Underwent Breast Magnetic Resonance Imaging Research Articles

Features from Computerized Texture Analysis of Breast Cancers at Pretreatment MR Imaging Are Associated with Response to Neoadjuvant Chemotherapy.

Purpose To evaluate whether features from texture analysis of breast cancers were associated with pathologic complete response (pCR) after neoadjuvant chemotherapy and to explore the association between texture features and tumor subtypes at pretreatment magnetic resonance (MR) imaging. Materials and Methods Institutional review board approval was obtained. This retrospective study included 85 patients with 85 breast cancers who underwent breast MR imaging before neoadjuvant chemotherapy between April 10, 2008, and March 12, 2015. Two-dimensional texture analysis was performed by using software at T2-weighted MR imaging and contrast material-enhanced T1-weighted MR imaging. Quantitative parameters were compared between patients with pCR and those with non-pCR and between patients with triple-negative breast cancer and those with non-triple-negative cancer. Multiple logistic regression analysis was used to determine independent parameters. Results Eighteen tumors (22%) were triple-negative breast cancers. pCR was achieved in 30 of the 85 tumors (35%). At univariate analysis, mean pixel intensity with spatial scaling factor (SSF) of 2 and 4 on T2-weighted images and kurtosis on contrast-enhanced T1-weighted images showed a significant difference between triple-negative breast cancer and non-triple-negative breast cancer (P = .009, .003, and .001, respectively). Kurtosis (SSF, 2) on T2-weighted images showed a significant difference between pCR and non-pCR (P = .015). At multiple logistic regression, kurtosis on T2-weighted images was independently associated with pCR in non-triple-negative breast cancer (P = .033). A multivariate model incorporating T2-weighted and contrast-enhanced T1-weighted kurtosis showed good performance for the identification of triple-negative breast cancer (area under the receiver operating characteristic curve, 0.834). Conclusion At pretreatment MR imaging, kurtosis appears to be associated with pCR to neoadjuvant chemotherapy in non-triple-negative breast cancer and may be a promising biomarker for the identification of triple-negative breast cancer. © RSNA, 2017.

Newly Diagnosed Breast Cancer: Comparison of Contrast-enhanced Spectral Mammography and Breast MR Imaging in the Evaluation of Extent of Disease.

Purpose To compare the diagnostic performances of contrast material-enhanced spectral mammography and breast magnetic resonance (MR) imaging in the detection of index and secondary cancers in women with newly diagnosed breast cancer by using histologic or imaging follow-up as the standard of reference. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study included 52 women who underwent breast MR imaging and contrast-enhanced spectral mammography for newly diagnosed unilateral breast cancer between March 2014 and October 2015. Of those 52 patients, 46 were referred for contrast-enhanced spectral mammography and targeted ultrasonography because they had additional suspicious lesions at MR imaging. In six of the 52 patients, breast cancer had been diagnosed at an outside institution. These patients were referred for contrast-enhanced spectral mammography and targeted US as part of diagnostic imaging. Images from contrast-enhanced spectral mammography were analyzed by two fellowship-trained breast imagers with 2.5 years of experience with contrast-enhanced spectral mammography. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated for both imaging modalities and compared by using the Bennett statistic. Results Fifty-two women with 120 breast lesions were included for analysis (mean age, 50 years; range, 29-73 years). Contrast-enhanced spectral mammography had similar sensitivity to MR imaging (94% [66 of 70 lesions] vs 99% [69 of 70 lesions]), a significantly higher PPV than MR imaging (93% [66 of 71 lesions] vs 60% [69 of 115 lesions]), and fewer false-positive findings than MR imaging (five vs 45) (P < .001 for all results). In addition, contrast-enhanced spectral mammography depicted 11 of the 11 secondary cancers (100%) and MR imaging depicted 10 (91%). Conclusion Contrast-enhanced spectral mammography is potentially as sensitive as MR imaging in the evaluation of extent of disease in newly diagnosed breast cancer, with a higher PPV. © RSNA, 2017.

Prospective study of magnetic resonance imaging (MRI) and multiparameter gene expression assay in ductal carcinoma in situ (DCIS): A trial of the ECOG-ACRIN Cancer Research Group (E4112).

