Changes in background parenchymal enhancement in HER2-positive breast cancer before and after neoadjuvant chemotherapy

Abstract

This study aimed to analyze the relationship between pathologic complete response (pCR) and changes in background parenchymal enhancement (BPE) levels in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and who received neoadjuvant chemotherapy (NAC).The pre- and post-NAC magnetic resonance imaging results of 51 patients with confirmed unilateral HER2-positive breast cancer were retrospectively analyzed by 2 experienced radiologists. Pre- and post-NAC of contralateral BPE levels were classified into 4 categories (1 = minimal, 2 = mild, 3 = moderate, and 4 = marked). The 4 categories of BPE were defined by the visually estimated enhancement of fibroglandular tissue of the breast. Changes in BPE before and after NAC were compared between the premenopausal and postmenopausal groups and between the pCR and non-pCR groups. The associations between BPE and pCR and between BPE and tumor size were analyzed before and after NAC.Twenty-three patients achieved pCR, and 28 patients achieved non-pCR. Premenopausal patients had significantly higher baseline BPE levels than postmenopausal women (P = .023). The post-NAC BPE levels of premenopausal patients significantly decreased relative to those of postmenopausal patients (P = .027). The baseline BPE levels of the pCR group were not significantly different from those of the non-pCR group (P = .892). However, the decrease in BPE levels in the pCR group was more drastic than that in the non-pCR group (P < .001). Decreased BPE levels were directly associated with pCR and tumor size reduction (P < .05). Women with hormone receptor (HR)-negative tumors were more likely to exhibit pCR than those with HR-positive tumors (P = .007).Decreased BPE of patients with HER2-positive breast cancer may serve as an indicator of NAC effectiveness. Furthermore, women with HR-negative tumors were more likely to exhibit pCR than women with HR-positive tumors.

MRI background parenchymal enhancement, fibroglandular tissue, and mammographic breast density in patients with invasive lobular breast cancer on adjuvant endocrine hormonal treatment: associations with survival

“…It did not evaluate response to adjuvant endocrine treatment. A similar study by Dong et al [ 49 ] produced similar results in HER2+ tumors. In patients undergoing reducing salpingo-oophorectomy, Bermot et al [ 50 ] showed that the reduction in BPE and FGT before and after risk-reducing salpingo-oophorectomy in women with high genetic risk of breast cancer was correlated with a higher risk of subsequent breast cancer compared to patients with stable BPE.…”

Evaluation of Concordance Between Histopathological, Radiological and Biomolecular Variables in Breast Cancer Neoadjuvant Treatment

“…Given an average follow-up period of 5.3 years, we highlighted how the achievement of pCR has been an endpoint of primary importance because it was associated with a higher percentage of EFS (37) compared to those who did not reach EFS 76.7% vs. 72.8% (Table VI). The same result was also observed in the OS analysis, in which the percentage was always higher in the pCR+ population (37), 96.1% against 88.4% compared to pCR-, which still presented with neoplasia in the final histological examination after surgery (Table VI). Analysis of EFS and OS scores based on the Lum and NLum subdivision of mammary carcinomas demonstrated that in luminal subjects the percentages of EFS and OS did not differ significantly with respect to pCR achievement, i.e.…”

“…Randomized studies have not actually shown a clear increase in the overall survival of patients following neoadjuvant therapy, therefore the pre-operative and post-operative systemic strategy appear to be equivalent (10)(11)(12)(13)(14)(15). Patients with total absence of BC after NAC, namely pathological complete response (pCR), demonstrate an advantage in overall survival (OS) and eventsfree survival (EFS) as recently confirmed by a metanalysis study presented at the San Antonio Breast Cancer Symposium in 2018 (16)(17)(18), where Spring et al showed that patients who obtained a pCR had reduced relapse probability of 69% than their counterparts with residual disease [HR=0.31, 95% probability intervals (PI)=0, [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (16). The importance of NAC has been suggested by oncological clinical studies; in fact, pCR rate is routinely used as a surrogate outcome related to OS and EFS in new drug development in biological and immunological therapy (19,20).…”

Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer

“…A decrease in background parenchymal enhancement between pretreatment and posttreatment MRI is associated with pCR and tumor size reduction. [57][58][59][60][61] This is most likely due to vascular injury inflicted by the therapy.…”

“…The overall decrease in enhancement after of chemotherapy has been found to be a prognostic factor itself. A decrease in background parenchymal enhancement between pretreatment and posttreatment MRI is associated with pCR and tumor size reduction 57–61 . This is most likely due to vascular injury inflicted by the therapy.…”