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Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response

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Abstract

Objectives

To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC).

Methods

One hundred and forty-six MRI examinations of 73 patients with 80 biopsy-proven breast cancers who underwent breast MRI before and after NAC were retrospectively analysed. All images were reviewed by two blinded readers, who classified BPE into categories (BEC; 1 = minimal, 2 = mild, 3 = moderate, 4 = marked) before and after NAC. Histopathological and morphological tumour responses were analysed and compared.

Results

The distribution of BEC 1/2/3/4 was 25/46/18/11 % before and 78/20/2/0 % after NAC. On average, BPE decreased by 0.87 BEC. Cohen’s kappa showed substantial agreement (k = 0.73–0.77) before and moderate agreement (k = 0.43–0.60) after NAC and moderate agreement (k = 0.62–0.60) concerning the change in BEC. Correlating the change in BPE with tumour response, the average decrease in BEC was 1.3 in cases of complete remission, 0.83 in cases with partial response, 0.85 in cases with stable disease and 0.40 in cases with progressive disease. Correlation analysis showed a significant correlation between the decrease in BEC and tumour response (r = −0.24, p = 0.03).

Conclusions

BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response.

Key Points

• BPE decreases by an average of 0.87 categories under neoadjuvant chemotherapy.

• The reduction of BPE following neoadjuvant chemotherapy correlates with the tumour response.

• The classification of the BPE shows good agreement among trained readers.

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References

  1. Morris E, Comstock C, Lee C, et al (2013) Magnetic Resonance Imaging. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology

  2. Hansen NL, Kuhl CK, Barabasch A, Strobel K, Schrading S (2014) Does MRI Breast “Density” (Degree of Background Enhancement) Correlate With Mammographic Breast Density? J Magn Reson Imaging 40:483–489

    Article  PubMed  Google Scholar 

  3. Cubuk R, Tasali N, Narin B, Keskiner F, Celik L, Guney S (2010) Correlation between breast density in mammography and background enhancement in MR mammography. Radiol Med 115:434–441

    Article  CAS  PubMed  Google Scholar 

  4. King V, Gu Y, Kaplan JB, Brooks JD, Pike MC, Morris EA (2012) Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI. Eur Radiol 22:2641–2647

    Article  PubMed  Google Scholar 

  5. Muller-Schimpfle M, Ohmenhauser K, Stoll P, Dietz K, Claussen CD (1997) Menstrual cycle and age: influence on parenchymal contrast medium enhancement in MR imaging of the breast. Radiology 203:145–149

    Article  CAS  PubMed  Google Scholar 

  6. Kuhl CK, Bieling HB, Gieseke J et al (1997) Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology 203:137–144

    Article  CAS  PubMed  Google Scholar 

  7. Baek JE, Kim SH, Lee AW (2014) Background parenchymal enhancement in breast MRIs of breast cancer patients: Impact on tumor size estimation. Eur J Radiol 83:1356–1362

    Article  PubMed  Google Scholar 

  8. Uematsu T, Kasami M, Watanabe J (2011) Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer? Eur Radiol 21:2261–2267

    Article  PubMed  Google Scholar 

  9. Park SY, Kang DK, Kim TH (2015) Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients? Br J Radiol 88:20140638

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kim JY, Kim SH, Kim YJ et al (2015) Enhancement parameters on dynamic contrast enhanced breast MRI: do they correlate with prognostic factors and subtypes of breast cancers? Magn Reson Imaging 33:72–80

    Article  CAS  PubMed  Google Scholar 

  11. Kim S-A, Cho N, Ryu EB et al (2013) Background Parenchymal Signal Enhancement Ratio at Preoperative MR Imaging: Association with Subsequent Local Recurrence in Patients with Ductal Carcinoma in Situ after Breast Conservation Surgery. Radiology 270:699–707

    Article  PubMed  Google Scholar 

  12. DeLeo MJ 3rd, Domchek SM, Kontos D, Conant E, Chen J, Weinstein S (2015) Breast MRI fibroglandular volume and parenchymal enhancement in BRCA1 and BRCA2 mutation carriers before and immediately after risk-reducing salpingo-oophorectomy. AJR Am J Roentgenol 204:669–673

    Article  PubMed  Google Scholar 

  13. Kim YJ, Kim SH, Choi BG et al (2014) Impact of radiotherapy on background parenchymal enhancement in breast magnetic resonance imaging. Asian Pac J Cancer Prev 15:2939–2943

