Breast Magnetic Resonance Imaging Features Research Articles

Investigation of breast cancer molecular subtype in a multi-ethnic population using MRI.

Accurate subtyping of breast cancer is crucial for its diagnosis, management, and prognostication. This study aimed to determine the association of magnetic resonance imaging (MRI) breast features with the molecular subtype and aggressiveness of breast cancer in a multi-ethnic population. Treatment-naive patients with invasive breast carcinoma were included in this retrospective study. Breast MRI features were recorded based on the American College of Radiology-Breast Imaging Reporting and Data System (ACR-BIRADS) criteria, with tumour size, and apparent diffusion coefficient value (ADC). The statistical association was tested with Pearson Chi-Square Test of Independence for categorical data or the Kruskal-Wallis/ Mann Whitney U test for numerical data between the MRI features and molecular subtype, receptor status, tumour grade, lymphovascular infiltration (LVI) and axillary lymph node (ALN). Multinomial logistic regression was used to test the predictive likelihood of the significant features. The breast cancer subtypes were determined via immunohistochemistry (IHC) and dual-color dual-hapten in-situ hybridization (D-DISH). The expression statuses of ER, PR, and HER-2, LVI, and ALN were obtained from the histopathology report. The ER / PR / HER-2 was evaluated according to the American Society of Clinical Oncology / College of American Pathologists. The study included 194 patients; 41.8% (n = 81) Chinese, 40.7% (n = 79) Malay, and 17.5% (n = 34) Indian, involving 71.6%(n = 139) luminal-like, 12.9%(n = 25) HER-2 enriched, and 15.5%(n = 30) Triple-negative breast cancer (TNBC). TNBC was associated with rim enhancement (p = 0.002) and peritumoral oedema (p = 0.004). HER-2 enriched tumour was associated with larger tumour size (p = 0.041). Luminal-like cancer was associated with irregular shape (p = 0.005) with circumscribed margin (p = 0.003). Other associations were ER-negative tumour with circumscribed margin (p = 0.002) and PR-negative with round shape (p = 0.001). Tumour sizes were larger in ER-negative (p = 0.044) and PR-negative (p = 0.022). Rim enhancement was significantly associated with higher grade (p = 0.001), and moderate peritumoral oedema with positive axillary lymph node (p = 0.002). Certain MRI features can be applied to differentiate breast cancer molecular subtypes, receptor status and aggressiveness, even in a multi-ethnic population.

Associations of Multiparametric Breast MRI Features, Tumor-Infiltrating Lymphocytes, and Immune Gene Signature Scores Following a Single Dose of Trastuzumab in HER2-Positive Early-Stage Breast Cancer.

Dynamic biomarkers that permit the real-time monitoring of the tumor microenvironment response to therapy are an unmet need in breast cancer. Breast magnetic resonance imaging (MRI) has demonstrated value as a predictor of pathologic complete response and may reflect immune cell changes in the tumor microenvironment. The purpose of this pilot study was to investigate the value of breast MRI features as early markers of treatment-induced immune response. Fourteen patients with early HER2+ breast cancer were enrolled in a window-of-opportunity study where a single dose of trastuzumab was administered and both tissue and MRIs were obtained at the pre- and post-treatment stages. Functional diffusion-weighted and dynamic contrast-enhanced MRI tumor measures were compared with tumor-infiltrating lymphocytes (TILs) and RNA immune signature scores. Both the pre-treatment apparent diffusion coefficient (ADC) and the change in peak percent enhancement (DPE) were associated with increased tumor-infiltrating lymphocytes with trastuzumab therapy (r = -0.67 and -0.69, p < 0.01 and p < 0.01, respectively). Low pre-treatment ADC and a greater decrease in PE in response to treatment were also associated with immune-activated tumor microenvironments as defined by RNA immune signatures. Breast MRI features hold promise as biomarkers of early immune response to treatment in HER2+ breast cancer.

