Predicting local recurrence following breast-conserving treatment: parenchymal signal enhancement ratio (SER) around the tumor on preoperative MRI

Abstract

Background

The level of background parenchymal enhancement around tumor is known to be associated with breast cancer risk. However, there is no study investigating predictive power of parenchymal signal enhancement ratio (SER) around tumor for ipsilateral breast tumor recurrence (IBTR).

Purpose

To investigate whether the breast parenchymal SER around the tumor on preoperative dynamic contrast-enhanced magnetic resonance imaging (MRI) is associated with subsequent IBTR in breast cancer patients who had undergone breast-conserving treatment.

Material and Methods

Nineteen consecutive women (mean age, 44 years; range, 34–63 years) with breast cancer who developed IBTR following breast-conserving treatment and 114 control women matched for age, as well as T and N stages were included. We compared the clinicopathologic features of the two groups including nuclear grade, histologic grade, hormonal receptor status, human epidermal growth factor receptor-2 (HER-2) status, lymphovascular invasion, negative margin width, use of adjuvant therapy, and parenchymal SER around the tumor on preoperative DCE-MRI. The SER was measured on a slice showing the largest dimension of the tumor. Multivariate conditional logistic regression analysis was used to identify independent factors associated with IBTR.

Results

In univariate analysis, ER negativity (odds ratio [OR] = 4.7; P = 0.040), PR negativity (OR = 4.0; P = 0.013), HER-2 positivity (OR = 3.6; P = 0.026), and a parenchymal SER greater than 0.53 (OR = 23.3; P = 0.011) were associated with IBTR. In multivariate analysis, ER negativity (OR = 3.8; P = 0.015) and a parenchymal SER greater than 0.53 (OR = 13.2; P = 0.040) on preoperative MRI were independent factors associated with IBTR.

Conclusion

In addition to ER negativity, a higher parenchymal SER on preoperative MRI was an independent factor associated with subsequent IBTR in patients with breast cancer who had undergone breast-conserving treatment.

Keywords

Breast neoplasms – primary MR imaging

Get full access to this article

View all access options for this article.

References

Veronesi

Cascinelli

Mariani

Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–32

Fisher

Anderson

Bryant

Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–41

Anderson

Wapnir

Dignam

Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol 2009;27:2466–73

Wapnir

Anderson

Mamounas

Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 2006;24:2028–37

Haffty

Reiss

Beinfield

Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local relapse. J Clin Oncol 1996;14:52–7

Darby

McGale

Correa

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011;378:1707–16

Sanghani

Truong

Raad

Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy. J Clin Oncol 2010;28:718–22

Komoike

Akiyama

Iino

Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer 2006;106:35–41

Arriagada

Lê

Contesso

Predictive factors for local recurrence in 2006 patients with surgically resected small breast cancer. Ann Oncol 2002;13:1404–13

10.

Clark

Whelan

Levine

Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology Group. J Natl Cancer Inst 1996;88:1659–64

11.

Millar

Graham

O'Toole

Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early-stage invasive breast cancer using a five-biomarker panel. J Clin Oncol 2009;27:4701–8

12.

Voduc

Cheang

Tyldesley

Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 2010;28:1684–91

13.

Park

Rembert

Chew

High mammographic breast density is independent predictor of local but not distant recurrence after lumpectomy and radiotherapy for invasive breast cancer. Int J Radiat Oncol Biol Phys 2009;73:75–9

14.

King

Brooks

Bernstein

Background parenchymal enhancement at breast MR imaging and breast cancer risk. Radiology 2011;260:50–60

15.

Hattangadi

Park

Rembert

Breast stromal enhancement on MRI is associated with response to neoadjuvant chemotherapy. Am J Roentgenol 2008;190:1630–6

16.

Cichon

Degnim

Visscher

Microenvironmental influences that drive progression from benign breast disease to invasive breast cancer. J Mammary Gland Biol Neoplasia 2010;15:389–97

17.

Heaphy

Griffith

Bisoffi

. Mammary field cancerization: molecular evidence and clinical importance. Breast Cancer Res Treat 2009;118:229–39

18.

Moore

Meng

Increased risk of local recurrence is associated with allelic loss in normal lobules of breast cancer patients. Cancer Res 2002;62:1000–3

19.

Roman-Perez

Casbas-Hernandez

Rein

Gene expression in extratumoral microenvironment predicts clinical outcome in breast cancer patients. Breast Cancer Res 2012;14:R51

20.

Graham

de Las Morenas

Gene expression profiles of estrogen receptor-positive and estrogen receptor-negative breast cancers are detectable in histologically normal breast epithelium. Clin Cancer Res 2011;17:236–46

21.

Kim

Kang

Laminin-332-rich tumor microenvironment for tumor invasion in the interface zone of breast cancer. Am J Pathol 2011;178:373–81

22.

Taghian

Jeong

Mamounas

Patterns of local failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: Results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol 2004;22:4247–54

23.

Shrout

Fleiss

. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86:420–8

24.

Barcellos-Hoff

Park

Wright

. Radiation and the microenvironment – tumorigenesis and therapy. Nat Rev Cancer 2005;5:867–75

25.

Henry

Wilmes

Kinetic assessment of breast tumors using high spatial resolution signal enhancement ratio (SER) imaging. Magn Reson Med 2007;58:572–81

26.

Partridge

Joe

Invasive breast cancer: predicting disease recurrence by using high-spatial-resolution signal enhancement ratio imaging. Radiology 2008;248:79–87

27.

Ross

Delamarter

Hueftle

Gadolinium-DTPA-enhanced MR imaging of the postoperative lumbar spine: time course and mechanism of enhancement. Am J Roentgenol 1989;152:825–34

28.

Müller-Schimpfle

Ohmenhaüser

Stoll

Menstrual cycle and age: influence on parenchymal contrast medium enhancement in MR imaging of the breast. Radiology 1997;203:145–9