Kirti Magudia PhD, Presenter: Nothing to Disclose

Janice S. Sung MD, Abstract Co-Author: Nothing to Disclose

Jennifer Brooks PhD, Abstract Co-Author: Nothing to Disclose

Jennifer Brisman Kaplan MD, Abstract Co-Author: Nothing to Disclose

Maxine S. Jochelson MD, Abstract Co-Author: Nothing to Disclose

D. David Dershaw MD, Abstract Co-Author: Nothing to Disclose

Elizabeth A. Morris MD, Abstract Co-Author: Nothing to Disclose

To evaluate if changes in background parenchymal enhancement (BPE) on breast MRI predict tumor response to neoadjuvant chemotherapy

Retrospective IRB approved review identified 86 patients with biopsy proven breast cancer that underwent bilateral breast MRI both before and after neoadjuvant chemotherapy between September 2008 and August 2012. Patients with synchronous bilateral cancers or a history of contralateral cancer were excluded. Clinicopathologic data were obtained from the electronic medical record. A breast-imaging radiologist blinded to clinical data rated the BPE level using BI-RADS criteria of the unaffected breast on pre- and post-neoadjuvant chemotherapy breast MRIs. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multinomial logistic regression adjusting for age, menopausal status and family history of breast/ovarian cancer. 

Age at cancer diagnosis ranged from 25-72 years (mean: 46). Tumor size ranged from 1.4-17.0 cm (mean: 6.3). 62 (72%) patients were pre/perimenopausal and 24 (28%) postmenopausal. 36 (42%) tumors were unifocal, and 50 (58%) multifocal/multicentric. There were 36 (42%) ER+, 28 (33%) PR+, 36 (42%) HER2+, and 32 (37%) triple negative (TN) tumors. Results suggest that a decrease in BPE between pre- and post-chemotherapy MRI is associated with a complete imaging response in ER+ (OR 9.1, 95% CI 1.1, 78.3, p= 0.04) and PR+ (OR 18.8, CI 1.1,307.7, p=0.04) tumors, though the confidence intervals are wide. BPE reduction was not associated with tumor response with TN or HER 2+ tumors. Changes in BPE were also not associated with clinical stage, MR imaging features, or disease focality.

Tumor response to neoadjuvant chemotherapy may be associated with a decrease in BPE in patients with ER+ tumors but not with other subtypes. 

Although larger studies are needed to confirm these results, analysis of BPE change in patients with ER+ tumors undergoing neoadjuvant chemotherapy may be useful to predict tumor response.

Magudia, K, Sung, J, Brooks, J, Kaplan, J, Jochelson, M, Dershaw, D, Morris, E, Ability of Background Parenchymal Enhancement on Breast MRI to Predict Tumor Response to Neoadjuvant Chemotherapy.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13018017.html