Preoperative breast MRI features associated with positive or close margins in breast-conserving surgery

PurposeTo determine preoperative magnetic resonance imaging (MRI) features associated with positive or close margins in patients with breast cancer who underwent breast-conserving surgery (BCS). Materials and methodsA retrospective review identified 249 patients with invasive ductal carcinoma (IDC) who underwent preoperative MRI and BCS as a primary procedure between 2008 and 2010. The MR images were reviewed for descriptions of findings with no new interpretations made. Margins were defined as positive (tumor touching the inked specimen margin), close (<2 mm tumor-free margin), or negative (≥2 mm tumor-free margin). Multivariate logistic regression analysis was performed to evaluate imaging and clinical factors predictive of positive or close margins. ResultsOf the 249 patients, 83 (33.3%) had positive or close margins and 166 (66.7%) had negative margins on the initial BCS specimen. Multivariate analysis showed that multifocal disease (odds ratio, 4.8; 95% CI, 1.9–12.2; p = 0.001), nonmass enhancement lesion (odds ratio, 3.0; 95% CI, 1.5–6.2, p = 0.003), greater background parenchymal enhancement (odds ratio, 2.5; 95% CI, 1.1–5.6; p = 0.023), larger lesion size (odds ratio, 1.3; 95% CI, 1.0–1.7, p = 0.032), and presence of ductal carcinoma in situ on needle biopsy (odds ratio, 2.4; 95% CI, 1.3–4.6; p = 0.008) were independent predictors of positive or close margins. ConclusionsMultifocal disease, nonmass enhancement lesion, or greater background parenchymal enhancement on preoperative breast MRI were significantly associated with positive or close margins. Identifying these MRI features before surgery can be helpful to reduce the reoperation rate in BCS.

Ductal Carcinoma in Situ: Quantitative Preoperative Breast MR Imaging Features Associated with Recurrence after Treatment.

Purpose To investigate whether specific imaging features on breast magnetic resonance (MR) images are associated with ductal carcinoma in situ (DCIS) recurrence risk after definitive treatment. Materials and Methods Patients with DCIS who underwent preoperative dynamic contrast material-enhanced (DCE) MR imaging between 2004 and 2014 with ipsilateral recurrence more than 6 months after definitive surgical treatment were retrospectively identified. For each patient, a control subject with DCIS that did not recur was identified and matched on the basis of clinical, histopathologic, and treatment features known to affect recurrence risk. On DCE MR images, lesion characteristics (longest diameter, functional tumor volume [FTV], peak percentage enhancement [PE], peak signal enhancement ratio [SER], and washout fraction) and normal tissue features (background parenchymal enhancement [BPE] volume, mean BPE) were quantitatively measured. MR imaging features were compared between patients and control subjects by using the Wilcoxon signed-rank test, with adjustment for multiple comparisons. Results Of 415 subjects with DCIS who underwent preoperative MR imaging, 14 experienced recurrence and 11 had an identifiable matching control subject (final cohort, 11 patients and 11 control subjects). Median time to recurrence was 14 months, and median follow-up for control subjects was 102 months. When compared with matched control subjects, patients with DCIS recurrence exhibited significantly greater FTV (median, 9.3 cm3 vs 1.3 cm3, P = .01), lesion peak SER (median, 1.7 vs 1.2; P = .03), and mean BPE (median, 58.3% vs 41.1%; P = .02). Conclusion Quantitative lesion and normal breast tissue characteristics at preoperative MR imaging in women with newly diagnosed DCIS show promise for association with breast cancer recurrence after treatment. © RSNA, 2017.

Qualitative Radiogenomics: Association between Oncotype DX Test Recurrence Score and BI-RADS Mammographic and Breast MR Imaging Features.

