Richard S. Ha MD, Abstract Co-Author: Nothing to Disclose

Brian Jin MD, Abstract Co-Author: Nothing to Disclose

Victoria Mango MD, Abstract Co-Author: Nothing to Disclose

Lauren C. Friedlander MD, Abstract Co-Author: Nothing to Disclose

Rend Al-Khalili MD, MBBCh, Presenter: Nothing to Disclose

Vesselin Miloushev MD, PhD, Abstract Co-Author: Nothing to Disclose

Ralph Thomas Wynn MD, Abstract Co-Author: Nothing to Disclose

Compared to breast density, breast MRI background parenchymal enhancement (BPE) is a less well established risk factor for breast cancer. We sought to determine whether a stronger association between BPE and breast cancer risk can be identified by stratifying breast cancer based on extent of disease.

A HIPAA compliant IRB waived retrospective study identified 330 consecutive pre-operative breast MRI cases with biopsy proven carcinoma from 1/2010-12/2013. Each case was categorized as multicentric disease (MCD, involving more than 1 quadrant or greater than 5 cm), multifocal disease (MFD) or unifocal disease (UFD). A fellowship trained radiologist, blinded to history, classified contralateral breast BPE as minimal, mild, moderate, or marked utilizing BI-RADS criteria, The contralateral breast was used for BPE evaluation to minimize bias and the effects of malignancy including edema and inflammation. In addition, the amount of fibroglandular tissue (FGT) was graded, as fatty, scattered, heterogeneously dense, or dense. Age and menopausal status was recorded. Univariate and multivariate logistic regression analysis were performed. 

A total of 55 MCD, 80 MFD and 195 UFD cases were identified in 330 patients with histopathologic confirmation. The frequency of minimal, mild, moderate and marked BPE was 21.5% (71/330), 42.7% (141/330), 27.8% (92/330) and 7.8% (26/330). MCD was 3.8 times more likely to be associated with moderate/marked BPE compared to UFD (95 % CI, 2.04- 7.14, P < 0.0001). MFD was 1.4 times more likely to be associated with moderate/marked BPE but this was not statistically significant (95% CI, 0.82 - 2.45, P = 0.2114). On multivariate analysis, the association between elevated BPE and MCD was independent of patient age, menopausal status and the amount of FGT. 

Patients with greater BPE may be at higher risk for more extensive breast cancer.

Breast MRI background parenchymal enhancement may be an important factor in breast cancer risk stratification.

Ha, R, Jin, B, Mango, V, Friedlander, L, Al-Khalili, R, Miloushev, V, Wynn, R, Are Patients with Greater Background Parenchymal Enhancement on MRI at Increased Risk for More Extensive Breast Cancer?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014849.html