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Background parenchymal enhancement in pregnancy-associated breast cancer: a hindrance to diagnosis?

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Abstract

Purpose

The purpose of this study is to investigate the detectability of pregnancy-associated breast cancer (PABC) in lactating glandular tissue on magnetic resonance imaging (MRI) by using pre- and post-contrast acquisitions and their derived postprocessed images and compare these results to ultrasound (US) and mammography (MG).

Materials and methods

We reviewed the electronic database for women with PABC and existing breast MRI. MR images (T2-weighted short inversion-recovery sequence [STIR], dynamic contrast-enhanced T1-weighted gradient echo sequence and postprocessed subtraction images [early post-contrast minus pre-contrast]) were retrospectively evaluated (image quality, parenchymal/tumour enhancement kintetics, tumour size and additional lesions). Supplemental subtraction images (latest post-contrast minus early post-contrast) to reduce plateau enhancement were additionally calculated and tumour conspicuity and size were measured. Findings were compared to US and MG reports.

Results

Nineteen patients (range 27–42 years) were included. Background parenchymal enhancement (BPE) was minimal (n=1), mild (n=3), moderate (n=7) and marked (n=8) with kinetics measured plateau (n=8), continuous (n=10) and not quantifiable (n=1). Tumour kinetics presented wash-out (n=17) and plateau (n=2). Eighteen of nineteen tumours were identified on the supplemental subtraction images. All tumours were visible on US; 12/19 were visible on MG (63.2%). MRI detected additional malignant lesions in two patients.

Conclusion

Despite high BPE of the lactating breast, MRI securely detects carcinomas and identifies satellite lesions. By using supplemental subtraction images, background enhancement can be eliminated to facilitate diagnosis. US remains a reliable diagnostic tool, but additional MRI is recommended to rule out satellite/contralateral lesions. MG interpretations can be difficult due to high parenchymal density.

Key Points

• Despite high background enhancement, MRI of the breast confidently detects carcinomas and identifies further lesions in the lactating breast.

• By using supplemental subtraction images, background enhancement in the lactating breast can be eliminated to facilitate diagnosis.

• US remains a reliable diagnostic tool. Mammography can be limited due to extremely dense breast tissue related to lactation.

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Abbreviations

ACR:

American College of Radiology

BCT:

Breast conserving therapy

BI-RADS®:

Breast Imaging Reporting and Data System

ER:

Estrogen receptor

FOV:

Field-of-View

HER2:

Human epidermal growth factor receptor 2

MG:

Mammography

MIP:

Maximum intensity projection

MRI:

Magnetic resonance imaging

NST:

Invasive ductal carcinoma of no special type

PBAC:

Pregnancy-associated breast cancer

PR:

Progesterone receptor

T:

Tesla

TE:

Echo time

TI:

Inversion time

TR:

Repetition time

US:

Ultrasound

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Funding

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

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Jana Taron, Sabrina Fleischer, Heike Preibsch, Konstantin Nikolaou & Sonja Bahrs

  2. Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany

    Ines Gruber

Authors
  1. Jana Taron
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  2. Sabrina Fleischer
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  3. Heike Preibsch
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  4. Konstantin Nikolaou
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  5. Ines Gruber
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  6. Sonja Bahrs
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Corresponding author

Correspondence to Jana Taron.

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Guarantor

The scientific guarantor of this publication is Dr. med. Sonja Bahrs.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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

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Taron, J., Fleischer, S., Preibsch, H. et al. Background parenchymal enhancement in pregnancy-associated breast cancer: a hindrance to diagnosis?. Eur Radiol 29, 1187–1193 (2019). https://doi.org/10.1007/s00330-018-5721-7

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  • DOI: https://doi.org/10.1007/s00330-018-5721-7

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