Is Breast Background Parenchymal Enhancement on MRI Related to BI-RADS Score and Follow-Up Rate?

Afsaneh Alikhassi,Farzin Roozafzai,Sona Akbari Kia,Seyedeh Nooshin Miratashi Yazdi,Hedieh Akbari

doi:10.4236/abcr.2018.71002

Abstract

Objective: We investigated the correlations between background parenchymal enhancement (BPE) and MRI interpretations with respect to short-interval follow-ups and biopsy rates. Methods: All accessible MRI examinations from 128 women during a limited time period in 2016 were evaluated. A blinded radiologist visually categorized BPE as minimal, mild, moderate, or marked. A BI-RADS category was also assigned. We used descriptive statistics to report the findings and chi-square and Fisher’s exact tests to compare categories. Results: Prevalence of minimal, mild, moderate, and marked BPE was 14.1%, 43.0%, 32.0%, and 10.9%, respectively. The short-interval follow-up rates were 22.2%, 27.3%, 26.8%, and 7.1% in women with minimal, mild, moderate, and marked BPE, respectively. BPE was not associated with the short-interval follow-up rate (p-value = 0.477). Biopsy rates were 22.2%, 27.3%, 22.0%, and 57.1% in women with minimal, mild, moderate, and marked BPE, respectively. Although there was no significant relationship between biopsy rates and BPE levels (p-value = 0.095) in the total population, these two factors were significantly associated in premenopausal women (p-value = 0.023) and in women of 30 - 39 years (p-value = 0.001). Conclusion: Higher BPE does not correlate with short-interval follow-up rates, but appears to be related to biopsy rate, thus causing false-positives and unnecessary biopsy recommendations, particularly in younger, premenopausal women.

Highlights

Background parenchymal enhancement (BPE), representing normal fibro-glandular tissue enhancement in dynamic contrast-enhanced magnetic resonance imaging (MRI), corresponds to hormonally responsive glandular tissue [1]
We investigated the correlations between background parenchymal enhancement (BPE) and MRI interpretations with respect to short-interval follow-ups and biopsy rates
Some authors have suggested that an increased BPE has the possibility to obscure breast lesions and decrease MRI sensitivity for detection of breast cancer (BC) or may even be misinterpreted as a suspicious finding itself, leading to an increased false-positive biopsy rate and short-interval follow-up rate [4] [10] [11] [12], but some others believe BPE does not significantly affect the diagnostic accuracy of breast MRIs [13]

Summary

Introduction

Background parenchymal enhancement (BPE), representing normal fibro-glandular tissue enhancement in dynamic contrast-enhanced magnetic resonance imaging (MRI), corresponds to hormonally responsive glandular tissue [1]. Some authors have suggested that an increased BPE has the possibility to obscure breast lesions and decrease MRI sensitivity for detection of BC or may even be misinterpreted as a suspicious finding itself, leading to an increased false-positive biopsy rate and short-interval follow-up rate [4] [10] [11] [12], but some others believe BPE does not significantly affect the diagnostic accuracy of breast MRIs [13]. Imaging material and hormonal status affect BPE and can limit breast MRI interpretation [14] [15]. We aimed to investigate the correlations between BPE and the interpretation of MRI examinations with respect to BI-RADS scores, short-interval follow-up rates, and biopsy rates.

Methods

Results

Discussion

Conclusion