Radiology: Breast MRI during neoadjuvant chemotherapy must pay attention to this sign!

In breast- enhanced MRI scans , the enhancement of normal fibroglandular tissue is called background parenchymal enhancement (BPE), which is described separately from tumor enhancement
.

In the fifth edition of the breast imaging report and data system, the qualitative assessment of BPE adopts the quadrant ( mild , mild, moderate or obvious) and incorporates it into clinical work

In breast- enhanced MRI scans , the enhancement of normal fibroglandular tissue is called background parenchymal enhancement (BPE), which is described separately from tumor enhancement

BPE is a dynamic phenomenon, which changes between different people and different periods of the same person

Recently, a study published in the journal Radiology explored the relationship between the lack of BPE inhibition and NAC treatment response in HR-positive and HR-negative cohorts, providing a reference for accurate disease identification and further evaluation of treatment effects

A retrospective analysis was performed on female patients with menopausal status data who received one of the 10 drug groups (standard NAC with or without experimental drugs) for breast cancer treatment from May 2010 to November 2016 .
The patient underwent MRI at four time points: before treatment (T0), early treatment (T1), interval (T2) and before surgery (T3) .
Quantitative measurement of BPE was performed by using automatic fibroadenoid tissue segmentation method .
In order to effectively test this hypothesis, a check subset of BPE with high-quality segmentation was selected .
The change in BPE starting from T0 is defined as inhibition or non-inhibition at each point .
In the hormone receptor (HR) positive and HR negative cohorts, Fisher's exact test and the ratio Z test with Yates continuity correction were used to examine the relationship between BPE inhibition and pathological complete response (pCR) .

A total of 3528 MRI scan images of 882 patients (average age 48 years ± 10 [standard deviation]) were evaluated, and a subset of patients with high-quality BPE segmentation was determined (T1, 433 patients; T2, 396 patients; T3 , 380 patients) .

In the HR-positive cohort, there was an association between lack of BPE suppression and lower pCR rates (no suppression and suppression, 11.
8% [6 of 51 cases] and 28.
9% [of 173 people] detected at the T2 stage Of 50 people]; difference, 17.
1% [95% CI: 4.
7, 29.
5]; P = .

A total of 3528 MRI scan images of 882 patients (average age 48 years ± 10 [standard deviation]) were evaluated, and a subset of patients with high-quality BPE segmentation was determined (T1, 433 patients; T2, 396 patients; T3 , 380 patients) .
In the HR-positive cohort, there was an association between lack of BPE suppression and lower pCR rates (no suppression and suppression, 11.
8% [6 of 51 cases] and 28.
9% [of 173 people] detected at the T2 stage Of 50 people]; difference, 17.

 

FIG an 55-year-old in postmenopausal women, the left side of invasive breast cancer, hormone receptor positive, in (A) T0 and time (B) T2, subtracting the early contrast enhancement in MRI axial maximum intensity projection .

The calculated background substantial enhancement (BPE) values ​​are (A) 32.
3% and (B) 35.
0%.

FIG an 55-year-old in postmenopausal women, the left side of invasive breast cancer, hormone receptor positive, in (A) T0 and time (B) T2, subtracting the early contrast enhancement in MRI axial maximum intensity projection .
The calculated background substantial enhancement (BPE) values ​​are (A) 32.
3% and (B) 35.
0%.

This study shows that the lack of background in real terms increased inhibition may be an early indicator of poor response to neoadjuvant chemotherapy, especially in hormone-receptor-positive breast cancer is more significant , this conclusion can discontinue ineffective treatment and further personalize The formulation of the treatment plan provides a reference basis

Original source :

Natsuko Onishi , Wen Li , David C Newitt , et al.

Breast MRI during Neoadjuvant Chemotherapy: Lack of Background Parenchymal Enhancement Suppression and Inferior Treatment Response.
DOI: 10.
1148/radiol.

Natsuko Onishi Wen Li David C Newitt 10.
1148/radiol.
2021203645 10.
1148/radiol.
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