Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk

• Published in: Academic radiology Vol. 26; no. 1; p. 69
• Main Authors: Grimm, Lars J, Saha, Ashirbani, Ghate, Sujata V, Kim, Connie, Soo, Mary Scott, Yoon, Sora C, Mazurowski, Maciej A
• Format: Journal Article
• Language: English
• Published: United States 01.01.2019
• Subjects: Adult; Aged; Breast - diagnostic imaging; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - epidemiology; Carcinoma, Ductal, Breast - epidemiology; Carcinoma, Intraductal, Noninfiltrating - epidemiology; Carcinoma, Lobular - epidemiology; Cohort Studies; Early Detection of Cancer; Female; Humans; Magnetic Resonance Imaging; Middle Aged; North Carolina - epidemiology; Parenchymal Tissue - diagnostic imaging; Retrospective Studies; Risk Factors; Young Adult; North Carolina; screening; high-risk; MRI; DCIS
• ISSN: 1878-4046
• DOI: 10.1016/j.acra.2018.03.013

To determine if background parenchymal enhancement (BPE) on screening breast magnetic resonance imaging (MRI) in high-risk women correlates with future cancer. All screening breast MRIs (n = 1039) in high-risk women at our institution from August 1, 2004, to July 30, 2013, were identified. Sixty-one patients who subsequently developed breast cancer were matched 1:2 by age and high-risk indication with patients who did not develop breast cancer (n = 122). Five fellowship-trained breast radiologists independently recorded the BPE. The median reader BPE for each case was calculated and compared between the cancer and control cohorts. Cancer cohort patients were high-risk because of a history of radiation therapy (10%, 6 of 61), high-risk lesion (18%, 11 of 61), or breast cancer (30%, 18 of 61); BRCA mutation (18%, 11 of 61); or family history (25%, 15 of 61). Subsequent malignancies were invasive ductal carcinoma (64%, 39 of 61), ductal carcinoma in situ (30%, 18 of 61) and invasive lobular carcinoma (7%, 4of 61). BPE was significantly higher in the cancer cohort than in the control cohort (P = 0.01). Women with mild, moderate, or marked BPE were 2.5 times more likely to develop breast cancer than women with minimal BPE (odds ratio = 2.5, 95% confidence interval: 1.3-4.8, P = .005). There was fair interreader agreement (κ = 0.39). High-risk women with greater than minimal BPE at screening MRI have increased risk of future breast cancer.