Possible Breast Cancer Risk Related to Background Parenchymal Enhancement at Breast MRI: A Meta-Analysis Study

PURPOSE To evaluate comparative associations of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and mammographic breast density with subsequent breast cancer risk. PATIENTS AND METHODS We examined women undergoing breast MRI in the Breast Cancer Surveillance Consortium from 2005 to 2015 (with one exam in 2000) using qualitative BPE assessments of minimal, mild, moderate, or marked. Breast density was assessed on mammography performed within 5 years of MRI. Among women diagnosed with breast cancer, the first BPE assessment was included if it was more than 3 months before their first diagnosis. Breast cancer risk associated with BPE was estimated using Cox proportional hazards regression. RESULTS Among 4,247 women, 176 developed breast cancer (invasive, n = 129; ductal carcinoma in situ,n = 47) over a median follow-up time of 2.8 years. More women with cancer had mild, moderate, or marked BPE than women without cancer (80% v 66%, respectively). Compared with minimal BPE, increasing BPE levels were associated with significantly increased cancer risk (mild: hazard ratio [HR], 1.80; 95% CI, 1.12 to 2.87; moderate: HR, 2.42; 95% CI, 1.51 to 3.86; and marked: HR, 3.41; 95% CI, 2.05 to 5.66). Compared with women with minimal BPE and almost entirely fatty or scattered fibroglandular breast density, women with mild, moderate, or marked BPE demonstrated elevated cancer risk if they had almost entirely fatty or scattered fibroglandular breast density (HR, 2.30; 95% CI, 1.19 to 4.46) or heterogeneous or extremely dense breasts (HR, 2.61; 95% CI, 1.44 to 4.72), with no significant interaction ( P = .82). Combined mild, moderate, and marked BPE demonstrated significantly increased risk of invasive cancer (HR, 2.73; 95% CI, 1.66 to 4.49) but not ductal carcinoma in situ (HR, 1.48; 95% CI, 0.72 to 3.05). CONCLUSION BPE is associated with future invasive breast cancer risk independent of breast density. BPE should be considered for risk prediction models for women undergoing breast MRI.

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Background parenchymal enhancement and fibroglandular tissue on breast MRI in women with high genetic risk: Are changes before and after risk-reducing salpingo-oophorectomy associated with breast cancer risk?

European Journal of Radiology ◽

10.1016/j.ejrad.2018.10.030 ◽

2018 ◽

Vol 109 ◽

pp. 171-177 ◽

Cited By ~ 2

Author(s):

Cécile Bermot ◽

Caroline Saint-Martin ◽

Caroline Malhaire ◽

Delphine Sebbag-Sfez ◽

Emmanuelle Mouret-Fourme ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Genetic Risk ◽

Breast Mri ◽

High Genetic Risk ◽

Background Parenchymal Enhancement ◽

Before And After ◽

Risk Reducing ◽

Parenchymal Enhancement

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Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications

Current Radiology Reports ◽

10.1007/s40134-021-00386-2 ◽

2021 ◽

Vol 9 (10) ◽

Author(s):

James S. Chalfant ◽

Shabnam Mortazavi ◽

Stephanie A. Lee-Felker

Keyword(s):

Breast Cancer ◽

Clinical Practice ◽

Breast Cancer Risk ◽

Neoadjuvant Chemotherapy ◽

Cancer Risk ◽

Quantitative Assessment ◽

Breast Mri ◽

Clinical Implications ◽

Background Parenchymal Enhancement ◽

Parenchymal Enhancement

Abstract 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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