Background Parenchymal Enhancement at Breast MR Imaging and Breast Cancer Risk

Department of Radiology, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 E 66th St, Room 715, New York, NY 10065, USA.
Radiology (Impact Factor: 6.87). 07/2011; 260(1):50-60. DOI: 10.1148/radiol.11102156
Source: PubMed


To examine the relationships between breast cancer and both amount of fibroglandular tissue (FGT) and level of background parenchymal enhancement (BPE) at magnetic resonance (MR) imaging.
A waiver of authorization was granted by the institutional review board for this retrospective HIPAA-compliant study. Among 1275 women who underwent breast MR imaging screening between December 2002 and February 2008, 39 breast carcinoma cases were identified. Two comparisons were performed: In one comparison, two normal controls--those of the women with negative (benign) findings at breast MR imaging--were matched to each breast cancer case on the basis of age and date of MR imaging. In the second comparison, one false-positive control--that of a woman with suspicious but nonmalignant findings at MR imaging--was similarly matched to each breast cancer case. Two readers independently rated the level of MR imaging-depicted BPE and the amount of MR imaging-depicted FGT by using a categorical scale: BPE was categorized as minimal, mild, moderate, or marked, and FGT was categorized as fatty, scattered, heterogeneously dense, or dense.
Compared with the odds ratio (OR) for a normal control, the OR for breast cancer increased significantly with increasing BPE: The ORs for moderate or marked BPE versus minimal or mild BPE were 10.1 (95% confidence interval [CI]: 2.9, 35.3; P < .001) and 3.3 (95% CI: 1.3, 8.3; P = .006) for readers 1 and 2, respectively. Similar odds were seen when the false-positive controls were compared with the breast cancer cases: The ORs for moderate or marked BPE versus minimal or mild BPE were 5.1 (95% CI: 1.4, 19.1; P = .005) and 3.7 (95% CI: 1.2, 11.2; P = .013) for readers 1 and 2, respectively. The breast cancer odds also increased with increasing FGT, but the BPE findings remained significant after adjustment for FGT.
Increased BPE is strongly predictive of breast cancer odds.

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    • "Both the volume and the intensity of enhancement were considered in this global assessment [5] [8] [15]. The degree of parenchymal enhancement was categorized into the following descriptive modifiers: minimal (<25% volumetric enhancement), mild (25–50% volumetric enhancement), moderate (51–75% volumetric enhancement), or marked (>75% volumetric enhancement) [5] [8] [15]. The categories are based on the proposed Breast Imaging Reporting and Data Systems (BI-RADS criteria). "
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    ABSTRACT: To measure background parenchymal enhancement (BPE) and compare with other contrast enhancement values and diffusion-weighted MRI parameters in healthy and cancerous breast tissue at the clinical level. This HIPAA-compliant, IRB approved retrospective study enrolled 77 patients (38 patients with breast cancer - mean age 51.8±10.0 years; 39 high-risk patients for screening evaluation - mean age 46.3±11.7 years), who underwent contrast-enhanced 3T breast MRI. Contrast enhanced MRI and diffusion-weighted imaging were performed to quantify BPE, lesion contrast enhancement, and apparent diffusion coefficient (ADC) metrics in fibroglandular tissue (FGT) and lesions. BPE did not correlate with ADC values. Mean BPE for the lesion-bearing patients was higher (43.9%) compared to that of the high-risk screening patients (28.3%, p=0.004). Significant correlation (r=0.37, p<0.05) was found between BPE and lesion contrast enhancement. No significant association was observed between parenchymal or lesion enhancement with conventional apparent diffusion metrics, suggesting that proliferative processes are not co-regulated in cancerous and parenchymal tissue. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 07/2015; DOI:10.1016/j.ejrad.2015.06.023 · 2.37 Impact Factor
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    • "Breast fibroglandular tissue (FGT) can be distinguished from fatty tissue using 3D T1-weighted MRI with fat suppression, allowing a 3D assessment of breast density. The level of enhancement in FGT (also termed background parenchymal enhancement) by contrastenhanced MRI has also been shown to be a strong independent predictor of breast cancer odds [7]. FGT enhancement can be characterized quantitatively by the percent enhancement after an injection of contrast agent. "
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    ABSTRACT: To evaluate the variability and repeatability of repeated magnetic resonance imaging (MRI) measurements in normal breast tissues between and within subjects. Eighteen normal premenopausal subjects underwent two contrast-enhanced MRI scans within 72 hours or during the same menstrual phase in two consecutive months. A subset of nine women also completed diffusion-weighted imaging (DWI). Fibroglandular tissue (FGT) density and FGT enhancement were measured on the contrast-enhanced MRI. Apparent diffusion coefficient (ADC) values were computed from DWI. Between- and within-subject coefficients of variation (bCV and wCV, respectively) were assessed. Repeatability of all measurements was assessed by the coefficient of repeatability (CR) and Bland-Altman plots. The bCV of FGT density and FGT enhancement at visit 1 and visit 2 ranged from 47% to 63%. The wCV was 13% for FGT density, 22% for FGT enhancement, and 11% for ADC. The CRs of FGT density and FGT enhancement were 0.15 and 0.19, respectively, and for ADC, it was 6.1 x 10(-4) mm(2)/s. We present an estimate of the variability and repeatability of MR measurements in normal breasts. These estimates provide the basis for understanding the normal variation of healthy breast tissue in MRI and establishing thresholds for agreement between measurements.
    Translational oncology 02/2014; 7(1):130-7. DOI:10.1593/tlo.13841 · 2.88 Impact Factor
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    • "Background parenchymal enhancement refers to the enhancement of the normal breast glandular tissue. Age, menstrual or menopausal status, and hormonal use can affect breast glandular tissue enhancements [23–25, 30, 99, 100], and this normal tissue enhancement may impact the diagnostic performance of breast MRI [28, 99, 101–103]. The value of normal tissue enhancement in the diseased breast on MRI was noted to be associated with response to NAC [104]. "
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    ABSTRACT: Neoadjuvant chemotherapy (NAC), also termed primary, induction, or preoperative chemotherapy, is traditionally used to downstage inoperable breast cancer. In recent years it has been increasingly used for patients who have operable cancers in order to facilitate breast-conserving surgery, achieve better cosmetic outcome, and improve prognosis by reaching pathologic complete response (pCR). Many studies have demonstrated that magnetic resonance imaging (MRI) can assess residual tumor size after NAC, and that provides critical information for planning of the optimal surgery. NAC also allows for timely adjustment of administered drugs based on response, so ineffective regimens could be terminated early to spare patients from unnecessary toxicity while allowing other effective regimens to work sooner. This review article summarizes the clinical application of MRI during NAC. The use of different MR imaging methods, including dynamic contrast-enhanced MRI, proton MR spectroscopy, and diffusion-weighted MRI, to monitor and evaluate the NAC response, as well as how changes of parameters measured at an early time after initiation of a drug regimen can predict final treatment outcome, are reviewed. MRI has been proven a valuable tool and will continue to provide important information facilitating individualized image-guided treatment and personalized management for breast cancer patients undergoing NAC.
    06/2013; 2013:348167. DOI:10.1155/2013/348167
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