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Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Breast fibroglandular tissue (FGT), as visualized on a mammogram (mammographic density, MD), is one of the strongest known risk factors for breast cancer. FGT is also visible on breast MRI, and increased background parenchymal enhancement (BPE) in the FGT has been identified as potentially a major breast cancer risk factor. The aim of this exploratory study was to examine the biologic basis of BPE.

Methods

We examined the unaffected contra-lateral breast of 80 breast cancer patients undergoing a prophylactic mastectomy before any treatment other than surgery of their breast cancer. BPE was classified on the BI-RADS scale (minimal/mild/moderate/marked). Slides were stained for microvessel density (MVD), CD34 (another measure of endothelial density), glandular tissue within the FGT and VEGF. Spearman correlations were used to evaluate the associations between BPE and these pathologic variables.

Results

In pre-menopausal patients, BPE was highly correlated with MVD, CD34 and glandular concentration within the FGT, and the pathologic variables were themselves highly correlated. The expression of VEGF was effectively confined to terminal duct lobular unit (TDLU) epithelium. The same relationships of the four pathologic variables with BPE were seen in post-menopausal patients, but the relationships were much weaker and not statistically significant.

Conclusion

The strong correlation of BPE and MVD together with the high correlation of MVD with glandular concentration seen in pre-menopausal patients indicates that increased breast cancer risk associated with BPE in pre-menopausal women is likely to result from its association with increased concentration of glandular tissue in the FGT. The effective confinement of VEGF expression to the TDLUs shows that the signal for MVD growth arises directly from the glandular tissue. Further studies are needed to understand the basis of BPE in post-menopausal women.

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Abbreviations

ACR:

American College of Radiology

BI-RADS:

Breast Imaging Reporting and Data System

BPE:

Background parenchymal enhancement

FGT:

Fibroglandular tissue

IHC:

Immunohistochemistry

MD:

Mammographic density

MRI:

Magnetic resonance imaging

MSK:

Memorial Sloan Kettering Cancer Center

MVD:

Microvessel density

TDLU:

Terminal duct lobular unit

VEGF:

Vascular endothelial growth factor

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Acknowledgements

We would especially like to thank all the patients who gave permission to have their tissues used for research.

Funding

This study was funded in part through the National Institutes of Health/National Cancer Institute Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center, which also provided special support through an Interdisciplinary Population Science Research award from the Survivorship, Outcomes and Risk Development Funds within Memorial Sloan Kettering Cancer Center. Additional funding was also provided by the Susan G. Komen Foundation.

Author information

Author notes

  1. Janice S. Sung and Adriana D. Corben are Joint first authors.

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Janice S. Sung, Delia M. Keating & Elizabeth A. Morris

  2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Adriana D. Corben & Marcia Edelweiss

  3. Department of Pathology, Mount Sinai School of Medicine, New York, NY, USA

    Adriana D. Corben

  4. Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Jennifer D. Brooks

  5. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, Room 2061, New York, NY, 10017, USA

    Christine Lin, Prusha Patel, Meghan Woods, Jonine L. Bernstein & Malcolm C. Pike

  6. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mark Robson

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Correspondence to Malcolm C. Pike.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Memorial Sloan Kettering Cancer Center institutional national research committee and with the 1964 Helsinki declaration and its later amendments. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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Sung, J.S., Corben, A.D., Brooks, J.D. et al. Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat 172, 487–496 (2018). https://doi.org/10.1007/s10549-018-4916-6

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