Background parenchymal enhancement: behavior during neoadjuvant chemotherapy for breast cancer and relationship with a pathological complete response.

Sandra Regina Campos Teixeira,Cesar Cabello,Hélio Sebastião Amâncio De Camargo Júnior

doi:10.1590/0100-3984.2019.0057

Abstract

ObjectiveTo evaluate background parenchymal enhancement (BPE) and its characteristics, as well as its behavior before and after neoadjuvant chemotherapy (NAC), in both breasts of patients with unilateral breast cancer.Materials and MethodsThis was a retrospective, cross-sectional observational study involving a consecutive sample of women with invasive breast cancer who underwent breast magnetic resonance imaging (MRI) between July 2007 and July 2017, as well as undergoing dynamic contrast-enhanced MRI before and after NAC. In both breasts, we evaluated the BPE in accordance with the Breast Imaging Reporting and Data System. We applied logistic regression analysis, and values of p < 0.05 were considered significant.ResultsWe evaluated 150 women. The mean age was 45.2 years (range, 20-74 years). The variables correlating independently with a high pre-NAC BPE, in the affected and contralateral breasts, were being under 50 years of age (odds ratio [OR] = 6.55; 95% confidence interval [95% CI]: 2.32-18.46, for both breasts) and a post-NAC BPE reduction (OR = 17.75; 95% CI: 4.94-63.73 and OR = 18.47; 95% CI: 5.19-66.49, respectively).ConclusionPatients with invasive unilateral breast cancer who have a high pre-NAC BPE in both breasts tend to be under 50 years of age and to show a post-NAC reduction in BPE.

Highlights

Neoadjuvant chemotherapy (NAC) has become a standard treatment for the triple-negative and human epidermal growth factor receptor 2 (HER2)-positive breast cancer subtypes[1,2]
We evaluated a consecutive sample of women with invasive breast cancer who were selected to undergo neoadjuvant chemotherapy (NAC) and who underwent DCE-magnetic resonance imaging (MRI) before and after the NAC
In addition to tumor enhancement on breast MRI, which has been shown to be an important marker of a response to NAC, another component, background parenchymal enhancement (BPE), appears to be a useful parameter in patients with unilateral breast cancer undergoing NAC

Summary

Introduction

Neoadjuvant chemotherapy (NAC) has become a standard treatment for the triple-negative and human epidermal growth factor receptor 2 (HER2)-positive breast cancer subtypes[1,2]. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been widely used in evaluating the response to NAC, allowing accurate measurement of tumor size at each stage of treatment[4,6]. It provides morphological information and functional information, through the evaluation of the many factors affecting contrast uptake by the tumor and normal breast tissue[7,8,9]. One of the main parameters evaluated in DCE-MRI is background parenchymal enhancement (BPE)

Methods

Results

Conclusion