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Can enhancement types on preoperative MRI reflect prognostic factors and surgical outcomes in invasive breast cancer?

  • Jieun Koh
  • Ah Young Park
  • Kyung Hee Ko
  • Hae Kyoung JungEmail author
Breast
  • 14 Downloads

Abstract

Objectives

This study was conducted in order to evaluate whether enhancement types on preoperative MRI can reflect prognostic factors and surgical outcomes in invasive breast cancer.

Methods

Among 484 consecutive patients who underwent preoperative breast MRI from October 2014 to July 2017 for biopsy-proven breast cancer, 313 patients with 315 invasive breast cancers who underwent subsequent surgery were finally included in this study. Two radiologists retrospectively reviewed preoperative MRI findings of these 315 lesions and categorized them to mass, nonmass, and combined type according to enhancement features. Combined type was defined as coexisted mass and nonmass enhancement. Histopathologic results focusing on prognostic factors and surgical outcomes were compared among the three types of lesion using Pearson’s chi-square, linear-by-linear association, Kruskal–Wallis, one-way ANOVA test, and multinomial logistic regression.

Results

Of the cancers analyzed, 198 (62.9%) were mass, 59 (18.7%) were nonmass, and 58 (18.4%) were combined type. The nonmass type showed the smallest invasive tumor size (p < 0.001) and the most common positive HER2 receptor status (p = 0.001). The combined type had the most frequent lymphovascular invasion (p = 0.011), axillary lymph node–positive status (p = 0.031), operation changes (p < 0.001), and first resection margin–positive status (p < 0.001). Initial operation of mastectomy was more frequent in the nonmass and combined types than that in the mass type (p < 0.001). But HER2 receptor status and operation changes showed no statistical significance on multivariate analysis.

Conclusions

Enhancement types on preoperative MRI reflect different prognostic factors and surgical outcomes in invasive breast cancer.

Key Points

• Morphologic features of contrast media uptake on contrast-enhanced MRI may be related with fundamental biological differences of invasive breast cancers.

• Mass or nonmass enhancement type on preoperative MRI might reflect different prognostic factors and surgical outcomes in invasive breast cancer.

• The combined mass and nonmass enhancement type might be associated with poorer prognosis and worse surgical outcomes.

Keywords

Magnetic resonance imaging Breast neoplasms Prognosis Surgical oncology 

Abbreviations

AJCC

American Joint Committee on Cancer

BCS

Breast-conserving surgery

DCIS

Ductal carcinoma in situ

ER

Estrogen receptor

HER2

Human epidermal growth factor receptor 2

IDC

Invasive ductal cancer

IHC

Immunohistochemical

LVI

Lymphovascular invasion

ME

Mass enhancement

MRI

Magnetic resonance imaging

NME

Nonmass enhancement

PR

Progesterone receptor

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Hae Kyoung Jung.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

