Breast MRI Fibroglandular Volume and Parenchymal Enhancement in BRCA1 and BRCA2 Mutation Carriers Before and Immediately After Risk-Reducing Salpingo-Oophorectomy

Abstract

OBJECTIVE. The purpose of this article is to assess the difference in fibroglandular volume and background parenchymal enhancement in BRCA1 and BRCA2 mutation carriers on contrast-enhanced breast MRI (CE-MRI) performed before and immediately after risk-reducing salpingo-oophorectomy (RRSO). MATERIALS AND METHODS. We retrospectively compared fibroglandular volume and background parenchymal enhancement in 55 female BRCA1 and BRCA2 mutation carriers before and after RRSO using standard BI-RADS categories and a paired Wilcoxon and Mann-Whitney U test. A two-sample Wilcoxon test was performed to compare fibroglandular volume and background parenchymal enhancement in women with and without subsequent breast cancer diagnosis on follow-up. RESULTS. The median time to post-RRSO CE-MRI was 8 months (range, 1-40 months). There was no difference in fibroglandular volume before and after RRSO (p = 0.65). The mean background parenchymal enhancement was 2.5 (range, 1-4) before and 1.5 (range, 1-4) after RRSO (overall range, -2.5 to 1.5; p = 0.0001). Breast cancer was detected in nine women at a median time of 4.8 years (range, 1.8-13.3 years) after RRSO. For women who received a diagnosis of breast cancer after RRSO compared with those who did not, mean background parenchymal enhancement before RRSO was 3 (range, 2-4) versus 2.5 (range, 1-4; p = 0.001), and mean background parenchymal enhancement after RRSO was 2.5 (range, 1.5-4) versus 1.5 (range 2-4; p = 0.0018). There was no difference in fibroglandular volume before and after RRSO. CONCLUSION. In BRCA1 and BRCA2 mutation carriers, we observed a significant reduction in background parenchymal enhancement on the first CE-MRI after RRSO and no significant change in fibroglandular volume. Higher background parenchymal enhancement before and after RRSO was observed in women who subsequently received a diagnosis of breast cancer. This suggests that background parenchymal enhancement, rather than fibro-glandular volume, may be a more sensitive imaging biomarker of breast cancer risk.

Evaluation of background parenchymal enhancement on breast MRI: a systematic review

“…7,8,17,25,39,[44][45][46]49 In particular, four studies 7,8,17,49 evaluated both intrareader and interreader agreements and the other five studies evaluated only interreader agreement. Kappa values for intrareader agreement were moderate to almost perfect, while more variability was The unenhanced images were not used.…”

“…In a total of 14 studies, the authors stated the menstrual period. 7,20,22,24,25,27,30,31,39,45,46,55,56,60 In 8 of these 14 studies, breast MRI were performed ideally in the second week of the menstrual cycle. 7,22,24,25,27,45,56,60 In three studies, 37,47,58 the patients were post-menopausal females.…”

Dose–response effects of aerobic exercise on estrogen among women at high risk for breast cancer: a randomized controlled trial

“…Another innovation of our study is the fully automated BPE measurements, which alleviate the subjectivity of visual assessment [16, 20, 44]. Prior studies have used a qualitative approach to analyzing BPE when characterizing the relationship with breast cancer risk.…”

“…This challenges direct comparison of our results to those prior studies. However, it is plausible that the difference in the percent change of 12.7 and 32 % from pre-to-post intervention in BPE, we observed between the control group and the low- and high-dose groups, respectively, represent at least a quintile category shift of BPE data [16, 20], which has been associated with breast cancer risk odds ratios ranging from 3.3 up to 10.1 [16]. …”

Invited Commentary for “Preoperative Magnetic Resonance Imaging-Based Breast Volumetry for Immediate Breast Reconstruction”

“…Additionally, breast surgeons have explored the role of MRI in evaluation of the nipple areolar complex of BRCA 1/2 patients contemplating nipple sparing mastectomies [2]. Breast imagers have recently established that contrastenhanced MRI in BRCA-positive patients has a potential role in gaging the breast tissue's physiologic response to oophorectomies and hormonal manipulation [3]. Recent studies have also found characteristics and patterns of background parenchymal enhancement on MRI that may be valuable in determining an individual's risk for developing breast cancer [4,5].…”