Background parenchymal enhancement in breast magnetic resonance imaging: A review of current evidences and future trends

Rella, Rossella; Bufi, Enida; Belli, Paolo; Contegiacomo, Andrea; Giuliani, Maddalena; Rosignuolo, Maria; Manfredi, Riccardo

doi:10.1016/j.diii.2018.08.011

Cited by 21 publications

(15 citation statements)

References 51 publications

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“…However, our study could not tease out whether BPE is associated with breast cancer in women with high risk due to BRCA mutations or women with high risk due to reasons other than BRCA mutations. A systematic review (14) and a review (15) evaluated BPE measured at breast MRI aside from our current meta-analysis. Bignotti et al (14) highlighted the methodologic variation in obtaining qualitative and quantitative BPE measures across different be confirmed and the findings reported in this study required re-evaluation in the light of possible confounders (32).…”

Section: Discussionmentioning

confidence: 99%

The Association of Background Parenchymal Enhancement at Breast MRI with Breast Cancer: A Systematic Review and Meta-Analysis

Thompson¹,

Mallawaarachchi²,

Dwivedi³

et al. 2019

Radiology

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he enhancement of normal breast tissue seen at breast MRI is termed background parenchymal enhancement (BPE) (1,2) and is typically measured in four qualitative categories according to the American College of Radiology Breast Imaging Reporting and Data System, or BI-RADS. These categories are minimal, mild, moderate, and marked BPE (3). BPE is a dynamic phenomenon and varies between individuals as well as over time in the same individual. BPE can also be influenced by several other factors such as endogenous hormonal status and the menstrual cycle. High levels of BPE may obscure small breast masses (1). The fifth edition of the BI-RADS lexicon requires the reporting of the amount of fibroglandular tissue along with BPE during MRI interpretation (4).Since 2011, there have been multiple studies reporting the association of BPE with breast cancer.There is also evidence for BPE having a role as an additional marker for higher risk of breast cancer (5-8). Conversely, there have been several studies reporting no association between BPE and breast cancer (9-12). Recently, reviews have been published on various BPE methods (13-15) and associated diagnostic challenges (1). These studies highlighted the importance of BPE noted at breast MRI, methodologic heterogeneity, and factors associated with assessment and interpretation of BPE.Because of the increased use of breast MRI for breast cancer screening and diagnosis, data on BPE is more readily available. As an emerging screening and diagnostic measure, it is thought that BPE may make a substantial contribution as a tool for improving early detection and prevention of breast cancer, as well as for identifying

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Section: Discussionmentioning

confidence: 99%

The Association of Background Parenchymal Enhancement at Breast MRI with Breast Cancer: A Systematic Review and Meta-Analysis

Thompson¹,

Mallawaarachchi²,

Dwivedi³

et al. 2019

Radiology

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“…It is known that both normal and pathologic fibroglandular breast tissue enhances during CE-MRI and that moderate to marked BPE (BPE 3–4), particularly if asymmetrical or “micronodular,” may reduce the diagnostic quality of MR examinations, affecting the accuracy of MRI interpretation and causing both false-positive and false-negative results (10). For this reason, the presence and the degree of BPE should always be reported, as suggested in the ACR BI-RADS MRI guidelines (9).…”

Section: Discussionmentioning

confidence: 99%

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

Marzocca

Moffa

Landi³

et al. 2021

Acta Radiol

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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.

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“…Although background appearance is important in stratifying patients and may affect which screening and preventive options might be offered to a patient, its usefulness is hindered by significant inter- and intraobserver variability. 12 For example, patients may be offered supplemental screening based on having dense breasts (ie, Breast Imaging Reporting and Data System category c or d), but because of reader variability, they may intermittently be assigned as having c density some years and b density other years. If the patient lives in a state requiring density notification, she would some years get a letter recommending that she consider supplemental screening, and other years, her letter would tell her she does not need it.…”

Section: Discussionmentioning

confidence: 99%

Classification of Background Parenchymal Uptake on Molecular Breast Imaging Using a Convolutional Neural Network

Carter

Attia

Geske

et al. 2019

JCO Clinical Cancer Informatics

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PURPOSE Background parenchymal uptake (BPU), which describes the level of radiotracer uptake in normal fibroglandular tissue on molecular breast imaging (MBI), has been identified as a breast cancer risk factor. Our objective was to develop and validate a deep learning model using image convolution to automatically categorize BPU on MBI. METHODS MBI examinations obtained for clinical and research purposes from 2004 to 2015 were reviewed to classify the BPU pattern using a standardized five-category scale. Two expert radiologists provided interpretations that were used as the reference standard for modeling. The modeling consisted of training and validating a convolutional neural network to predict BPU. Model performance was summarized in data reserved to test the performance of the algorithm at the per-image and per-breast levels. RESULTS Training was performed on 24,639 images from 3,133 unique patients. The model performance on the withheld testing data (6,172 images; 786 patients) was evaluated. Using direct matching on the predicted classification resulted in an accuracy of 69.4% (95% CI, 67.4% to 71.3%), and if prediction within one category was considered, accuracy increased to 96.0% (95% CI, 95.2% to 96.7%). When considering the breast-level prediction of BPU, the accuracy remained strong, with 70.3% (95% CI, 68.0% to 72.6%) and 96.2% (95% CI, 95.3% to 97.2%) for the direct match and allowance for one category, respectively. CONCLUSION BPU provided a robust target for training a convolutional neural network. A validated computer algorithm will allow for objective, reproducible encoding of BPU to foster its integration into risk-stratification algorithms.

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Background parenchymal enhancement in breast magnetic resonance imaging: A review of current evidences and future trends

Cited by 21 publications

References 51 publications

The Association of Background Parenchymal Enhancement at Breast MRI with Breast Cancer: A Systematic Review and Meta-Analysis

The Association of Background Parenchymal Enhancement at Breast MRI with Breast Cancer: A Systematic Review and Meta-Analysis

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

Classification of Background Parenchymal Uptake on Molecular Breast Imaging Using a Convolutional Neural Network

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