534 Background: Prior retrospective studies have evaluated breast MRI in DCIS, and prospective-retrospective biomarker studies have shown that the DCIS Score is prognostic for recurrence after BCS alone. E4112 is a prospective cohort study designed to assess the combined impact of breast MRI and DCIS Score on surgical and RT management. Methods: Women diagnosed with screen-detected DCIS on core biopsy, if BCS eligible, underwent breast MRI. Those remaining so following MRI and related biopsies, with no invasive disease, underwent BCS. If final surgical margins were ≥2 mm, the DCIS lesion was submitted for DCIS Score assay. Women with low DCIS Score (≤39, LS) were advised that RT could be avoided; RT was recommended to those with high/intermediate (H/I) scores. The primary objective was to estimate the fraction converting to mastectomy (Mx) following MRI. Secondary objectives included estimation of re-operation rates after first BCS, and DCIS Score distribution.A sample size of 333 evaluable women would allow estimation of Mx rate of 12% with 95% confidence interval 9-16%. Results: 334 enrolled women had completed surgery; the first surgical procedure was Mx in 54 (16.2%) and BCS in 280 (83.8%), of whom 62 (22.1%) required at least one re-excision, and 11 (3.9%) converted to Mx. DCIS Scores were obtained on 171 patients who completed BCS, of whom 82 were LS and 89 were H/I. Demographics were similar between the two groups, other features will be reported. Only 7/82 (8.5%) of the LS group received RT, whereas 82/89 (92.1%) of the H/I group received RT. Of the 98 BCS patients who did not qualify for DCIS Score-based therapy, 23 had invasive disease, 34 had final surgical margins &lt; 2 mm, and 13 had both. There was insufficient tissue for DCIS Score in 11, and 17 did not complete follow-up. Conclusions: In this study, among DCIS patients who were BCS-eligible following MRI, total mastectomy rate was 19.5%; re-excision rate was 22.1% for women who had BCS. Approximately half had low DCIS Scores, and RT recommendations based on the DCIS Score were acceptable to most women. Clinical trial information: E4112.

Breast cancer diagnosed before the 40\xa0years: imaging findings and correlation with histology and molecular subtype

BackgroundTo evaluate the imaging findings in patients with breast cancer diagnosed before age 40 and their correlation with histological type and molecular subtype.MethodsA descriptive, retrospective, single-center study was conducted by reviewing imaging exams and medical records, after approval of the institution’s Ethics Review Board. Among the 120 patients studied, 112 (93.3%) had mammography, 113 (94.2%) underwent ultrasonography and 105 (87.5%) underwent breast magnetic resonance imaging (MRI). Histopathology data was performed in most cases after surgical resection, which was available for 113 patients (94.2%).ResultsThe mean age at diagnosis of primary breast cancer was 34 years. Most patients had no family history of breast cancer or ovarian cancer (60.7%), and were symptomatic at diagnosis (75.6%). The most common histological type was no-special type (NST) invasive carcinoma (73.8%). Regarding the molecular subtype, luminal B was the most common (42.6%), followed by triple negative (20.2%). The malignant tumor was identified in 92.9% of patients who underwent mammography, 96.5% of patients submitted to ultrasound and 98% of those who performed MRI. MRI was superior to other methods in the evaluation of multifocal and multicentric lesions. There was no statistically significant association between imaging findings and molecular subtypes in the present study.ConclusionsThis study demonstrated that imaging methods play a fundamental role in the characterization of cases of breast cancer diagnosed in patients younger than 40 years. Despite the ultrasound has been the most widely used method, we found improved characterization of breast lesions when also used mammography and MRI.

Water–fat Dixon sequences in the evaluation of breast implants: proposal of a time effective rapid approach in the clinical practice

