<p>Breast Cancer Brain Metastasis: The Potential Role of MRI Beyond Current Clinical Applications</p>

Abstract

Breast cancer brain metastasis (BCBM) represents a major clinical challenge. Can MRI help in advancements in the management of BCBM? This review discusses MRI developments and the corresponding potential advancements in BCBM management. Methods: An exhaustive literature search was undertaken to identify studies which look into the potential of MRI in BCBM management. Seven hundred and eighty-four studies published from September 1984 to May 2020 were identified. Three topics are covered where MRI is not clinically established yet: 1) the prognosis of BCBM; 2) the screening of BC patients for BCBM development, and 3) the assessment of imaging features correlated to BC subtype. Results: Thirty-six studies were considered eligible for the purposes of this review. Ongoing progress is made with the identification of different BCBM characteristics and MRI metrics that might be related to prognosis. Progress has been made with the identification of different BCBM characteristics, including BCBM location, degree of edema, white matter disruption, tumor edge sharpness, and temporal muscle thickness. A more accurate prediction of prognosis could lead to more suitable patient management and treatment. The use of MRI in BCBM screening of the high-risk breast cancer population remains a controversial subject. To date, there are no results from clinical trials; however, there is a rising number of relatively small studies that show concern on this subject and support BCBM screening. It is important to oncologists to be able to assess the tumor subtype non-invasively. MRI features, which have shown some correlation with subtype, include the number of tumors, location, and their distribution in the brain. Advanced tools and metrics have been produced to carry out radiological characteristics analysis on MRI images. Assessing MRI features in more detail could provide a more personalized management of patients. Conclusion: Developments in the use of MRI have the potential to improve BCBM management.

Overview of Patients with Metastatic Brain Tumors from Breast Cancer at H. Adam Malik Hospital, Medan in 2017-2021

“…Patients with HER2-positive characteristics had a longer life expectancy than patients with HER2-negative disease (18 versus 11 months; p=0.02). [11] This observation is consistent with a recent study examining the effect of HER2 expression on patient outcomes after diagnosis of brain metastases. In a cohort of 60 patients treated with stereotactic radiosurgery, another study demonstrated an extended 1-year survival rate in HER2-positive patients treated with trastuzumab compared with similar patients with HER2-negative disease (78% vs 55%; p=0.02).…”

“…Lapatinib is a tyrosine kinase inhibitor directed against epidermal growth factor receptor (EGFR) and HER2. This compound has a much lower molecular weight than trastuzumab (943 Da) compared to 148,000 Da) and it has been reported by various studies that it can cross the blood-brain barrier [11], [13]. A phase II study, reported that 66% of patients with brain metastases previously untreated HER2-positive metastatic breast cancer responded well to combination therapy with lapatinib plus capecitabine.…”

Analysis of microRNAs in Exosomes of Breast Cancer Patients in Search of Molecular Prognostic Factors in Brain Metastases

“…Therefore, additional patient samples and molecular studies on in vitro BBB models should be conducted in further investigations. A major problem is the recruitment of patients with brain metastases, as clinically normal patients are not routinely screened for brain metastases [ 50 ], while the incidence at autopsy is much higher [ 51 ]. There are rarely patients with only brain metastases, as most of them demonstrate visceral metastases first and, in the further course of the disease, the formation of brain metastases.…”

The Pattern of Care for Brain Metastasis from Breast Cancer over the Past 10 Years in Korea: A Multicenter Retrospective Study (KROG 16-12)

“…This might result from the timing of brain imaging after patients have symptoms. Currently, controversies exist on the role of brain magnetic resonance imaging (MRI) as a screening tool for BM [ 21 ]. However, recent studies emphasize and favor the use of MRI because early detection of BM could be managed by SRS with less invasiveness and toxicities [ 21 , 22 ].…”