Background parenchymal enhancement at breast MR imaging and breast cancer risk

Abstract

Purpose: To examine the relationships between breast cancer and both amount of fibroglandular tissue (FGT) and level of background parenchymal enhancement (BPE) at magnetic resonance (MR) imaging.

Materials and methods: A waiver of authorization was granted by the institutional review board for this retrospective HIPAA-compliant study. Among 1275 women who underwent breast MR imaging screening between December 2002 and February 2008, 39 breast carcinoma cases were identified. Two comparisons were performed: In one comparison, two normal controls--those of the women with negative (benign) findings at breast MR imaging--were matched to each breast cancer case on the basis of age and date of MR imaging. In the second comparison, one false-positive control--that of a woman with suspicious but nonmalignant findings at MR imaging--was similarly matched to each breast cancer case. Two readers independently rated the level of MR imaging-depicted BPE and the amount of MR imaging-depicted FGT by using a categorical scale: BPE was categorized as minimal, mild, moderate, or marked, and FGT was categorized as fatty, scattered, heterogeneously dense, or dense.

Results: Compared with the odds ratio (OR) for a normal control, the OR for breast cancer increased significantly with increasing BPE: The ORs for moderate or marked BPE versus minimal or mild BPE were 10.1 (95% confidence interval [CI]: 2.9, 35.3; P < .001) and 3.3 (95% CI: 1.3, 8.3; P = .006) for readers 1 and 2, respectively. Similar odds were seen when the false-positive controls were compared with the breast cancer cases: The ORs for moderate or marked BPE versus minimal or mild BPE were 5.1 (95% CI: 1.4, 19.1; P = .005) and 3.7 (95% CI: 1.2, 11.2; P = .013) for readers 1 and 2, respectively. The breast cancer odds also increased with increasing FGT, but the BPE findings remained significant after adjustment for FGT.

Conclusion: Increased BPE is strongly predictive of breast cancer odds.

Figure 1a:

T1-weighted fat-suppressed contrast-enhanced subtraction MR images show different right breasts with (a) minimal, (b) mild, (c) moderate, and (d) marked BPE.

Figure 1b:

T1-weighted fat-suppressed contrast-enhanced subtraction MR images show different right breasts with (a) minimal, (b) mild, (c) moderate, and (d) marked BPE.

Figure 1c:

T1-weighted fat-suppressed contrast-enhanced subtraction MR images show different right breasts with (a) minimal, (b) mild, (c) moderate, and (d) marked BPE.

Figure 1d:

T1-weighted fat-suppressed contrast-enhanced subtraction MR images show different right breasts with (a) minimal, (b) mild, (c) moderate, and (d) marked BPE.

Figure 2a:

T1-weighted non–fat-suppressed MR images show different breasts with (a) fatty, (b) scattered, (c) heterogeneously dense, and (d) dense amounts of FGT. (a and d = right breasts, b and c = left breasts.)

Figure 2b:

T1-weighted non–fat-suppressed MR images show different breasts with (a) fatty, (b) scattered, (c) heterogeneously dense, and (d) dense amounts of FGT. (a and d = right breasts, b and c = left breasts.)

Figure 2c:

T1-weighted non–fat-suppressed MR images show different breasts with (a) fatty, (b) scattered, (c) heterogeneously dense, and (d) dense amounts of FGT. (a and d = right breasts, b and c = left breasts.)

Figure 2d:

T1-weighted non–fat-suppressed MR images show different breasts with (a) fatty, (b) scattered, (c) heterogeneously dense, and (d) dense amounts of FGT. (a and d = right breasts, b and c = left breasts.)