The Role of Dynamic Contrast-Enhanced Screening Breast MRI in Populations at Increased Risk for Breast Cancer

The 2009 NCCN Clinical Practice Guidelines in Oncology for Breast Cancer Screening and Diagnosis include significant updates for the role of MRI in screening women at increased risk for breast cancer. The NCCN now recommends considering breast MRI as an adjunct to annual mammography and clinical breast examination for women who have a BRCA1 or -2 mutation or who have a first-degree relative who has a BRCA1 or -2 mutation but who have not undergone genetic testing themselves; those who are determined to have a lifetime risk greater than 20% based on models that are highly dependent on family history; and those with a history of lobular carcinoma in situ. MRI is also recommended for patients who underwent radiation treatment to the chest between 10 and 30 years of age, and in those who carry or have a first-degree relative who carries a genetic mutation in the TP53 or PTEN genes (Li-Fraumeni, Cowden, and Bannahyan-Riley-Ruvalcaba syndromes). MRI is specifically not recommended for screening women at average risk for breast cancer. This article describes the peer-reviewed, published clinical research trials evaluating breast MRI in high-risk patients, on which the NCCN guidelines were based, and provides suggestions for future research.

Download Full-text

Dynamic contrast-enhanced breast MRI features correlate with invasive breast cancer angiogenesis

npj Breast Cancer ◽

10.1038/s41523-021-00247-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jennifer Xiao ◽

Habib Rahbar ◽

Daniel S. Hippe ◽

Mara H. Rendi ◽

Elizabeth U. Parker ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Characteristic Curve ◽

Breast Mri ◽

Texture Features ◽

Dce Mri ◽

Dynamic Contrast Enhanced ◽

Mri Features ◽

Contrast Enhanced ◽

Initial Peak

AbstractAngiogenesis is a critical component of breast cancer development, and identification of imaging-based angiogenesis assays has prognostic and treatment implications. We evaluated the association of semi-quantitative kinetic and radiomic breast cancer features on dynamic contrast-enhanced (DCE)-MRI with microvessel density (MVD), a marker for angiogenesis. Invasive breast cancer kinetic features (initial peak percent enhancement [PE], signal enhancement ratio [SER], functional tumor volume [FTV], and washout fraction [WF]), radiomics features (108 total features reflecting tumor morphology, signal intensity, and texture), and MVD (by histologic CD31 immunostaining) were measured in 27 patients (1/2016–7/2017). Lesions with high MVD levels demonstrated higher peak SER than lesions with low MVD (mean: 1.94 vs. 1.61, area under the receiver operating characteristic curve [AUC] = 0.79, p = 0.009) and higher WF (mean: 50.6% vs. 22.5%, AUC = 0.87, p = 0.001). Several radiomics texture features were also promising for predicting increased MVD (maximum AUC = 0.84, p = 0.002). Our study suggests DCE-MRI can non-invasively assess breast cancer angiogenesis, which could stratify biology and optimize treatments.

Download Full-text