Alexander Martijn Theodorus Schmitz MD, Presenter: Nothing to Disclose

Claudette Elisabeth Loo MD, Abstract Co-Author: Nothing to Disclose

Kenneth G.A. Gilhuijs PhD, Abstract Co-Author: Nothing to Disclose

Rim enhancement on dynamic contrast-enhanced (DCE) MR imaging of breast cancer has been associated with high histologic tumor grade, increased VEGF expression, negative hormone receptor expression, and axillary lymph node metastases. However, association with patient outcome is largely unknown, and potential benefit as a predictive marker for therapy selection has not yet been established. The aim of this study was to determine if rim enhancement is associated with invasive breast cancer recurrence (IBCR) and death attributable to breast cancer (DBC) on follow-up (FU).

A retrospective study was performed on 561 consecutively included women (age 26–86 years) in the MARGINS trial (2000-2008) who had pathology proven invasive breast cancer eligible for breast-conserving therapy on conventional imaging and clinical examination. Median FU was 87 months (range 3–150). Patients received an additional preoperative DCE-MRI. Presence of rim enhancement was assessed according to BI-RADS. Tumor characteristics on pathology were assessed from surgical resection specimens. Patients were stratified upon immunohistochemical breast cancer subtype. Associations with IBCR and DBC were analyzed using Kaplan Meier and log-rank tests. Multivariate Cox regression was employed to discriminate between good and poor outcome.

Overall, IBCR was recorded in 53 and DBC in 39 women. For IBCR, association was seen with tumor grade (p=0,032), resection margin status (p=0,042), ER-status (p=0,050) and rim enhancement (p=0,056). Rim enhancement and grade retained independent significance in multivariate analysis to discriminate between good (95,7%) and poor (79,6%) survival. For DBC, no association with rim enhancement was observed (p=0,189). No associations were found in the ER+/Her2- subgroup (N=419), and in the Her2+ subgroup (N=75). However, in the triple negative subgroup (N=65), IBCR (N=10) was strongly associated with rim enhancement (p=0,001) and resection margin status (p=0,002). Moreover, rim enhancement was the only characteristic significantly associated with DBC (N=9; p=0,003).

Presence of rim enhancement on DCE-MRI may be a promising biomarker for tumor recurrence in patients with triple negative breast cancer.

Patients with triple negative breast cancers with rim enhancement on MRI may benefit from adjusted therapy and follow-up procedures.

Schmitz, A, Loo, C, Gilhuijs, K, Association Between Rim Enhancement of Breast Tumors in Dynamic Contrast-Enhanced MRI and Outcome of Patients With Invasive Breast Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010577.html