Purpose To evaluate the association between Breast Imaging Reporting and Data System (BI-RADS) mammographic and magnetic resonance (MR) imaging features and breast cancer recurrence risk in patients with estrogen receptor-positive breast cancer who underwent the Oncotype DX assay. Materials and Methods In this institutional review board-approved and HIPAA-compliant protocol, 408 patients diagnosed with invasive breast cancer between 2004 and 2013 who underwent the Oncotype DX assay were identified. Mammographic and MR imaging features were retrospectively collected according to the BI-RADS lexicon. Linear regression assessed the association between imaging features and Oncotype DX test recurrence score (ODxRS), and post hoc pairwise comparisons assessed ODxRS means by using imaging features. Results Mammographic breast density was inversely associated with ODxRS (P ≤ .05). Average ODxRS for density category A was 24.4 and that for density category D was 16.5 (P < .02). Both indistinct mass margins and fine linear branching calcifications at mammography were significantly associated with higher ODxRS (P < .01 and P < .03, respectively). Masses with indistinct margins had an average ODxRS of 31.3, which significantly differed from the ODxRS of 18.5 for all other mass margins (P < .01). The average ODxRS for fine linear branching calcifications was 29.6, whereas the ODxRS for all other suspicious calcification morphologies was 19.4 (P < .03). Average ODxRS was significantly higher for irregular mass margins at MR imaging compared with spiculated mass margins (24.0 vs 17.6; P < .02). The presence of nonmass enhancement at MR imaging was associated with lower ODxRS than was its absence (16.4 vs 19.9; P < .05). Conclusion The BI-RADS features of mammographic breast density, calcification morphology, mass margins at mammography and MR imaging, and nonmass enhancement at MR imaging have the potential to serve as imaging biomarkers of breast cancer recurrence risk. Further prospective studies involving larger patient cohorts are needed to validate these preliminary findings. © RSNA, 2017 Online supplemental material is available for this article.

Association of preoperative breast MRI features with locoregional recurrence after breast conservation therapy.

Background Locoregional recurrence (LRR) following breast conservation therapy (BCT) is associated with an increased risk of distant metastasis and death in patients with breast cancer. Purpose To investigate whether preoperative breast magnetic resonance imaging (MRI) features are associated with the risk of LRR in patients undergoing BCT. Material and Methods A total of 3781 women with primary invasive breast cancer underwent preoperative MRI and BCT between 2003 and 2013. Forty-eight patients who developed LRR comprised the LRR cohort and one-to-one matching (age, tumor stage, grade, and axillary nodal status) of each patient to a control participant was performed in patients who did not develop recurrence. Three readers independently reviewed MR images of the index cancer and the presence of multifocal disease was assessed. Χ2 analysis was used to compare imaging and clinical features between LRR and control cohorts, with multivariate logistic regression analysis used to identify independent features. Results Significant differences were found in the proportion of multifocal disease ( P = 0.001), background parenchymal enhancement level ( P = 0.007), and breast cancer molecular subtype ( P = 0.01) between LRR and control cohorts. Multivariate analysis showed that multifocal disease (odds ratio [OR] = 11.9; 95% confidence interval [CI] = 1.4-102.5; P = 0.02) and human epidermal growth factor receptor 2-positive subtype (OR = 12.7; 95% CI = 1.3-127.6; P = 0.03) were both independently associated with LRR. Conclusion Multifocal disease on preoperative breast MRI may indicate an increased risk of LRR in patients treated with BCT.

MR imaging features associated with distant metastasis-free survival of patients with invasive breast cancer: a case-control study.