To evaluate the diagnostic accuracy achieved from a fat-water Dixon sequence alone compared to a combination of a silicone-specific magnetic resonance imaging (MRI) sequence and a water-specific MRI sequence in the assessment of breast implants. In this institutional review board (IRB)-approved study the integrity of breast implants was assessed retrospectively in 27 patients undergoing breast MRI at 3 T. A qualitative evaluation of (set 1) a silicon-selective water-saturated short tau inversion recovery (STIR) sequence in combination with a water-only Dixon dataset (total acquisition time 7 minutes 17 seconds), and of (set 2) fat-only and water-only Dixon datasets (4 minutes 8 seconds) was performed by two readers independently evaluating the following features: margin definition of the implant, water suppression homogeneity, image quality, presence of artefacts and their effects on the imaging interpretation, and diagnostic confidence. Diagnostic accuracy in implant rupture detection was determined and either surgical confirmation or diagnosis from the radiological report was used as a standard of reference. In both sequences, margin definition of the implant wall, water suppression homogeneity, and overall image quality were rated good-excellent in most of cases. Water suppression homogeneity was moderate-poor in a greater number of cases in set 1. Movement artefacts were more frequent in set 1 whereas five cases (18.5%) exhibited swap artefacts between silicone and water in set 2. Diagnostic confidence was rated high-very high with both sequences in most of cases. Diagnostic accuracy was 100% for both readers using set 1 and 96.2% and 100% using set 2. A single Dixon sequence allows an accurate diagnostic evaluation of breast implants and concomitant shortening of the overall acquisition time.

Abstract P3-02-04: Is breast magnetic resonance imaging (MRI) useful for diagnosis of additional sites of disease in patients recently diagnosed with ductal carcinoma in situ (DCIS)?

Abstract Purpose: To determine if breast MRI is useful for detecting additional sites of disease in patients initially diagnosed with pure DCIS. Materials and Methods: A retrospective review of women diagnosed with pure DCIS who underwent a breast MRI for evaluation of extent of disease was performed at a single institution from January 2013 to April 2015. Data analysis included imaging (mammography, ultrasound and MRI) and pathology characteristics (histology and biomarker status) of the primary DCIS as well as descriptors for the additional sites of disease incidentally found by breast MRI. Results: A total of 94 patients were diagnosed with pure DCIS during this time period, ages ranging from 38 to 79 years old (median, 58.5 years); sizes ranging from 0.6 to 16 cm (mean, 4.5 cm). A total of 28 patients (30%) had other MRI findings suspicious for additional sites of disease in either breast. From this group of patients, 23 (82%) patients underwent MRI-guided biopsy. The 5 patients who did not have the MRI guided-biopsy either underwent total mastectomies or declined biopsy. Five out of the twenty-three patients (22%) were diagnosed with an additional site of cancer. Three of these patients were Hispanic, one was Asian/Pacific and one was Caucasian. Of the five patients, five had contralateral disease (100%) and none had a second site of disease in the ipsilateral breast. The size of the additional sites of disease ranged from 0.4 to 7.2 cm (mean, 2.1 cm) and the size of the primary lesion in this selected group ranged from 0.4 to 9 cm (mean, 3.4 cm). Ages ranged from 47 to 63 years old (median, 55 years). Four out of five patients (80%) presented with the first site of disease as pure DCIS with estrogen (ER) and progesterone (PR) receptors positive and one case (20%) was pure DCIS ER/PR- negative. The second incidental lesion found on MRI demonstrated 3 cases of contralateral pure DCIS. From this group, all the biomarkers status for the first and second site were concordant. From the 5 cases of second disease, 2 (40%) presented with invasive component in the contralateral side of the initially biopsy-proven pure DCIS and, one of these cases had discordant biomarkers compared with the first site of disease, the first site of pure DCIS was ER/PR-negative and the second site of invasive ductal carcinoma (IDC) presented with ER/PR-positive status. Conclusion: From a total of 94 patients with recent diagnosis of pure DCIS who underwent breast MRI examination for diagnosis of additional sites of disease, approximately 5% were diagnosed with an additional site of cancer and 2% of the total cases had invasive disease in the additional sites with different biomarker status; changing their management and prognosis. Breast MRI plays a role in the setting of staging patients initially diagnosed with pure DCIS. Citation Format: Ortiz-Perez T, Benveniste AP, Ebuoma LO, Sepulveda KA, Severs FJ, Kapoor M, Sedgwick EL. Is breast magnetic resonance imaging (MRI) useful for diagnosis of additional sites of disease in patients recently diagnosed with ductal carcinoma in situ (DCIS)? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-04.

Background Parenchymal Enhancement and Fibroglandular Tissue Proportion on Breast MRI: Correlation with Hormone Receptor Expression and Molecular Subtypes of Breast Cancer.

