Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients?

Park, S Y; Kang, Doo Kyoung; Kim, Tae Hyeon

doi:10.1259/bjr.20140638

Cited by 23 publications

(14 citation statements)

References 32 publications

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“…MR imaging is routinely used to monitor treatment response to neoadjuvant chemotherapy. Studies have suggested a correlation between various MR imaging parameters, such as baseline morphologic features, functional tumor volume, background parenchymal enhancement, and pCR in patients with HER2-positive breast cancer (23)(24)(25)(26)(27). These studies show good results, with some suggestion that MR imaging is more accurate in predicting pCR in ER-negative tumors (28).…”

Section: Discussionmentioning

confidence: 99%

Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

2018

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Purpose To determine the relationship between the presence or absence of mammographic calcifications in human epidermal growth factor receptor 2 (HER2)-positive breast cancers and pathologic complete response (pCR) to neoadjuvant chemotherapy and to determine other tumor and clinical characteristics that may be predictive of such a response. Materials and Methods A database of all patients with HER2-positive breast cancer who underwent neoadjuvant chemotherapy between 2007 and 2015 was retrospectively reviewed. Patient demographic characteristics, mammographic appearance, molecular subtype of cancer (luminal or nonluminal), radiologic response (based on breast magnetic resonance images), surgery, and pathologic response to treatment were recorded. Inter- and subgroup comparison was performed for presence of mammographic microcalcification and cancer subtype by using Mann-Whitney and χ tests and logistic regression. Results A total of 111 patients with a median age of 49 years (interquartile range, 40-57 years) were evaluated. Of these, 64.9% (72 of 111) had mammographic microcalcifications, 63.1% (70 of 111) had luminal B cancer, and 36.9% (41 of 111) had nonluminal HER2-positive cancer. Radiologic response to neoadjuvant chemotherapy was observed in 70.3% (78 of 111) of patients. Surgery was performed in 97.3% (108 of 111) of patients, and 30.6% (34 of 111) of patients underwent breast conservation. pCR was observed in 33.3% (37 of 111) of patients; 16.2% (18 of 111) showed residual ductal carcinoma in situ and 50.5% (56 of 111) had residual invasive disease. The pCR rate was the same (P = .21) in patients with mammographic microcalcification (29.2% [21 of 72]) as in those without calcification (41.0% [16 of 39]). The pCR rate in patients with nonluminal HER2-positive cancers (46.3% [19 of 41]) was higher (P = .01) than in those with luminal B cancers (25.7% [18 of 70]). pCR was associated with nonluminal HER2-positive subtype (odds ratio, 5.4; 95% confidence interval: 1.8, 16.0; P = .01) and complete radiologic response (odds ratio, 20.4; 95% confidence interval: 3.3, 126.6; P = .01). Conclusion Patients with HER2-positive cancer and mammographic microcalcification can achieve pCR after neoadjuvant chemotherapy. Nonluminal HER2-positive subtype and complete radiologic response are predictors of pCR.

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Section: Discussionmentioning

confidence: 99%

Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

2018

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“…In general, a higher risk of breast cancer is reported with increased BPE (8,9,39,40,43). Patients with increased BPE have an increased risk of tumors with positive resection margins (44). More pronounced stromal enhancement surrounding the tumor is related to extensive ductal carcinoma in situ (45).…”

Section: Discussionmentioning

confidence: 99%

Complementary Value of Contralateral Parenchymal Enhancement on DCE-MRI to Prognostic Models and Molecular Assays in High-risk ER+/HER2− Breast Cancer

Velden

Elias

Bismeijer

et al. 2017

Clinical Cancer Research

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To determine whether markers of healthy breast stroma are able to select a subgroup of patients at low risk of death or metastasis from patients considered at high risk according to routine markers of the tumor. Patients with ER/HER2 breast cancer were consecutively included for retrospective analysis. The contralateral parenchyma was segmented automatically on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), where upon the average of the top-10% late enhancement was calculated. This contralateral parenchymal enhancement (CPE) was analyzed with respect to routine prognostic models and molecular assays (Nottingham Prognostic Index, Dutch clinical chemotherapy-selection guidelines, 70-gene signature, and 21-gene recurrence score). CPE was split in tertiles and tested for overall and distant disease-free survival. CPE was adjusted for patient and tumor characteristics, as well as systemic therapy, using inverse probability weighting (IPW). Subanalyses were performed in patients at high risk according to prognostic models and molecular assays. Four-hundred-and-fifteen patients were included, constituting the same group in which the association between CPE and survival was discovered. Median follow-up was 85 months, 34/415(8%) patients succumbed. After IPW-adjustment for patient and tumor characteristics, patients with high CPE had significantly better overall survival than those with low CPE in groups at high risk according to the Nottingham Prognostic Index [HR (95% CI): 0.08 (0.00-0.40), < 0.001]; Dutch clinical guidelines [HR (95% CI): 0.22 (0.00-0.81), = 0.021]; and 21-gene recurrence score [HR (95% CI): 0.14 (0.00-0.84), = 0.030]. One group showed a trend [70-gene signature: HR (95% CI): 0.25 (0.00-1.02), = 0.054]. In patients at high risk based on the tumor, subgroups at relatively low risk were identified using pretreatment enhancement of the stroma on breast DCE-MRI. .

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“…Second, the rates of residual suspicious calcifications on post-excision mammography and residual malignancy in our study was higher than those previously reported. 12,25,26 However, excisions were performed in our study for pathologic confirmation and not for complete tumor removal.…”

Section: Gyeongmin Park Et Almentioning

confidence: 98%

Prediction of Residual Malignancy After Excisional Biopsy for Breast Cancer With Suspicious Microcalcifications: Comparison of Mammography and Magnetic Resonance Imaging

Park

Bae

Hwang

et al. 2019

Clinical Breast Cancer

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The ability of mammography and magnetic resonance imaging (MRI) to predict residual malignancy after excisional biopsy for microcalcifications and whether background parenchymal enhancement (BPE) on MRI influences diagnostic performance was assessed in 51 patients. MRI was more accurate than mammography; however, BPE decreased the diagnostic performance of MRI. Patients with breast cancer with moderate or marked BPE require careful assessment. Background: Whether surgery should be performed after excisional biopsy based on mammography or magnetic resonance imaging (MRI) findings has not been evaluated for breast cancer with suspicious microcalcifications on mammography. This study investigated the ability of mammography and MRI to predict residual malignancy after excisional biopsy for suspicious microcalcifications and whether background parenchymal enhancement (BPE) influences the diagnostic performance of MRI. Patients and Methods: Fifty-one patients with breast cancer who underwent excisional biopsy for suspicious microcalcifications between January 2009 and February 2019 were enrolled in this single-center retrospective study. Two expert readers independently evaluated the ability of mammography and MRI to predict residual malignancy at the surgical site. The diagnostic value of mammography and MRI was evaluated using histopathology as the standard. Results: Thirty-two patients had residual malignancy. The average overall sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve for residual malignancy were 78.

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Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients?

Cited by 23 publications

References 32 publications

Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

Human Epidermal Growth Factor 2–positive Breast Cancer with Mammographic Microcalcification: Relationship to Pathologic Complete Response after Neoadjuvant Chemotherapy

Complementary Value of Contralateral Parenchymal Enhancement on DCE-MRI to Prognostic Models and Molecular Assays in High-risk ER+/HER2− Breast Cancer

Prediction of Residual Malignancy After Excisional Biopsy for Breast Cancer With Suspicious Microcalcifications: Comparison of Mammography and Magnetic Resonance Imaging

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