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Kim, Kim, Baik, Kim, and Kang: Background Parenchymal Enhancement on Breast MRI in Breast Cancer Patients : Impact on Biopsy Rate and Cancer Yield
Original Article

Journal of the Korean Society of Magnetic Resonance in Medicine 2013; 17(3): 224-231.

Published online: 30 September 2013

DOI: https://doi.org/10.13104/jksmrm.2013.17.3.224

Background Parenchymal Enhancement on Breast MRI in Breast Cancer Patients : Impact on Biopsy Rate and Cancer Yield

Tae Yun Kim, Sung Hun Kim, Jee Eun Baik, Yun Joo Kim, Bong Joo Kang

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.

Corresponding author: Sung Hun Kim, M.D. Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel. 82-2-2258-1455, Fax. 82-2-2258-1457, rad-ksh@catholic.ac.kr

Received 9 July 2013       Revised 28 August 2013       Accepted 6 September 2013

Copyright © 2013 Journal of the Korean Society of Magnetic Resonance in Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the potential effects of background parenchymal enhancement of MR imaging in diagnosed breast cancer patients on the rate of additional biopsy and resultant cancer yield.

Materials and Methods

322 patients who were diagnosed with breast cancer and had undergone breast MR imaging were included in this study. Two radiologists reviewed the MRI for degree of background parenchymal enhancement and additional suspicious lesions described as BI-RADS category 4 or 5 on radiologic reports. Biopsy was done for these lesions, pathology reports were reviewed to calculate the cancer yield.

Results

Background parenchymal enhancement of MR imaging in a total of 322 patients were classified as minimal degree 47.5%, mild degree 28.9%, moderate degree 12.4% and marked degree 11.2%. Among these 332 patients, MR imaging of 70 patients showed additional suspicious malignant lesions described as BI-RADS category 4 or 5, and consequently, 66 patients underwent biopsy. Biopsy rates in those with minimal or mild background parenchymal enhancement and those with moderate and marked background parenchymal enhancement were 19.9% and 22.3% (p-value 0.77) respectively. Cancer yields in those with minimal or mild background parenchymal enhancement and those with moderate and marked background parenchymal enhancement were 6.5% and 5.2% (p value 0.88) respectively. Both these results did not show stastically significant difference between the two groups.

Conclusion

The degree of background parenchymal enhancement in MR imaging of breast cancer patients did not significantly impact additional biopsy rates or cancer yields.

Keywords: Breast, Magnetic resonance imaging, Image-guided biopsy, Breast cancer

Figures and Tables

Fig. 1
A 57-year-old woman with right breast cancer and minimal parenchymal enhancement.
a. Axial early T1-weighted contrast-enhanced MR subtraction image shows minimal parenchymal enhancement.
b. On Maximum-intensity-projection (MIP) image, there is index cancer in the right breast (arrow). Another lobular, homogeneously enhancing mass is seen in the left breast (arrow head), which was classified as BI-RADS category C4A, low suspicion of malignancy, and proved to be fibrocystic disease (FCD) on US-guided biopsy.
jksmrm-17-224-g001
Fig. 2
A 46-year-old woman with left breast cancer and minimal parenchymal enhancement.
a. Axial early T1-weighted contrast-enhanced MR subtraction image shows minimal parenchymal enhancement.
b. On MIP image, two pathologic proven invasive ductal carcinomas are noted at the 10-11 o'clock direction of left breast (arrow heads). Another enhancing mass is seen at the 3 o'clock direction of left breast (arrow).
c. Axial T1-weighted contrast-enhanced MRI with fat supression at early dynamic phase shows this mass to be an enhancing, oval, spiculated mass in the left breast (arrow), consistent with BI-RADS category C4C, moderate suspicion of malignancy.
d. An irregular, spiculated, non-parallel-oriented mass is detected on 2nd look US, which corresponds to the lesion on MRI and later proved to be invasive ductal carcinoma on US-guided biopsy.
jksmrm-17-224-g002
Fig. 3
A 46-year-old woman with right breast cancer and marked parenchymal enhancement.
a. Axial early T1-weighted contrast-enhanced MR subtraction image shows marked parenchymal enhancement and an index cancer (arrow), known invasive lobular carcinoma, in the right breast.
b. Axial T1-weighted contrast-enhanced MRI with fat supression at early dynamic phase shows another oval, homogeneously enhancing mass at the 11 o'clock direction of right breast (arrow head), which was classified as BI-RADS category C4A, low suspicion of malignancy.
c. Kinetic curve of the mass at the 11 o'clock direction shows delayed washout pattern; the mass proved to be lobular carcinoma in situ (LCIS) on US-guided biopsy.
jksmrm-17-224-g003
Fig. 4
A 40-year-old woman with left breast cancer and moderate parenchymal enhancement.
a. Axial early T1-weighted contrast-enhanced MR subtraction image shows moderate parenchymal enhancement.
b. MIP image shows moderate parenchymal enhancement and an index cancer, known invasive ductal carcinoma, in the left breast (arrow). Another enhancing mass similar to the index cancer is seen in the right breast (arrow head).
c. On axial T1-weighted contrast-enhanced MRI with fat supression at early dynamic phase, an lobular, heterogeneously enhancing mass is seen in the right breast (arrow head), which was categorized as BI-RADS C4C, moderate suspicion of malignancy,
d. The kinetic curve of the right breast mass shows delayed washout pattern. The mass proved to be tubular adenoma on US-guided biopsy.
jksmrm-17-224-g004
Table 1
Biopsy rate, Cancer rate, MR Assessment according to Background Parenchymal Enhancement
jksmrm-17-224-i001

Note.- 1)BPE-background parenchymal enhancement 1(minimal degree), 2(mild degree), 3(moderate degree), 4(marked degree)

2)C4A-BI-RADS category low suspicion of malignancy

3)C4B-BI-RADS category intermediate suspicion of malignancy

4)C4C-BI-RADS category moderate suspicion of malignancy

5)C5-BI-RADS category, highly suggestive of malignancy

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