References

  1. 1.
    Leithner D, Wengert G, Helbich T et al (2018) Clinical role of breast MRI now and going forward. Clin Radiol 73:700–714CrossRefGoogle Scholar
  2. 2.
    Buadu LD, Murakami J, Murayama S et al (1996) Breast lesions: correlation of contrast medium enhancement patterns on MR images with histopathologic findings and tumor angiogenesis. Radiology 200:639–649CrossRefGoogle Scholar
  3. 3.
    Lee SH, Cho N, Kim SJ et al (2008) Correlation between high resolution dynamic MR features and prognostic factors in breast cancer. Korean J Radiol 9:10–18CrossRefGoogle Scholar
  4. 4.
    Matsubayashi R, Matsuo Y, Edakuni G, Satoh T, Tokunaga O, Kudo S (2000) Breast masses with peripheral rim enhancement on dynamic contrast-enhanced MR images: correlation of MR findings with histologic features and expression of growth factors. Radiology 217:841–848CrossRefGoogle Scholar
  5. 5.
    Szabó BK, Aspelin P, Kristoffersen Wiberg M, Tot T, Boné B (2003) Invasive breast cancer: correlation of dynamic MR features with prognostic factors. Eur Radiol 13:2425–2435Google Scholar
  6. 6.
    Teifke A, Behr O, Schmidt M et al (2006) Dynamic MR imaging of breast lesions: correlation with microvessel distribution pattern and histologic characteristics of prognosis. Radiology 239:351–360CrossRefGoogle Scholar
  7. 7.
    Jansen SA, Shimauchi A, Zak L, Fan X, Karczmar GS, Newstead GM (2011) The diverse pathology and kinetics of mass, nonmass, and focus enhancement on MR imaging of the breast. J Magn Reson Imaging 33:1382–1389CrossRefGoogle Scholar
  8. 8.
    Machida Y, Shimauchi A, Tozaki M, Kuroki Y, Yoshida T, Fukuma E (2016) Descriptors of malignant non-mass enhancement of breast MRI: their correlation to the presence of invasion. Acad Radiol 23:687–695Google Scholar
  9. 9.
    Lee SM, Nam KJ, Choo KS et al (2018) Patterns of malignant non-mass enhancement on 3-T breast MRI help predict invasiveness: using the BI-RADS lexicon fifth edition. Acta Radiol 59:1292–1299CrossRefGoogle Scholar
  10. 10.
    Jiang L, Zhou Y, Wang Z, Lu X, Chen M, Zhou C (2013) Is there different correlation with prognostic factors between “non-mass” and “mass” type invasive ductal breast cancers? Eur J Radiol 82:1404–1409Google Scholar
  11. 11.
    D’Orsi CJ, Sickles EA, Mendelson EB et al (2013) ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. American College of Radiology, Reston, VAGoogle Scholar
  12. 12.
    Giuliano AE, Edge SB, Hortobagyi GN (2018) Eighth edition of the AJCC cancer staging manual: breast cancer. Ann Surg Oncol 25:1783–1785CrossRefGoogle Scholar
  13. 13.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  14. 14.
    Gweon HM, Jeong J, Son EJ, Youk JH, Kim J-A, Ko KH (2017) The clinical significance of accompanying NME on preoperative MR imaging in breast cancer patients. PLoS One 12:e0178445CrossRefGoogle Scholar
  15. 15.
    Cho YH, Cho KR, Park EK et al (2016) Significance of additional non-mass enhancement in patients with breast cancer on preoperative 3T dynamic contrast enhanced MRI of the breast. Iran J Radiol 23:e30909Google Scholar
  16. 16.
    Allred D, Harvey JM, Berardo M, Clark GM (1998) Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Mod Pathol 11:155–168Google Scholar
  17. 17.
    Chen JH, Baek HM, Nalcioglu O, Su MY (2008) Estrogen receptor and breast MR imaging features: a correlation study. J Magn Reson Imaging 27:825–833CrossRefGoogle Scholar
  18. 18.
    Ménard S, Fortis S, Castiglioni F, Agresti R, Balsari A (2001) HER2 as a prognostic factor in breast cancer. Oncology 61:67–72CrossRefGoogle Scholar
  19. 19.
    Piccart M, Lohrisch C, Di Leo A, Larsimont D (2001) The predictive value of HER2 in breast cancer. Oncology 61:73–82CrossRefGoogle Scholar
  20. 20.
    Miller B, Abbott A, Tuttle T (2012) The influence of preoperative MRI on breast cancer treatment. Ann Surg Oncol 19:536–540CrossRefGoogle Scholar
  21. 21.
    Brouwer de Koning SG, Vrancken Peeters MTFD, Jóźwiak K, Bhairosing PA, Ruers TJM (2018) Tumor resection margin definitions in breast conserving surgery—a systematic review and meta-analysis of current literature. Clin Breast Cancer 18:e595–e600Google Scholar
  22. 22.
    Kim OH, Kim SJ, Lee JS (2016) Enhancing patterns of breast cancer on preoperative dynamic contrast-enhanced magnetic resonance imaging and resection margin in breast conserving therapy. Breast Dis 36:27–35CrossRefGoogle Scholar
  23. 23.
    Murphy BL, Boughey JC, Keeney MG et al (2018) Factors associated with positive margins in women undergoing breast conservation surgery. Mayo Clin Proc 93:429–435CrossRefGoogle Scholar
  24. 24.
    van Deurzen CH (2016) Predictors of surgical margin following breast-conserving surgery: a large population-based cohort study. Ann Surg Oncol 23:627–633CrossRefGoogle Scholar
  25. 25.
    Jia H, Jia W, Yang Y et al (2014) HER-2 positive breast cancer is associated with an increased risk of positive cavity margins after initial lumpectomy. World J Surg Oncol 20:289CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Jieun Koh
    • 1
  • Ah Young Park
    • 1
  • Kyung Hee Ko
    • 1
  • Hae Kyoung Jung
    • 1
    Email author
  1. 1.Department of Radiology, CHA Bundang Medical Center, School of MedicineCHA UniversitySeongnamSouth Korea

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