Preoperative breast magnetic resonance (MR) imaging features of primary breast cancers may have the potential to act as prognostic biomarkers by providing morphologic and kinetic features representing inter- or intra-tumor heterogeneity. Recent radiogenomic studies reveal that several radiologist-annotated image features are associated with genes or signal pathways involved in tumor progression, treatment resistance, and distant metastasis (DM). We investigate whether preoperative breast MR imaging features are associated with worse DM-free survival in patients with invasive breast cancer. Of the 3536 patients with primary breast cancers who underwent preoperative MR imaging between 2003 and 2009, 147 patients with DM were identified and one-to-one matched with control patients (n=147) without DM according to clinical-pathologic variables. Three radiologists independently reviewed the MR images of 294 patients, and the association of DM-free survival with MR imaging and clinical-pathologic features was assessed using Cox proportional hazard models. Of MR imaging features, rim enhancement (hazard ratio [HR], 1.83 [95% confidence interval, CI 1.29, 2.51]; p=0.001) and peritumoral edema (HR, 1.48 [95% CI 1.03, 2.11]; p=0.032) were the significant features associated with worse DM-free survival. The significant MR imaging features, however, were different between breast cancer subtypes and stages. Preoperative breast MR imaging features of rim enhancement and peritumoral edema may be used as prognostic biomarkers that help predict DM risk in patients with breast cancer, thereby potentially enabling improved personalized treatment and monitoring strategies for individual patients.

Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components

PurposeDuctal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery. Materials and methodsPatients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components. ResultsOf the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens. ConclusionInvasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression.

The Clinical Significance of Breast MRI in the Management of Ductal Carcinoma In Situ Diagnosed on Needle Biopsy

To identify the factors associated with invasive disease in ductal carcinoma in situ diagnosed on needle biopsy by analyzing breast magnetic resonance imaging findings with the histopathological factors of biopsy specimens. This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. Seventy-five ductal carcinoma in situ patients diagnosed by needle biopsy who underwent preoperative magnetic resonance imaging were retrospectively reviewed. The magnetic resonance imaging and histopathological variables were assessed between pure ductal carcinoma in situ and invasive breast cancer diagnosed on surgical specimens. Multivariable analyses were performed to determine the independent factors for invasion using a logistic-regression model. The median age of patients was 55 (34-76) years. On dynamic magnetic resonance imaging, 60 cases out of 75 (80%) were classified as non-mass-like enhancement type and 15/75 (20%) were Mass type. In non-mass-like enhancement, 11/60 (18%) were ultimately diagnosed as invasive breast cancer. Lesion size (P = 0.027), signal intensity ratios (calculated as the signal intensity of detected lesions divided by the signal intensity of surrounding normal breast tissue; P = 0.032) on magnetic resonance imaging and the number of biopsy-cores containing cancer nests (P = 0.012) were each independently associated with invasion. Furthermore, each signal intensity ratio of invasive and non-invasive components of invasive breast cancer represented a value significantly higher than that of 49 pure ductal carcinoma in situ classified as non-mass-like enhancement (P = 0.001 and P = 0.034, respectively). Conversely, there were no significant magnetic resonance imaging findings to distinguish seven invasive breast cancer from among Mass type. Needle-biopsy-proven ductal carcinoma in situ cases with non-mass-like enhancement type might be sufficiently managed using breast magnetic resonance imaging features such as enhanced lesion size and signal intensity, incorporating the number of cancer-cores at needle biopsy specimen in the clinical setting.

Automated chest wall line detection for whole‐breast segmentation in sagittal breast MR images