To assess the relationship between background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) proportion on breast magnetic resonance imaging (MRI) and hormone receptor expression and molecular subtypes in invasive breast cancer. This retrospective study enrolled 75 breast cancer patients who underwent breast MRI before treatment. T1-weighted images were reviewed to determine the FGT proportion, and contrast-enhanced fat-suppressed T1-weighted images were reviewed to determine BPE. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2-neu (HER2) status, and molecular subtypes of the tumors were compared with the BPE and FGT proportions. Women with high BPE tended to have increased rate of ER and PR positive tumors (p=0.018 and p=0.013). FGT proportion was associated with ER positivity (p=0.009), but no significant differences between FGT proportion and PR positivity were found (p=0.256). There was no significant difference between HER2 status and any of the imaging features (p=0.453 and p=0.922). For premenopausal women, both FGT proportion and BPE were associated with molecular subtypes (p=0.025 and p=0.042). FGT proportion was also associated with BPE (p<0.001). In women with invasive breast cancer, both high FGT containing breasts and high BPE breasts tended to have ER positive tumors.

Role of magnetic resonance imaging in the planning of breast cancer treatment strategies: comparison with conventional imaging techniques.

ObjectiveTo assess the role of magnetic resonance imaging (MRI) in the planning of breast cancer treatment strategies.Materials and MethodsThe study included 160 women diagnosed with breast cancer, who underwent breast MRI for preoperative staging. Using Pearson's correlation coefficient (r), we compared the size of the primary tumor, as determined by MRI, by conventional imaging (mammography and ultrasound), and in the pathological examination (gold standard). The identification of lesions not identified in previous examinations was also evaluated, as was its influence on treatment planning.ResultsThe mean age of the patients was 52.2 years (range, 30–81 years), and the most common histological type was invasive ductal carcinoma (in 60.6% of the patients). In terms of the tumor size determined, MRI correlated better with the pathological examination than did mammography (r = 0.872 vs. 0.710) or ultrasound (r = 0.836 vs. 0.704). MRI identified additional lesions in 53 patients (33.1%), including malignant lesions in 20 (12.5%), which led to change in the therapeutic planning in 23 patients (14.4%).ConclusionBreast MRI proved to be more accurate than conventional imaging in determining the dimensions of the main tumor and was able to identify lesions not identified by other methods evaluated, which altered the therapeutic planning in a significant proportion of cases.

Correlation of MRI features and pathohistological prognostic factors in invasive ductal breast carcinoma

Objective: The aim of this study was to correlate magnetic resonance imaging (MRI) features of invasive ductal carcinomas (IDC) with pathohistological prognostic factors. Such an association, if present, could have significant translational implications for early identification of aggressive types of breast cancer.Materials and methods: One hundred and fourteen consecutive women with IDC who underwent breast MRI within one month prior to surgery were included in this retrospective study. MRI features were analyzed and then interpreted with a Göttingen score (GS) that included morphological (shape, margins, and pattern of enhancement) and kinetic characteristics (initial signal increase and post-initial behavior of the time-signal intensity curve). Histological specimens were analyzed for tumor size, axillary lymph node status, histological grade, estrogen receptors (ER), progesterone receptors (PR), HER2, and Ki-67.Results: By multivariate analysis, a smooth margin was a significant, independent predictor of a larger tumor size (p = 0.041), lymph node invasion (p = 0.013), and lower expression of ER (p = 0.022). High GS was a significant, independent predictor of a higher histological grade (p = 0.022) while round or oval shape of lesion was independent predictor of a higher PR expression (p = 0.027).Conclusion: A smooth margin of breast cancer on breast MRI was able to predict positive axillary lymph nodes, larger tumor size, and lower expression of ER. Except for a higher histological grade, GS was not able to predict other unfavorable prognostic factors, probably due to the fact that smooth margins were assigned fewer points than spiculated margins.

Ductal carcinoma in situ of the breast: Evaluation of main presentations on magnetic resonance imaging compared with findings on mammogram and histology.

The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS. A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI. The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases. DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.

