independently associated with BPE in the unaffected breast among postmenopausal cases. Two small clinical studies previously identified univariable associations between hormone receptors and BPE [32,33] while others did not identify any associations [34][35][36]. This study is the first to report the association in a large population of women with breast cancer using a multivariable approach, but these results should be interpreted with caution and require confirmation in future studies.…”

Section: Discussionmentioning

confidence: 60%

Association of breast cancer with MRI background parenchymal enhancement: the IMAGINE case-control study

et al. 2020

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Background Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) may be associated with breast cancer risk, but previous studies of the association are equivocal and limited by incomplete blinding of BPE assessment. In this study, we evaluated the association between BPE and breast cancer based on fully blinded assessments of BPE in the unaffected breast. Methods The Imaging and Epidemiology (IMAGINE) study is a multicenter breast cancer case-control study of women receiving diagnostic, screening, or follow-up breast MRI, recruited from three comprehensive cancer centers in the USA. Cases had a first diagnosis of unilateral breast cancer and controls had no history of or current breast cancer. A single board-certified breast radiologist with 12 years’ experience, blinded to case-control status and clinical information, assessed the unaffected breast for BPE without view of the affected breast of cases (or the corresponding breast laterality of controls). The association between BPE and breast cancer was estimated by multivariable logistic regression separately for premenopausal and postmenopausal women. Results The analytic dataset included 835 cases and 963 controls. Adjusting for fibroglandular tissue (breast density), age, race/ethnicity, BMI, parity, family history of breast cancer, BRCA1/BRCA2 mutations, and other confounders, moderate/marked BPE (vs minimal/mild BPE) was associated with breast cancer among premenopausal women [odds ratio (OR) 1.49, 95% CI 1.05–2.11; p = 0.02]. Among postmenopausal women, mild/moderate/marked vs minimal BPE had a similar, but statistically non-significant, association with breast cancer (OR 1.45, 95% CI 0.92–2.27; p = 0.1). Conclusions BPE is associated with breast cancer in premenopausal women, and possibly postmenopausal women, after adjustment for breast density and confounders. Our results suggest that BPE should be evaluated alongside breast density for inclusion in models predicting breast cancer risk.

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Section: Discussionmentioning

confidence: 60%

Association of breast cancer with MRI background parenchymal enhancement: the IMAGINE case-control study

et al. 2020

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“…The qualitative measurement of these class parameters was also subject to inter-intraobserver variability [25,30,31,[36][37][38] and would require the consensus of three radiologists through BIRADS criteria [20,39]. Therefore, an independent qualitative analysis with three different operators was carried out in order to minimize variability.…”

Section: Discussionmentioning

confidence: 99%

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

Forgia

Vestito

Lasciarrea

et al. 2021

JPM

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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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“…This variability in the literature may in part be explained by the heterogeneous nature of breast cancer. Molecular subtypes of breast cancer play an important role in prognosis [87], but the interrelationships between BPE, molecular subtype, and prognosis are unclear. Studies have suggested that moderate or marked BPE is associated with an increased rate of estrogen receptor (ER) positive and progesterone receptor (PR) positive cancers [88,89], while minimal or mild BPE may be more frequently associated with triple negative breast cancers [90].…”

Section: Prognosismentioning

confidence: 99%

Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications

2021

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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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Evaluation of association between degree of background parenchymal enhancement on MRI and breast cancer subtype

Cited by 11 publications

References 41 publications

Association of breast cancer with MRI background parenchymal enhancement: the IMAGINE case-control study

Association of breast cancer with MRI background parenchymal enhancement: the IMAGINE case-control study

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

Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications

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