Nariya Cho MD, Presenter: Nothing to Disclose

Sun Ah Kim MD, Abstract Co-Author: Nothing to Disclose

Min Sun Bae, Abstract Co-Author: Nothing to Disclose

Jung Min Chang MD, Abstract Co-Author: Nothing to Disclose

Mi Ri Nae Seo, Abstract Co-Author: Nothing to Disclose

Woo Kyung Moon, Abstract Co-Author: Nothing to Disclose

Jihe Lim, Abstract Co-Author: Nothing to Disclose

Eun Bi Ryu MD, Abstract Co-Author: Nothing to Disclose

To retrospectively investigate whether the signal enhancement ratio (SER) of the background parenchyma around the tumor on dynamic contrast enhanced MR imaging was associated with recurrence-free survival (RFS) in breast ductal carcinoma in situ (DCIS) patients.

Between 2004 and 2009, 304 consecutive women (mean age, 48.5years; range, 24-79years) with pure DCIS (mean size, 3.1cm; range, 0.1-10.5cm) who underwent preoperative MRI, curative surgery and had 1-year follow-up data were identified. Their clinicopathologic features (age, menopausal status, surgery type, adjuvant therapy, ER, PR, HER2 status, nuclear grade, margin width) and MRI features [lesion size, morphology, fibroglandular density, background parenchymal enhancement grade, parenchymal SER defined as (S1-S0)/(S2-S0), where S0, S1, and S2 represent the signal intensity on the precontrast, first postcontrast, and delayed images] were analyzed. Receiver operating characteristic curves were used to determine the best cut-off value of variables for the prediction of cancer recurrence. RFS was estimated using the Kaplan-Meier method. A multivariate Cox proportional hazards model was used to determine associations between survival outcome and MRI variables, adjusting for clinicopathologic variables.

There were 19 (6.3%, 19 of 304) breast cancer recurrences (13 ipsilateral, 6 contralateral and 10 DCIS, 9 invasive recurrences). The mean follow-up period for the no recurrence group (n=285) was 46 months (range 13-94 months). On multivariate analysis, high mean SER was an independent factor associated with cancer recurrence (hazard ratio, 9.986; 95% confidence interval, 3.563-27.987; P <.001). Estimated 5-year RFS for the high mean SER group (total 58 women with SER≥0.51) was 72.4% versus 97.2% in the low mean SER group (total 246 women with SER<0.51) (P <.001). In addition to high SER, premenopausal status (P =.015) and breast conserving surgery rather than mastectomy (P =.031) were found to be associated with cancer recurrence on univariate analysis. 

High SER in the background parenchyma around the tumor was an independent factor associated with cancer recurrence in breast DCIS patients. 

When women with DCIS show high SER in the background parenchyma around the tumor on preoperative MRI, more aggressive treatment to prevent cancer recurrence should be considered.

Cho, N, Kim, S, Bae, M, Chang, J, Seo, M, Moon, W, Lim, J, Ryu, E, Background Parenchymal Signal Enhancement Ratio on Preoperative MRI May Predict Recurrence in Breast Ductal Carcinoma in Situ Patients after Surgery.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12031166.html