Prognostic Significance of Transverse Relaxation Rate (R2*) in Blood Oxygenation Level-Dependent Magnetic Resonance Imaging in Patients with Invasive Breast Cancer

ObjectiveTo examine the relationship between magnetic resonance transverse relaxation rate (R2*) and prognostic factors.Materials and MethodsA total of 159 women with invasive ductal carcinomas (IDCs) underwent breast magnetic resonance imaging (MRI) including blood oxygenation level-dependent (BOLD) sequence at 3 T. The distribution of the measured R2* values were analyzed, and the correlation between R2* and various prognostic factors (age, tumor size, histologic grade, lymphovascular invasion, and axillary lymph node status, as well as expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, p53, and Ki-67) were retrospectively assessed using patient medical records.ResultsThe baseline R2* values of the IDCs were very heterogeneous with wide range among the patients. The mean R2* value was (32.8 ± 14.0) Hz with a median of 29.3 Hz (range 13.5–109.4 Hz). In multivariate analysis, older age was associated with decreased R2* value (P = 0.011) and IDCs with p53-overexpression showed higher R2* values than those without p53-overexpression group (P = 0.031). Other prognostic factors were not significantly correlated with R2* value.ConclusionIn this study, R2* values were significantly correlated with age and expression of p53. Further studies are necessary to determine the prognostic value of BOLD-MRI.

MRI Background Parenchymal Enhancement Is Not Associated with Breast Cancer

BackgroundPreviously, a strong positive association between background parenchymal enhancement (BPE) at magnetic resonance imaging (MRI) and breast cancer was reported in high-risk populations. We sought to determine, whether this was also true for non-high-risk patients.Methods540 consecutive patients underwent breast MRI for assessment of breast findings (BI-RADS 0–5, non-high-risk screening (no familial history of breast cancer, no known genetic mutation, no prior chest irradiation, or previous breast cancer diagnosis)) and subsequent histological work-up. For this IRB-approved study, BPE and fibroglandular tissue FGT were retrospectively assessed by two experienced radiologists according to the BI-RADS lexicon. Pearson correlation coefficients were calculated to explore associations between BPE, FGT, age and final diagnosis of breast cancer. Subsequently, multivariate logistic regression analysis, considering covariate colinearities, was performed, using final diagnosis as the target variable and BPE, FGT and age as covariates.ResultsAge showed a moderate negative correlation with FGT (r = -0.43, p<0.001) and a weak negative correlation with BPE (r = -0.28, p<0.001). FGT and BPE correlated moderately (r = 0.35, p<0.001). Final diagnosis of breast cancer displayed very weak negative correlations with FGT (r = -0.09, p = 0.046) and BPE (r = -0.156, p<0.001) and weak positive correlation with age (r = 0.353, p<0.001). On multivariate logistic regression analysis, the only independent covariate for prediction of breast cancer was age (OR 1.032, p<0.001).ConclusionsBased on our data, neither BPE nor FGT independently correlate with breast cancer risk in non-high-risk patients at MRI. Our model retained only age as an independent risk factor for breast cancer in this setting.

Background parenchymal enhancement over exam time in patients with and without breast cancer.

To compare background parenchymal enhancement (BPE) over time in patients with and without breast cancer. This retrospective Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study included 116 women (25-84 years, mean 54 years) with breast cancer who underwent breast magnetic resonance imaging at 3T between 1/2/2009 and 12/29/2009 and 116 age and date-of-exam-matched women without breast cancer (23-84 years, mean 51 years). Two independent, blinded readers (R1, R2) recorded BPE (minimal, mild, moderate, marked) at three times (100, 210, and 320 seconds postcontrast). Subsequent cancers were diagnosed in 9/96 control patients with follow up (12.6-93.0 months, mean 63.6 months). Exact Mann-Whitney, Fisher's exact, and McNemar tests were performed. Mean BPE was not found to be different between patients with and without breast cancer at any time (P = 0.36-0.64). At time 2 as compared with time 1, there were significantly more patients, both with and without breast cancer, with BPE >minimal (R1: 90 vs. 41 [P < 0.001] and 81 vs. 36 [P < 0.001]; R2: 84 vs. 52 [P < 0.001] and 79 vs. 43 [P < 0.001]) and BPE >mild (R1: 59 vs. 10 [P < 0.001] and 47 vs. 13 [P < 0.001]; R2: 49 vs. 12 [P < 0.001] and 41 vs. 18 [P < 0.001]). BPE changes between times 2 and 3 were not significant (P = 0.083-1.0). Odds ratios for control patients developing breast cancer were significant only for R2 and ranged up to 7.67 (1.49, 39.5; P < 0.01) for BPE >mild at time 2. BPE changes between the first and second postcontrast scans and stabilizes thereafter in most patients. Further investigation into the most clinically relevant timepoint for BPE assessment is warranted. 3 J. Magn. Reson. Imaging 2017;45:74-83.

