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

Abstract

Background: For assessing the predictability of oncology neoadjuvant therapy results, the background parenchymal enhancement (BPE) parameter in breast magnetic resonance imaging (MRI) has acquired increased interest. This work aims to qualitatively evaluate the BPE parameter as a potential predictive marker for neoadjuvant therapy. Method: Three radiologists examined, in triple-blind modality, the MRIs of 80 patients performed before the start of chemotherapy, after three months from the start of treatment, and after surgery. They identified the portion of fibroglandular tissue (FGT) and BPE of the contralateral breast to the tumor in the basal control pre-treatment (baseline). Results: We observed a reduction of BPE classes in serial MRI checks performed during neoadjuvant therapy, as compared to baseline pre-treatment conditions, in 61.3% of patients in the intermediate step, and in 86.7% of patients in the final step. BPE reduction was significantly associated with sequential anthracyclines/taxane administration in the first cycle of neoadjuvant therapy compared to anti-HER2 containing therapies. The therapy response was also significantly related to tumor size. There were no associations with menopausal status, fibroglandular tissue (FGT) amount, age, BPE baseline, BPE in intermediate, and in the final MRI step. Conclusions: The measured variability of this parameter during therapy could predict therapy effectiveness in early stages, improving decision-making in the perspective of personalized medicine. Our preliminary results suggest that BPE may represent a predictive factor in response to neoadjuvant therapy in breast cancer, warranting future investigations in conjunction with radiomics.

Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer

“…In recent years, it has also been suggested to use background parenchymal enhancement (BPE) in the assessment of responses to NAC, which describes the enhancement of the normal breast tissue related to physiological vascularization. La Forgia et al, indicated that BPE is an important aspect that conditions the diagnosis and that it is a potential predictive factor in the response to neoadjuvant cancer therapies in graphic contrast examinations, as already confirmed in MRI and CESM examinations [ 46 , 47 , 48 ].…”

Radiomics Analysis of Multi-Phase DCE-MRI in Predicting Tumor Response to Neoadjuvant Therapy in Breast Cancer

“…Dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) is increasingly being used to evaluate the NAC response because of its high sensitivity and accuracy [10,11]. It not only reflects the morphological characteristics of the lesion, determining the size and boundary of the residual tumor, but also evaluates the changes in tissue function, microenvironment characteristics and metabolism [11][12][13][14].…”

Radiomics in Triple Negative Breast Cancer: New Horizons in an Aggressive Subtype of the Disease

“…Another factor associated with BPE reduction after initiating neoadjuvant therapy was tumor size. Analyzing the BPE obtained from breast MRI images, La Forgia and collaborators highlight the potential of the method to predict early the response to therapy but also mention the potential of including radiomic analysis in the algorithm for early prediction of response to neoadjuvant therapy in breast cancer [55].…”