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. 2021 Feb 4:10:595820.
doi: 10.3389/fonc.2020.595820. eCollection 2020.

Background Parenchymal Enhancement on Breast MRI as a Prognostic Surrogate: Correlation With Breast Cancer Oncotype Dx Score

Michelle Zhang  1   2 , Meredith Sadinski  1 , Dana Haddad  1   3   4   5 , Min Sun Bae  1   6 , Danny Martinez  1 , Elizabeth A Morris  1 , Peter Gibbs  1 , Elizabeth J Sutton  1
Affiliations

Background Parenchymal Enhancement on Breast MRI as a Prognostic Surrogate: Correlation With Breast Cancer Oncotype Dx Score

Michelle Zhang et al. Front Oncol. .

Abstract

Purpose: Breast MRI background parenchymal enhancement (BPE) can potentially serve as a prognostic marker, by possible correlation with molecular subtype. Oncotype Dx, a gene assay, is a prognostic and predictive surrogate for tumor aggressiveness and treatment response. The purpose of this study was to investigate the association between contralateral non-tumor breast magnetic resonance imaging (MRI) background parenchymal enhancement and tumor oncotype score.

Methods: In this retrospective study, patients with ER+ and HER2- early stage invasive ductal carcinoma who underwent preoperative breast MRI, oncotype risk scoring, and breast conservation surgery from 2008-2010 were identified. After registration, BPE from the pre and three post-contrast phases was automatically extracted using a k-means clustering algorithm. Four metrics were calculated: initial enhancement (IE) relative to the pre-contrast signal, late enhancement, overall enhancement (OE), and area under the enhancement curve (AUC). Histogram analysis was performed to determine first order metrics which were compared to oncotype risk score groups using Mann-Whitney tests and Spearman rank correlation analysis.

Results: This study included 80 women (mean age = 51.1 ± 10.3 years); 46 women were categorized as low risk (≤17) and 34 women were categorized as intermediate/high risk (≥18) according to Oncotype Dx. For the mean of the top 10% pixels, significant differences were noted for IE (p = 0.032), OE (p = 0.049), and AUC (p = 0.044). Using the risk score as a continuous variable, correlation analysis revealed a weak but significant correlation with the mean of the top 10% pixels for IE (r = 0.26, p = 0.02), OE (r = 0.25, p = 0.02), and AUC (r = 0.27, p = 0.02).

Conclusion: BPE metrics of enhancement in the non-tumor breast are associated with tumor Oncotype Dx recurrence score, suggesting that the breast microenvironment may relate to likelihood of recurrence and magnitude of chemotherapy benefit.

Keywords: background parenchymal enhancement; breast cancer; magnetic resonance imaging; oncotype; risk score.

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Conflict of interest statement

EM received a grant from GRAIL Inc. for research not related to the present article. MS is currently employed by Promaxo in San Francisco, CA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Fibroglandular tissue enhancement in a low risk group patient (top row) and a high risk group patient (bottom row). The first postcontrast images are illustrated (left) alongside segmented fibroglandular tissue with early enhancement overlay (middle) and overall enhancement overlay (right). Note the higher enhancement values evident for the high risk group patient. Oncotype Dx is a prognostic and predictive surrogate for tumor aggressiveness and treatment response. A Oncotype Dx score of 11 is a representative example of a patient that is a low risk. Oncotype Dx score of 35 is a representative example of a patient that is at intermediate/high risk. The “top 10%” corresponds to the voxels exhibiting the 10% highest enhancement level in the middle and right figures.
Figure 2
Figure 2
Correlation between background parenchymal enhancement (mean top 10%) and Oncotype Dx Recurrence Score.
See this image and copyright information in PMC

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