Use of BI-RADS-MRI descriptors for differentiation between mucinous carcinoma and fibroadenoma

ObjectiveWe evaluated the latest breast imaging reporting and data system (BI-RADS) magnetic resonance imaging (MRI) (5th edition) descriptors and non BI-RADS MRI factors that contribute to differentiation between mucinous carcinomas (MCs) and fibroadenomas (FAs). Materials and methodsThis retrospective study included 27 patients with P-MCs or M-MCs similar to P-MCs and 22 patients with FAs who underwent breast MRI between October 2008 and July 2014 at our institution. Definitive histopathological diagnoses were made for all of the MCs and FAs. The latest BI-RADS MRI descriptors for abnormal enhancement, including maximum diameter, shape (irregular or round/oval), margin (irregular or circumscribed), rim enhancement (present or absent), dark internal septation (absent or present), delayed internal enhancement (heterogeneous or homogeneous), and the time–intensity curve pattern (not persistent or persistent) were evaluated. As additional non BI-RADS MRI factors related to differentiation between MC and FA, age, signal intensity in the T2-weighted image (high or not high), extent of lobulation (strong or weak), enhancing internal septation (present or absent), and the apparent diffusion coefficient value were also evaluated. One radiologist retrospectively evaluated interpreted MR findings and analyzed the findings. Statistically significant findings were identified through univariate and multivariate analyses. Then, three blinded radiologists reviewed the MR images where MR findings had shown a significant association with outcomes during univariate analyses. Independently, the three blinded readers reviewed the MR images for the evaluation of inter-observer variability, and then arrived at a consensus for the evaluation of observer performance. Observer performance and inter-observer variability were determined via a receiver-operating-characteristic curve analysis and weighted k statistics. The sensitivity, specificity, and accuracy of each of the MR findings were calculated. ResultsUnivariate analyses showed that irregular margins were observed more frequently in MCs than in FAs (11/27, 41% vs. 1/22, 0.5%, p<0.05). MCs also showed rim enhancement, delayed heterogeneous enhancement, and enhancing internal septation more frequently than FAs (p<0.05). FAs showed circumscribed margins more frequently than MCs (21/22, 95% vs. 16/27, 59%, p<0.05). FAs also showed dark internal septation more frequently than MCs (18/22, 82% vs. 3/27, 11%, p<0.05). In multivariate analyses, the most significant feature in lesion characterization was delayed heterogeneous enhancement. In the blinded reading, a combination of irregular margin and delayed heterogeneous enhancement showed the highest sensitivity (96.3%) and accuracy (87.8%). Enhancing internal septation showed the highest specificity (90.9%). The κ values with confidence ratings for differentiation between MCs and FAs were 0.63–0.67, which showed substantial agreement among the three radiologists. ConclusionsThe combination of irregular margin and delayed heterogeneous enhancement and enhancing internal septation were significant findings for differentiation between P-MC or M-MC similar to P-MC and FA.

Abstract P4-02-05: Predictors of MRI detection of occult lesions in newly diagnosed breast cancer