Breast magnetic resonance imaging (MRI) plays an important role in the clinical management of breast cancer. Computerized analysis is increasingly used to quantify breast MRI features in applications such as computer-aided lesion detection and fibroglandular tissue estimation for breast cancer risk assessment. Automated segmentation of the whole-breast as an organ from the other parts imaged is an important step in aiding lesion localization and fibroglandular tissue quantification. For this task, identifying the chest wall line (CWL) is most challenging due to image contrast variations, intensity discontinuity, and bias field. In this work, the authors develop and validate a fully automated image processing algorithm for accurate delineation of the CWL in sagittal breast MRI. The CWL detection is based on an integrated scheme of edge extraction and CWL candidate evaluation. The edge extraction consists of applying edge-enhancing filters and an edge linking algorithm. Increased accuracy is achieved by the synergistic use of multiple image inputs for edge extraction, where multiple CWL candidates are evaluated by the dynamic time warping algorithm coupled with the construction of a CWL reference. Their method is quantitatively validated by a dataset of 60 3D bilateral sagittal breast MRI scans (in total 3360 2D MR slices) that span the full American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) breast density range. Agreement with manual segmentation obtained by an experienced breast imaging radiologist is assessed by both volumetric and boundary-based metrics, including four quantitative measures. In terms of breast volume agreement with manual segmentation, the overlay percentage expressed by the Dice's similarity coefficient is 95.0% and the difference percentage is 10.1%. More specifically, for the segmentation accuracy of the CWL boundary, the CWL overlay percentage is 92.7% and averaged deviation distance is 2.3 mm. Their method requires ≈ 4.5 min for segmenting each 3D breast MRI scan (56 slices) in comparison to ≈ 35 min required for manual segmentation. Further analysis indicates that the segmentation performance of their method is relatively stable across the different BI-RADS density categories and breast volume, and also robust with respect to a varying range of the major parameters of the algorithm. Their fully automated method achieves high segmentation accuracy in a time-efficient manner. It could support large scale quantitative breast MRI analysis and holds the potential to become integrated into the clinical workflow for breast cancer clinical applications in the future.

Inflammatory breast cancer: defining breast magnetic resonance imaging features.

Abstract Abstract #4008 PURPOSE: &amp;#x2028; Inflammatory breast carcinoma (IBC) is an aggressive cancer with radiological and clinical features of a heterogeneous disease. The clinical presentation of IBC is characterized by the sudden onset of breast erythema and edema, often without an associated palpable breast mass. Mammography is associated with variable, not descriptive findings and it is often not diagnostic. We planned to address the role of Magnetic Resonance Imaging (MRI) of the breast in women with newly diagnosed IBC.&amp;#x2028; MATERIALS AND METHODS:&amp;#x2028; We performed a retrospective analysis of newly diagnosed IBC cases evaluated at the University of Texas. M D Anderson Cancer Center between December 2003 and February 2008. Baseline breast MRI exams were performed on 1.5-Tesla (T) or 3.0-T GE scanners and included dynamic three-dimensional T1-weighted fast spoiled gradient echo sequences with parallel imaging after a bolus injection of gadolinium based IV contrast. Exams were reviewed in batches and the findings rated in accordance with the ACR BI-RADS MRI Lexicon. The following parameters were evaluated; presence and characteristics of breast masses and skin description. All patients had concomitant mammograms and ultrasound exams.&amp;#x2028; RESULTS: &amp;#x2028; Eighty women with a clinical diagnosis of IBC were included in the study with a median age of 52 years, (range, 25 to 78). MRI detected a primary breast lesion in 80 of 82 symptomatic breasts (98%), compared to only 53 of 78 (68%) with mammogram (p &amp;lt; 0.0001). The most common MRI morphologic characteristic of the lesions was irregular margins (72%) with heterogeneous internal enhancement (82%). Qualitative evaluation of the enhancement pattern demonstrated wash-out in 85% of the cases.&amp;#x2028; MRI detected skin thickening in 90% of the patients (average skin thickness of 8 mm [range, 4-17 mm]), compared to 69% with mammogram. Heterogeneous skin enhancement (82%) and nodular or irregular skin lesions (43%) were identified only with MRI. These skin lesions demonstrated a progressive enhancing pattern, in contrast to the rapid wash-out pattern expected for malignant breast lesion.&amp;#x2028; CONCLUSIONS: &amp;#x2028; This study establishes breast MRI as the most sensitive and accurate imaging modality in assessing the breast of IBC patients. The most common radiological features are represented by the presence of a primary breast lesion and global skin thickening with heterogeneous skin enhancement. The combination of morphology and enhancing pattern may provide information to understand the biology of this disease and accurately monitor residual disease during neoadjuvant therapies. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4008.