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Association of breast cancer risk, density, and stiffness: global tissue stiffness on breast MR elastography (MRE)

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Abstract

Purpose

Quantify in vivo biomechanical tissue properties in various breast densities and in average risk and high-risk women using Magnetic Resonance Imaging (MRI)/MRE and examine the association between breast biomechanical properties and cancer risk based on patient demographics and clinical data.

Methods

Patients with average risk or high-risk of breast cancer underwent 3.0 T breast MR imaging and elastography. Breast parenchymal enhancement (BPE), density (from most recent mammogram), stiffness, elasticity, and viscosity were recorded. Within each breast density group (non-dense versus dense), stiffness, elasticity, and viscosity were compared across risk groups (average versus high). Separately for stiffness, elasticity, and viscosity, a multivariable logistic regression model was used to evaluate whether the MRE parameter predicted risk status after controlling for clinical factors.

Results

50 average risk and 86 high-risk patients were included. Risk groups were similar in age, density, and menopausal status. Among patients with dense breasts, mean stiffness, elasticity, and viscosity were significantly higher in high-risk patients (N = 55) compared to average risk patients (N = 34; all p < 0.001). Stiffness remained a significant predictor of risk status (OR = 4.26, 95% CI [1.96, 9.25]) even after controlling for breast density, BPE, age, and menopausal status. Similar results were seen for elasticity and viscosity.

Conclusion

A structurally based, quantitative biomarker of tissue stiffness obtained from MRE is associated with differences in breast cancer risk in dense breasts. Tissue stiffness could provide a novel prognostic marker to help identify high-risk women with dense breasts who would benefit from increased surveillance and/or risk reduction measures.

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Data availability

The imaging data were stored on a shared internal drive between the authors. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

N/A.

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Acknowledgements

We would like to think the Mayo Clinic Cancer Center for providing grant funding for this study. We would also like to acknowledge the Women's Health staff who have been instrumental with recruitment for this study and the breast imaging staff who helped with imaging patients using this new technology. Special thanks to Diana Almader-Smith, who assisted with formatting the references for this manuscript.

Funding

This study was funded by the Mayo Clinic Cancer Center MEGA grant.

Author information

Authors and Affiliations

  1. Diagnostic Radiology, Mayo Clinic, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA

    Bhavika K. Patel & Yuxiang Zhou

  2. Diagnostic Radiology, Mayo Clinic, Rochester, MN, USA

    Kay Pepin, Kathy R. Brandt, Jun Chen & Richard Ehman

  3. Department of Biostatistics, Mayo Clinic, Phoenix, AZ, USA

    Gina L. Mazza

  4. Department of Surgery, Mayo Clinic, Phoenix, AZ, USA

    Barbara A. Pockaj

  5. Department of Oncology, Mayo Clinic, Phoenix, AZ, USA

    Donald W. Northfelt & Karen Anderson

  6. Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA

    Juliana M. Kling

  7. Department of Epidemiology, Mayo Clinic, Rochester, MN, USA

    Celine M. Vachon

  8. Department of Neurosurgery, Mayo Clinic, Phoenix, AZ, USA

    Kristin R. Swanson

  9. School of Biological and Health Systems Engineering, Arizona State University, Phoenix, AZ, USA

    Mehdi Nikkhah

  10. Biodesign Virginia G. Piper Center for Personalized Diagnostics, Arizona State University, Tempe, AZ, USA

    Mehdi Nikkhah

Authors
  1. Bhavika K. Patel
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  2. Kay Pepin
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  3. Kathy R. Brandt
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  14. Richard Ehman
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by BKP, KP, KRB, and GM. The first draft of the manuscript was written by BKP, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bhavika K. Patel.

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Conflict of interest

BKP has received unrelated grant funding from GRAIL Inc. and Hologic Inc. with monies directed to Mayo Clinic. Dr. Kay Pepin is an employee at Resoundant Inc. Dr. Jun Chen is an employee who holds patents and intellectual property at Resoundant Inc. Dr. Yuxiang Zhou holds intellectual property in interventional MRI. Dr. Northfelt has research funding with Genentech/Roche (Inst); GlaxoSmithKline (Inst); Incyte (Inst); Merck (Inst); Novartis (Inst); Pfizer (Inst) Dr. Anderson has Stock and Other Ownership Interests—FlexBioTech; SafeGen Therapeutics, Consulting or Advisory Role and research funding from Merck. Dr. Vachon does not have insurance, owns stock inexact sciences, receives research funding from grail, has intellectual property with breast density software algorithms and has received travel expenses from GRAIL Inc. Dr. Ehman owns stock, has research funding, and discloses uncompensated relationships with Resoundant. Dr. Swanson discloses Precision Oncology Insights Inc. Dr. Ehman and Mayo Clinic have financial interest and intellectual properties related to MR Elastography.

Ethical approval

The study was approved by our research institutional review board. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients signed informed consent regarding publishing their data. Previously presented at ASCO 20201: https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.10541

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Patel, B.K., Pepin, K., Brandt, K.R. et al. Association of breast cancer risk, density, and stiffness: global tissue stiffness on breast MR elastography (MRE). Breast Cancer Res Treat 194, 79–89 (2022). https://doi.org/10.1007/s10549-022-06607-2

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  • DOI: https://doi.org/10.1007/s10549-022-06607-2

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