Quantitative background parenchymal enhancement to predict recurrence after neoadjuvant chemotherapy for breast cancer

Abstract

Breast background parenchymal enhancement (BPE) is an increasingly studied MRI parameter that reflects the microvasculature of normal breast tissue, which has been shown to change during neoadjuvant chemotherapy (NAC) for breast cancer. We aimed at evaluating the BPE in patients undergoing NAC and its prognostic value to predict recurrence. MRI BPE was visually and quantitatively evaluated before and after NAC in a retrospective cohort of 102 women with unilateral biopsy-proven invasive breast cancer. Pre-therapeutic BPE was not predictive of pathological response or recurrence. Quantitative post-therapeutic BPE was significantly decreased compared to pre-therapeutic value. Post-therapeutic quantitative BPE significantly predicted recurrence (HR = 6.38 (0.71, 12.06), p < 0.05).

Response Predictivity to Neoadjuvant Therapies in Breast Cancer: A Qualitative Analysis of Background Parenchymal Enhancement in DCE-MRI

“…The qualitative measurement of these class parameters was also subject to inter-intra-observer variability [ 25 , 30 , 31 , 36 , 37 , 38 ] and would require the consensus of three radiologists through BIRADS criteria [ 20 , 39 ]. Therefore, an independent qualitative analysis with three different operators was carried out in order to minimize variability.…”

“…According to some previous studies, BPE is considered to be a potential predictor of response to neoadjuvant therapy [ 22 , 23 , 24 , 25 , 26 ]. In particular, the reduction in BPE intensity over time, measured by MRI in the disease-free breast, depends on the menopausal status and appears to be more associated with pCR than NAC.…”

“…This evaluation can be carried out by qualitative method, i.e., by the visual evaluation of one or more radiologists, or by automatic or semi-automatic quantitative methods [ 25 , 30 , 31 ]. It is important to note that assessing BPE using an objective and automated evaluation method may achieve opposite results [ 30 , 31 ].…”

Background Parenchymal Enhancement on Breast MRI: Assessment and Clinical Implications

“…Identifying imaging markers predictive of treatment response prior to the start of therapy would be even more beneficial. Unfortunately, most studies have found no correlation between pre-treatment BPE and pCR [74,[76][77][78], with a minority suggesting a link between pretreatment BPE and pCR [79].…”

“…In contrast, two recent studies have shown no correlation with recurrence [85,86]. Another study evaluated BPE qualitatively and quantitatively before and after NAC and found that only post-therapeutic quantitative BPE predicted recurrence [77]. In a systemic review by Rella et al, no significant association was found between BPE and invasiveness, histological cancer type, T-and N-stage, multifocality, lymphatic and vascular invasion, and histological tumor grade [ 70 • ].…”