A retrospective review of MRI features associated with metastasis-free survival in women with breast cancer: focusing on skin thickening and skin enhancement

Objectives: To identify associations between MRI-detected skin thickening and enhancement and metastasis-free survival (MFS) given recent reports of skin thickening on ultrasound being a poorer prognostic indicator. Methods: Interrogation of a prospectively collected database of ultrasound-visible breast lesions showed 214 lesions with pre-treatment MRIs available for analysis in a single centre. Data on MFS was prospectively collected. Retrospective MRI review was performed blinded to outcome. Imaging factors recorded were presence of skin thickening and enhancement, non-mass-enhancement (NME) and abnormal nodes, mass characteristics, perilesional oedema and background parenchymal enhancement. Statistical analysis used chi-squared test, Kaplan-Meier survival curves, the Log-rank test and receiver-operator characteristic (ROC) curves. Results: During a median follow-up period of 5.6 years, 21 (10%) of 212 patients developed distant metastases. Skin thickening [24 of 30 (80%) vs 169 of 184 (92%), p = 0.043] and skin enhancement [15 of 20 (75%) vs 178 of 194 (92%), p = 0.016] were associated with poorer MFS. Large index lesion size [p < 0.001, AUC 0.823], large sum of masses [p < 0.001, AUC 0.813], increasing total lesion extent including NME [p < 0.001, AUC 0.749] and abnormal axillary nodes [55 of 66 (83%) vs 138 of 148 (93%), p = 0.024] were also associated with poorer MFS. Conclusions: Skin thickening and enhancement on breast MRI are associated with poorer MFS. These findings should be taken into account when managing patients with invasive breast cancer. Advances in knowledge: Skin enhancement on breast MRI at diagnosis is associated with metastases development. Skin thickening on breast MRI is associated with future metastatic disease.

Fibroglandular Tissue and Background Parenchymal Enhancement on Breast MR Imaging Correlates With Breast Cancer

ObjectivesTo evaluate the association of breast cancer with both the background parenchymal enhancement intensity and volume (BPEI and BPEV, respectively) and the amount of fibroglandular tissue (FGT) using an automatic quantitative assessment method in breast magnetic resonance imaging (MRI).Materials and MethodsAmong 17,274 women who underwent breast MRI, 132 normal women (control group), 132 women with benign breast lesions (benign group), and 132 women with breast cancer (cancer group) were randomly selected and matched by age and menopausal status. The area under the receiver operating characteristic curve (AUC) was compared in Cancer vs Control and Cancer vs Benign groups to assess the discriminative ability of BPEI, BPEV and FGT.ResultsCompared with the control groups, the cancer group showed a significant difference in BPEV with a maximum AUC of 0.715 and 0.684 for patients in premenopausal and postmenopausal subgroup, respectively. And the cancer group showed a significant difference in BPEV with a maximum AUC of 0.622 and 0.633 for patients in premenopausal and postmenopausal subgroup, respectively, when compared with the benign group. FGT showed no significant difference when breast cancer group was compared with normal control and benign lesion group, respectively. Compared with the control groups, BPEI showed a slight difference in the cancer group. Compared with the benign group, no significant difference was seen in cancer group.ConclusionIncreased BPEV is correlated with a high risk of breast cancer While FGT is not.

Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications

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.

Gadoteridol-enhanced MRI of the breast: can contrast agent injection rate impact background parenchymal enhancement?

Background Normal background parenchymal enhancement (BPE) is a dynamic parameter affected by multiple factors. Purpose To determine whether contrast agent injection rate affects the degree of BPE in women undergoing breast magnetic resonance imaging (MRI). Material and Methods A total of 85 patients included in our prospective study randomly received 0.1 mmol/kg gadoteridol at a rate of 3 mL/s (group A; n = 46) or 2 mL/s (group B; n = 39). Breast MRI was performed at 3T using a standard protocol including postcontrast axial 3D GRE T1-weighted sequences. Two expert breast radiologists, blinded to clinical and radiological information, independently quantified BPE on early postcontrast subtracted images, assigning a score of 1–4. Mean comparison and regression analysis were performed to assess the influence of injection rate on BPE. Results Groups were homogeneous in terms of age and final BI-RADS score. The mean BPE score was significantly lower among patients in group A (mean of two readers: 1.36 vs. 1.90; P < 0.01) with 70%–72% of patients assigned a BPE score of 1, compared with 36%–38% of patients in group B. Lower BPE scores were noted with the higher flow rate in subgroup analyses of both pre- and postmenopausal women, although the effect was more evident in premenopausal women. Regression analysis confirmed that the likelihood of a BPE 1 score was significantly increased with a higher flow rate ( P < 0.01). The inter-reader agreement was excellent (0.83). Conclusion A higher contrast agent injection flow rate (3 mL/s) during breast MRI significantly reduces the degree of BPE, potentially allowing improved diagnostic accuracy by reducing false-positive and false-negative findings.