Abstract
BackgroundWe investigated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) contrast enhancement kinetic variables quantified from normal breast parenchyma for association with presence of breast cancer, in a case-control study.MethodsUnder a Health Insurance Portability and Accountability Act compliant and Institutional Review Board-approved protocol, DCE-MRI scans of the contralateral breasts of 51 patients with cancer and 51 controls (matched by age and year of MRI) with biopsy-proven benign lesions were retrospectively analyzed. Applying fully automated computer algorithms on pre-contrast and multiple post-contrast MR sequences, two contrast enhancement kinetic variables, wash-in slope and signal enhancement ratio, were quantified from normal parenchyma of the contralateral breasts of both patients with cancer and controls. Conditional logistic regression was employed to assess association between these two measures and presence of breast cancer, with adjustment for other imaging factors including mammographic breast density and MRI background parenchymal enhancement (BPE). The area under the receiver operating characteristic curve (AUC) was used to assess the ability of the kinetic measures to distinguish patients with cancer from controls.ResultsWhen both kinetic measures were included in conditional logistic regression analysis, the odds ratio for breast cancer was 1.7 (95 % CI 1.1, 2.8; p = 0.017) for wash-in slope variance and 3.5 (95 % CI 1.2, 9.9; p = 0.019) for signal enhancement ratio volume, respectively. These odds ratios were similar on respective univariate analysis, and remained significant after adjustment for menopausal status, family history, and mammographic density. While percent BPE was associated with an odds ratio of 3.1 (95 % CI 1.2, 7.9; p = 0.018), in multivariable analysis of the three measures, percent BPE was non-significant (p = 0.897) and the two kinetics measures remained significant. For the differentiation of patients with cancer and controls, the unadjusted AUC was 0.71 using a combination of the two measures, which significantly (p = 0.005) outperformed either measure alone (AUC = 0.65 for wash-in slope variance and 0.63 for signal enhancement ratio volume).ConclusionsKinetic measures of wash-in slope and signal enhancement ratio quantified from normal parenchyma in DCE-MRI are jointly associated with presence of breast cancer, even after adjustment for mammographic density and BPE.
Highlights
We investigated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) contrast enhancement kinetic variables quantified from normal breast parenchyma for association with presence of breast cancer, in a case-control study
Based on mammography and/or ultrasound, 40 (78 %) of the 51 breasts studied in patients with cancer were classified as Breast Imaging-Reporting and Data System (BI-RADS) 5, and 47 (92 %) of the 51 breasts studied in controls with benign lesions were classified as BI-RADS 4
Of the 49 invasive cancers, 37 were estrogen receptor (ER)-positive or progesterone receptor (PR)-positive, including 9 that were positive for human epidermal growth factor receptor 2 (HER2); 10 were ER-negative and PR-negative; and 2 were missing receptor status
Summary
We investigated dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) contrast enhancement kinetic variables quantified from normal breast parenchyma for association with presence of breast cancer, in a case-control study. A set of common kinetic variables, such as wash-in slope, wash-out slope, time to peak, and peak enhancement, have been derived from the kinetic curves to specify characteristics of temporal contrast enhancement [14, 15], and have been associated with genetic estimates of breast cancer recurrence risk [16] and neoadjuvant chemotherapy response [17]. Other empirical variables of enhancement kinetics, such as the signal enhancement ratio (SER) computed based upon an early and a delayed post-contrast MR sequence, have been derived as an imaging biomarker and shown useful for predicting benignity/malignancy [18] and breast tumor response to chemotherapy [10]
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