Abstract BACKGROUND: The appropriate use of preoperative magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains a topic of debate. We aimed to determine the usefulness of MRI in the detection of occult multicentric, multifocal and contralateral lesions not seen by ultrasound or mammography. METHODS: We performed a retrospective analysis of consecutive patients who underwent preoperative MRI for newly diagnosed biopsy-proven stage 0-III breast cancer who were treated surgically from January 2006-March 2013. All newly diagnosed breast cancer patients at our two affiliated institutions were evaluated with pre-operative MRI. Patients who received neoadjuvant systemic therapy or surgery at an outside institution were excluded from our study. Demographic, radiographic and pathologic data points including age, race, body mass index (BMI), lesion size, mammographic density, biopsy histology, and biomarkers were assessed for each patient with respect to the findings of multifocality, multicentricity, and the presence of contralateral lesions on all three imaging modalities. We performed univariate analysis associating factors separately in each of three models with multicentric, multifocal and contralateral disease on surgical pathology followed by multivariable analysis using logistic regression to calculate odds ratios. RESULTS: Of 857 patients undergoing breast MRI within this time period, 770 patients were identified who met inclusion criteria. All patients underwent diagnostic mammogram and ultrasound followed by MRI. The patient population was 44.2% Hispanic, reflective of the population of our two institutions. Mean age was 54.7 years. MRI identified 86 patients with biopsy-proven multicentricity compared to 66 on conventional imaging. MRI identified 170 patients with biopsy-proven multifocality compared to 132 on conventional imaging. Finally, MRI identified 24 patients with biopsy-proven contralateral cancers compared to 7 on conventional imaging. Biopsy histology of invasive lobular carcinoma was predictive of the presence of multifocality on MRI (p=0.038, OR=1.95, 95% CI 1.09-3.48). Mammographic density was found to be a predictor of multicentricity (p=0.015, OR=2.22, 95% CI 1.13-3.33). Lesion size trended towards statistical significance on multivariate analysis of the multicentric lesions (p=0.057, OR=1.88, 95% CI 1.00-3.51). For contralateral cancers seen on MRI the presence of invasive lobular carcinoma on biopsy (p=0.027, OR=4.83, 95% CI 1.25-16.21) was predictive of finding a contralateral cancer. CONCLUSIONS: Predictive factors including breast density, biopsy histology, and lesion size should be taken into account as clinical predictors of utility of pre-operative breast MRI. This data is being used to construct nomograms to predict multicentric, multifocal and contralateral disease to aid clinicians in evaluating the potential clinical utility of preoperative breast MRI. Citation Format: Wecsler JS, Raghavendra A, Mack WJ, Tripathy D, Yamashita M, Sheth P, Hovanessian-Larsen L, Sener SF, Russell CA, MacDonald H, Lang JE. Predictors of MRI detection of occult lesions in newly diagnosed breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-05.

Perceptions of Cancer Risk, Cause, and Needs in Participants from Low Socioeconomic Background at Risk for Hereditary Cancer

ABSTRACTThe purpose of this study was to describe perceptions of cancer risk, cause, and needs in participants from a low socioeconomic background at risk for hereditary cancer. We surveyed 307 individuals with the Cancer Awareness and Needs survey and received 128 responses (41.6% response rate). Family history, genetics, and tobacco use were selected most frequently as a cause of cancer; 36% (n = 46) selected fate and/or God's will. A total of 87.5% (n = 112) understood that having a close family member with breast cancer could increase personal risk; however responses were varied when asked if this was related to risk for other cancers. Most participants had undergone cancer screening, half reported undergoing breast magnetic resonance imaging, which was associated with personal (p < 0.01) and family cancer history (p = 0.03). An additional 76.6% (n = 98) felt informed about cancer screening and most received information from health care providers and family or friends. Ensuring that patients and clinicians are educated about hereditary cancer risk, detection, and prevention should be priorities for future research.

Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer.

PurposeThe purpose of this study was to assess magnetic resonance imaging (MRI) features of malignant internal mammary lymph nodes (IMLNs) and benign IMLNs in breast cancer patients.MethodsFrom 2009 to 2014, the records of 85 patients with IMLNs were archived using MRI report data; 26 patients with small size (long axis diameter <5 mm) nodes were subsequently excluded. The current study evaluated internal mammary lymph nodes in 59 patients who underwent breast MRI for breast cancer staging and for posttherapy follow-up. All MRI findings were retrospectively evaluated. Malignancy was determined based on pathologic examination and positron emission tomography computed tomography findings. Independent t-tests, Mann-Whitney U tests, chi-square tests, and receiver operating characteristics (ROC) curve analysis were used.ResultsAmong MRI features, there were statistically significant differences between benign and malignant IMLN groups, in short axis length (3.6±1.3 vs. 8.2±2.9 mm, respectively), long axis length (8.1±2.4 vs. 14.5±4.8 mm, respectively), short/long axis ratio (0.45±0.10 vs. 0.59±0.17, respectively), absent fatty hilum (mean, 0% vs. 95%, respectively), and restricted diffusion (15.8% vs. 85.0%, respectively) (p<0.050). Multiplicity and location of intercostal spaces was not different between the two groups. Short axis length was the most discriminative variable for predicting metastatic nodes (area under the ROC curve, 0.951; threshold, 4 mm; sensitivity, 92.5%; specificity, 84.2%).ConclusionConventional MRI and diffusion-weighted MRI are helpful to detect metastasis of internal mammary lymph nodes in breast cancer.

