Afsaneh Alikhassi¹, Hedieh Akbari¹, Seyedeh Nooshin Miratashi Yazdi¹, Sona Akbari Kia¹, Farzin Roozafzai²

Show more
¹ Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
² Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Show less

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.

Keywords: Breast MRI, Background Parenchymal Enhancement, BI-RADS, Short-Interval Follow-Up, Biopsy

Cite this paper: Alikhassi, A. , Akbari, H. , Yazdi, S. , Kia, S. and Roozafzai, F. (2018) Is Breast Background Parenchymal Enhancement on MRI Related to BI-RADS Score and Follow-Up Rate?. Advances in Breast Cancer Research, 7, 15-22. doi: 10.4236/abcr.2018.71002.

References

[1]   Bennani-Baiti, B., Dietzel, M. and Baltzer, P.A. (2016) MRI Background Parenchymal Enhancement Is Not Associated with Breast Cancer. PLoS ONE, 11, 7.
https://doi.org/10.1371/journal.pone.0158573

[2]   Pike, M.C. and Pearce, C.L. (2013) Mammographic Density, MRI Background Parenchymal Enhancement and Breast Cancer Risk. Annals of Oncology: Official Journal of the European Society for Medical Oncology, 24, 37-41.

[3]   Zeppa, R. (1969) Vascular Response of the Breast to Estrogen. The Journal of Clinical Endocrinology and Metabolism, 29, 695-700.
https://doi.org/10.1210/jcem-29-5-695

[4]   Hambly, N.M., Liberman, L., Dershaw, D.D., Brennan, S. and Morris, E.A. (2011) Background Parenchymal Enhancement on Baseline Screening Breast MRI: Impact on Biopsy Rate and Short-Interval Follow-Up. AJR American Journal of Roentgenology, 196, 218-224.
https://doi.org/10.2214/AJR.10.4550

[5]   King, V., Brooks, J.D., Bernstein, J.L., Reiner, A.S., Pike, M.C. and Morris, E.A. (2011) Background Parenchymal Enhancement at Breast MR Imaging and Breast Cancer Risk. Radiology, 260, 50-60.
https://doi.org/10.1148/radiol.11102156

[6]   Muller-Schimpfle, M., Ohmenhauser, K., Stoll, P., Dietz, K. and Claussen, C.D. (1997) Menstrual Cycle and Age: Influence on Parenchymal Contrast Medium Enhancement in MR Imaging of the Breast. Radiology, 203, 145-149.
https://doi.org/10.1148/radiology.203.1.9122383

[7]   Morris, E.A., Comstock, C.E. and Lee, C.H. (2013) ACR BI-RADS® Magnetic Resonance Imaging. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System, Reston, VA, American College of Radiology.

[8]   Menezes, G.L., Knuttel, F.M., Stehouwer, B.L., Pijnappel, R.M. and Van den Bosch, M.A. (2014) Magnetic Resonance Imaging in Breast Cancer: A Literature Review and Future Perspectives. World Journal of Clinical Oncology, 5, 61-70.
https://doi.org/10.5306/wjco.v5.i2.61

[9]   Kuhl, C.K. (2007) Current Status of Breast MR Imaging. Part 2. Clinical Applications. Radiology, 244, 672-691.
https://doi.org/10.1148/radiol.2443051661

[10]   Orel, S.G. and Schnall, M.D. (2001) MR Imaging of the Breast for the Detection, Diagnosis, and Staging of Breast Cancer. Radiology, 220, 13-30.
https://doi.org/10.1148/radiology.220.1.r01jl3113

[11]   Kawamura, A., Satake, H., Ishigaki, S., Ikeda, M., Kimura, R., Shimamoto, K. and Shinji, N. (2015) Prediction of Background Parenchymal Enhancement on Breast MRI Using Mammography, Ultrasonography, and Diffusion-Weighted Imaging. Nagoya Journal of Medical Science, 77, 425-437.

[12]   Kuhl, C. (2007) The Current Status of Breast MR Imaging. Part I. Choice of Technique, Image Interpretation, Diagnostic Accuracy, and Transfer to Clinical Practice. Radiology, 244, 356-378.
https://doi.org/10.1148/radiol.2442051620

[13]   De Martini, W.B., Liu, F., Peacock, S., Eby, P.R., Gutierrez, R.L. and Lehman, C.D. (2012) Background Parenchymal Enhancement on Breast MRI: Impact on Diagnostic Performance. AJR American Journal of Roentgenology, 198, 373-380.
https://doi.org/10.2214/AJR.10.6272

[14]   Telegrafo, M., Rella, L., Stabile Ianora, A.A., Angelelli, G. and Moschetta, M. (2016) Breast MRI Background Parenchymal Enhancement (BPE) Correlates with the Risk of Breast Cancer. Magnetic Resonance Imaging, 34, 173-176.
https://doi.org/10.1016/j.mri.2015.10.014

[15]   Telegrafo, M., Rella, L., Stabile Ianora, A.A., Angelelli, G. and Moschetta, M. (2016) Effect of Background Parenchymal Enhancement on Breast Cancer Detection with Magnetic Resonance Imaging. Diagnostic and Interventional Imaging, 97, 315-320.
https://doi.org/10.1016/j.diii.2015.12.006

[16]   Giess, C.S., Yeh, E.D., Raza, S. and Birdwell, R.L. (2014) Background Parenchymal Enhancement at Breast MR Imaging: Normal Patterns, Diagnostic Challenges, and Potential for False-Positive and False-Negative Interpretation. Radiographics: A Review Publication of the Radiological Society of North America, 34, 234-247.
https://doi.org/10.1148/rg.341135034

[17]   Vogel, P.M., Georgiade, N.G., Fetter, B.F., Vogel, F.S. and McCarty, K.S. (1981) The Correlation of Histologic Changes in the Human Breast with the Menstrual Cycle. The American Journal of Pathology, 104, 23-34.