The correlation of background parenchymal enhancement in the contralateral breast with patient and tumor characteristics of MRI-screen detected breast cancers

<div><p>Purpose</p><p>Higher background parenchymal enhancement (BPE) could be used for stratification of MRI screening programs since it might be related to a higher breast cancer risk. Therefore, the purpose of this study is to correlate BPE to patient and tumor characteristics in women with unilateral MRI-screen detected breast cancer who participated in an intermediate and high risk screening program. As BPE in the affected breast may be difficult to discern from enhancing cancer, we assumed that BPE in the contralateral breast is a representative measure for BPE in women with unilateral breast cancer.</p><p>Materials and methods</p><p>This retrospective study was approved by our local institutional board and a waiver for consent was granted. MR-examinations of women with unilateral breast cancers screen-detected on breast MRI were evaluated by two readers. BPE in the contralateral breast was rated according to BI-RADS. Univariate analyses were performed to study associations. Observer variability was computed.</p><p>Results</p><p>Analysis included 77 breast cancers in 76 patients (age: 48±9.8 years), including 62 invasive and 15 pure ductal carcinoma in-situ cases. A negative association between BPE and tumor grade (p≤0.016) and a positive association with progesterone status (p≤0.021) was found. The correlation was stronger when only considering invasive disease. Inter-reader agreement was substantial.</p><p>Conclusion</p><p>Lower BPE in the contralateral breast in women with unilateral breast cancer might be associated to higher tumor grade and progesterone receptor negativity. Great care should be taken using BPE for stratification of patients to tailored screening programs.</p></div

Cols bleus : hebdomadaire de la Marine française

18 novembre 19951995/11/18 (N2327)-1995/11/18

The association between BPE and tumor grade for Reader 1 and Reader 2.

<p>The association between BPE and tumor grade for Reader 1 and Reader 2.</p

Maximum Intensity Projection (MIP, top image) and subtraction image (bottom image) of woman with unilateral cancer (70 years old, breast tumor in the right breast, IDC grade 2) with BPE rated as moderate by both readers.

<p>Maximum Intensity Projection (MIP, top image) and subtraction image (bottom image) of woman with unilateral cancer (70 years old, breast tumor in the right breast, IDC grade 2) with BPE rated as moderate by both readers.</p

Influence of risk category and screening round on the performance of an MR imaging and mammography screening program in carriers of the BRCA mutation and other women at increased risk

Purpose: To evaluate the real-life performance of a breast cancer screening program for women with different categories of increased breast cancer risk with multiple follow-up rounds in an academic hospital with a large screening population. Materials and Methods: Screening examinations (magnetic resonance [MR] imaging and mammography) for women at increased breast cancer risk (January 1, 2003, to January 1, 2014) were evaluated. Risk category, age, recall for workup of screening-detected abnormalities, biopsy, and histopathologic diagnosis were recorded. Recall rate, biopsy rate, positive predictive value of recall, positive predictive value of biopsy, cancer detection rate, sensitivity, and specificity were calculated for first and follow-up rounds. Results: There were 8818 MR and 6245 mammographic examinations performed in 2463 women. Documented were 170 cancers; of these, there were 129 screening-detected cancers, 16 interval cancers, and 25 cancers discovered at prophylactic mastectomy. Overall sensitivity was 75.9% including the cancers discovered at prophylactic mastectomy (95% confidence interval: 69.5%, 82.4%) and 90.0% excluding those cancers (95% confidence interval: 83.3%, 93.7%). Sensitivity was lowest for carriers of the BRCA1 mutation (66.1% and 81.3% when including and not including cancers in prophylactic mastectomy specimens, respectively). Specificity was higher at follow-up (96.5%; 95% confidence interval: 96.0%, 96.9%) than in first rounds (85.1%; 95% confidence interval: 83.4%, 86.5%) and was high for both MR imaging (97.1%; 95% confidence interval: 96.7%, 97.5%) and mammography (98.7%; 95% confidence interval: 98.3%, 99.0%). Positive predictive value of recall and positive predictive value of biopsy were lowest in women who had only a family history of breast cancer. Conclusion: Screening performance was dependent on risk category. Sensitivity was lowest in carriers of the BRCA1 mutation. The specificity of high-risk breast screening improved at follow-up rounds

Maximum Intensity Projection (MIP, top image) and subtraction image (bottom image) of woman with unilateral cancer (60 years old, breast tumor in the left breast, IDC grade 1) with BPE rated as marked by both readers.

<p>Maximum Intensity Projection (MIP, top image) and subtraction image (bottom image) of woman with unilateral cancer (60 years old, breast tumor in the left breast, IDC grade 1) with BPE rated as marked by both readers.</p

Results of univariate analysis for BPE.

<p>Results of univariate analysis for BPE.</p

Patient and cancer characteristics.

<p>Patient and cancer characteristics.</p

The association between BPE and progesterone status (PR status) for Reader 1 and Reader 2.

<p>The association between BPE and progesterone status (PR status) for Reader 1 and Reader 2.</p

Results of univariate analysis for BPE.

<p>Results of univariate analysis for BPE.</p