Impact of Background Parenchymal Enhancement in Preoperative Magnetic Resonance Imaging Breast Assessment for Women with Newly Diagnosed Breast Cancer
WS Wan, CY Lee, CY Lui
Hong Kong J Radiol 2015;18:141-5
DOI: 10.12809/hkjr1514252
Objectives: To determine the influence of background parenchymal enhancement (BPE) in preoperative magnetic resonance imaging (MRI) breast assessment and its impact on subsequent management for patients with newly diagnosed breast cancer.
Methods: Consecutive patients with newly diagnosed breast cancer undergoing breast MRI examination for staging from January 2010 to July 2013 were retrospectively reviewed. The BPE categories of minimal, mild, moderate, or marked intensity (Breast Imaging Reporting and Data System MRI lexicon definitions) were retrospectively reported. Associations with abnormal interpretation rates (which defined as detection of additional findings other than the known malignant lesions that render clinical attention), presence of non-mass enhancement, mean number of additional breast masses, biopsy rates and cancer yield of additional lesions, mastectomy rates, and positive specimen margin rates for patients undergoing conservative breast treatment were compared using statistical tests.
Results: Of the 95 preoperative breast MRI examinations, women with marked enhancement had significantly higher additional abnormal interpretation rates (100.0%), rate of non-mass enhancement (85.7%), and mean number of additional breast masses (2.6 lesions per study) than those respective rates in women with moderate (65.0%; 35.0%; 1.2), mild (52.3%; 31.8%; 0.9), or minimal (41.7%; 20.8%; 0.3) enhancement (p < 0.05). No significant difference in other parameters among different BPE categories was observed.
Conclusions: Increased BPE on preoperative breast MRI was associated with higher abnormal interpretation rate, higher rates of non-mass enhancement, and an increased mean number of additional breast masses in women with known carcinoma of the breasts. However, it did not lead to significant difference in the subsequent management among the enhancement categories.
中文摘要
術前磁共振乳房評估中背景實質強化對乳腺癌患者的影響
溫詠雪、李芷茵、呂振英
目的：找出背景實質強化（BPE）對於術前磁共振成像（MRI）乳房評估以及對新診斷的乳腺癌患者的後續治療的影響。
方法：回顧分析2010年1月至2013年7月期間為腫瘤分期而接受乳腺MRI檢查的所有新診斷的乳腺癌患者資料。按BI-RADS MRI定義，把病例的BPE分級為最低、輕度、中等或顯著強化。採用統計檢驗比較以下幾方面與BPE的關係：判讀異常率（即除了已知的惡性病變外，檢測到額外病灶而引起臨床關注）、非腫塊強化、額外的乳腺腫塊的平均數量、活檢率和額外的癌症病變率、乳房切除率、接受保乳治療者的標本邊緣陽性率。
結果：接受術前乳腺MRI檢查的共有95例。BPE為顯著強化的病例的判讀異常率（100.0%）、非腫塊強化的出現率（85.7%）和額外的乳腺腫塊平均數量（每個病例平均有2.6個灶），都比其他分級的BPE病例顯著增高：中度BPE（依次為65.0%，35.0%，1.2），輕度BPE（52.3%，31.8%，0.9），以及最低BPE（41.7%，20.8%，0.3）；p值<0.05。其他參數於不同分級的BPE病例之間均無顯著差異。
結論：在乳癌確診患者中，術前乳房MRI顯示的BPE增加與較高的判讀異常率、非腫塊物質的發生率和額外的乳腺腫塊的平均增加數量有關。然而，不同BPE分級患者的後續治療無顯著差異。