Early-stage invasive ductal carcinoma: Association of tumor apparent diffusion coefficient values with axillary lymph node metastasis

PurposeTo evaluate any association between tumor apparent diffusion coefficient (ADC) values and axillary lymph node metastasis (ALNM) in early-stage invasive ductal carcinoma. Materials and methodsRecords of 270 invasive ductal carcinoma patients with stages T1 and T2 disease who underwent breast magnetic resonance imaging, including diffusion-weighted imaging with b values of 0 and 1000s/mm2 were reviewed retrospectively. The tumor ADC values were analyzed for their utility in predicting ALNM using multivariate regression analysis and receiver operating characteristic (ROC) curve analysis. ResultsOf the 270 patients, 58 (21.5%) experienced ALNM. The mean tumor ADC values were significantly lower in patients with ALNM than in those without metastasis (0.880×10−3 vs. 0.999×10−3mm2/s, P<0.001). A ROC curve demonstrated a tumor ADC value of 0.991×10−3mm2/s to be the optimal cut-off for predicting ALNM. In a multivariate analysis, lower tumor ADC (≤0.991×10−3mm2/s; adjusted odds ratio (OR)=5.861, P<0.001), large tumor size (>2cm; adjusted OR=3.156, P=0.002) and the presence of lymphovascular invasion (adjusted OR=4.125, P<0.001) were independent variables associated with ALNM. When tumor ADC value was added to known risk factors (i.e., tumor size and lymphovascular invasion), a significant improvement in the accuracy of risk prediction for axillary node metastasis was shown (c-statistic=0.758 vs. 0.816, P=0.026). ConclusionIn early-stage invasive ductal carcinoma, lower tumor ADC values are associated with the presence of ALNM.

Evaluation of Pathologic Nipple Discharge: What is the Added Diagnostic Value of MRI?

To determine the diagnostic value of magnetic resonance imaging (MRI) for the evaluation of patients with pathologic nipple discharge. We performed a retrospective review of women with nipple discharge who underwent breast MRI between January 1, 2004, and December 31, 2013. Radiographic findings, pathology results, and clinical notes were reviewed. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated. Over a 10-year period, 103 women (mean age 46 years, range 25-72 years) underwent MRI for evaluation of nipple discharge. Ninety-one patients (88 %) underwent surgical excision or had clinical and/or radiographic follow-up at least 2 years after presentation and thus comprise the study population. Eleven (30 %) of 37 patients with MRIs coded as American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) 4 of 5 were diagnosed with ductal carcinoma in situ (n = 6) or invasive adenocarcinoma (n = 5). Seven (64 %) of 11 patients diagnosed with malignancy had a negative mammographic and sonographic workup. None of the patients with MRIs coded as BI-RADS 1, 2, or 3 was diagnosed with malignancy immediately after presentation or during the 2-year follow-up period. The sensitivity and specificity of MRI for the detection of malignancy were 100 % (11 of 11) and 68 % (54 of 80), respectively. The positive predictive value and negative predictive value were 37 and 100 %, respectively. MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge when conventional imaging is negative. A negative MRI in this symptomatic population may obviate the need for duct exploration and excision.

Role of second-look ultrasound examinations for MR-detected lesions in patients with breast cancer.

To assess the clinical value of second-look ultrasound (US) examination for the evaluation of additional enhancing lesions detected on magnetic resonance (MR) imaging. Between May 2008 and February 2011, 794 consecutive patients with histologically confirmed breast cancer underwent breast MR imaging. We included 101 patients with 132 additional enhancing breast lesions detected on MR imaging who underwent second-look US. The imaging features and lesion category according to the Breast Imaging and Reporting and Data System (BI-RADS) were assessed with MR and US imaging, respectively. According to the BI-RADS system, 67 lesions (50.8 %) were classified as category 0, 33 lesions (25.0 %) as category 3, and 32 lesions (24.2 %) as category 4. Of the 67 indeterminate lesions on MR imaging, 34 (50.7 %) were demonstrated on second-look US. 11 of these 34 lesions showed suspicious sonographic features, including 1 lesion that showed malignancy (9.1 %, 1/11). Most of the suspicious lesions on MR imaging (26 of 32 BI-RADS category 4 lesions, 81.3 %) were demonstrated on second-look US, and 17 were malignant (65.4 %, 17/26). Of the 6 BI-RADS category 4 lesions without sonographic correlation, 1 was malignant (16.7 %, 1/6). Second-look US examination was useful for evaluating MR-detected lesions in patients with breast cancer.