    Article  PubMed  Google Scholar 

  14. Chen JH, Yu HJ, Hsu C, Mehta RS, Carpenter PM, Su MY (2015) Background Parenchymal Enhancement of the Contralateral Normal Breast: Association with Tumor Response in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy. Transl Oncol 8:204–209

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schrading S, Kuhl CK (2015) Breast Cancer: Influence of Taxanes on Response Assessment with Dynamic Contrast-enhanced MR Imaging. Radiology. doi:10.1148/radiol.2015150006:150006

    Google Scholar 

  16. King V, Goldfarb SB, Brooks JD et al (2012) Effect of aromatase inhibitors on background parenchymal enhancement and amount of fibroglandular tissue at breast MR imaging. Radiology 264:670–678

    Article  PubMed  Google Scholar 

  17. King V, Kaplan J, Pike MC et al (2012) Impact of tamoxifen on amount of fibroglandular tissue, background parenchymal enhancement, and cysts on breast magnetic resonance imaging. Breast J 18:527–534

    Article  CAS  PubMed  Google Scholar 

  18. Schrading S, Schild H, Kuhr M, Kuhl C (2014) Effects of tamoxifen and aromatase inhibitors on breast tissue enhancement in dynamic contrast-enhanced breast MR imaging: a longitudinal intraindividual cohort study. Radiology 271:45–55

    Article  PubMed  Google Scholar 

  19. Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

    Article  CAS  PubMed  Google Scholar 

  20. Giess CS, Yeh ED, Raza S, Birdwell RL (2014) Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation. RadioGraphics 34:234–247

    Article  PubMed  Google Scholar 

  21. Jansen SA, Lin VC, Giger ML, Li H, Karczmar GS, Newstead GM (2011) Normal parenchymal enhancement patterns in women undergoing MR screening of the breast. Eur Radiol 21:1374–1382

    Article  PubMed  Google Scholar 

  22. Uematsu T, Kasami M, Watanabe J (2012) Background enhancement of mammary glandular tissue on breast dynamic MRI: imaging features and effect on assessment of breast cancer extent. Breast Cancer 19:259–265

    Article  PubMed  Google Scholar 

  23. Melsaether A, McDermott M, Gupta D, Pysarenko K, Shaylor SD, Moy L (2014) Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training. AJR Am J Roentgenol 203:209–215

    Article  PubMed  Google Scholar 

  24. Edwards SD, Lipson JA, Ikeda DM, Lee JM (2013) Updates and revisions to the BI-RADS magnetic resonance imaging lexicon. Magn Reson Imaging Clin N Am 21:483–493

    Article  PubMed  Google Scholar 

  25. Dontchos BN, Rahbar H, Partridge SC et al (2015) Are Qualitative Assessments of Background Parenchymal Enhancement, Amount of Fibroglandular Tissue on MR Images, and Mammographic Density Associated with Breast Cancer Risk? Radiology 276:371–380

    Article  PubMed  Google Scholar 

  26. van der Velden BH, Dmitriev I, Loo CE, Pijnappel RM, Gilhuijs KG (2015) Association between Parenchymal Enhancement of the Contralateral Breast in Dynamic Contrast-enhanced MR Imaging and Outcome of Patients with Unilateral Invasive Breast Cancer. Radiology. doi:10.1148/radiol.15142192:142192

    PubMed  Google Scholar 

  27. Hattangadi J, Park C, Rembert J et al (2008) Breast stromal enhancement on MRI is associated with response to neoadjuvant chemotherapy. AJR Am J Roentgenol 190:1630–1636

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Benjamin Wiesinger, M.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained.

Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    H. Preibsch, L. Wanner, S. D. Bahrs, B. M. Wietek, K. Nikolaou & B. Wiesinger

  2. Diagnostic Center for Breast Cancer and Screening Mammography Brandenburg Ost, Koepenicker Straße 29, 15711, Koenigs Wusterhausen, Germany

    K. C. Siegmann-Luz

  3. Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany

    E. Oberlecher & M. Hahn

  4. Institute of Pathology and Neuropathology, University Hospital Tuebingen, Liebermeisterstr. 8, 72076, Tuebingen, Germany

    A. Staebler

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  1. H. Preibsch
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  2. L. Wanner
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  3. S. D. Bahrs
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  9. K. Nikolaou
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Correspondence to H. Preibsch.

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Preibsch, H., Wanner, L., Bahrs, S.D. et al. Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response. Eur Radiol 26, 1590–1596 (2016). https://doi.org/10.1007/s00330-015-4011-x

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  • DOI: https://doi.org/10.1007/s00330-015-4011-x

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