Rationale and Objectives
Breast magnetic resonance imaging (MRI) is recommended for the screening of women with a history of chest radiotherapy and consequent increased breast cancer risk. The purpose of this study was to evaluate the impact of prior chest radiotherapy on breast tissue background parenchymal enhancement (BPE) at screening breast MRI.
Materials and Methods
A departmental database was reviewed to identify asymptomatic women with either a history of chest radiotherapy for Hodgkin's lymphoma or age-matched controls who underwent screening breast MRI between 2009 and 2013. MRI studies were analyzed on an automated breast MRI viewing platform to calculate breast BPE and breast density.
A total of 61 cases (mean age 41.6 ± 6.75 years) and 61 controls (mean age 40.8 ± 6.99 years) were included. The age of patients at the time of chest radiotherapy was 22.6 ± 8.17 years. Screening MRI was performed 19.0 ± 7.43 years after chest radiotherapy. BPE was significantly higher in patients who received chest radiotherapy (50% vs. 37%, P < 0.01). A weak to moderate positive correlation (r > 0.3; P < 0.03) was found between BPE and number of years post radiotherapy. There was a trend toward significant difference between the two groups in the correlation of BPE and age (P = 0.05). Breast density was not significantly different between the two groups.
BPE is significantly greater in women who receive chest radiotherapy for childhood Hodgkin's lymphoma, and unexpectedly, it positively correlates with the number of years passed after radiation therapy. Long-term biological effects of radiation therapy on breast parenchyma need further research.
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- Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma.J Natl Cancer Inst. 2005; 97: 1428-1437
- Breast cancer after chest radiation therapy for childhood cancer.J Clin Oncol. 2014; 32: 2217-2223
- Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition.N Engl J Med. 2004; 351: 427-437
- Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination.JAMA. 2004; 292: 1317-1325
- Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer.J Clin Oncol. 2005; 23: 8469-8476
- American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography.CA Cancer J Clin. 2007; 57: 75-89
- Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer.J Am Coll Radiol. 2010; 7: 18-27
- Screening breast MR imaging in women with a history of chest irradiation.Radiology. 2011; 259: 65-71
- Prospective study of the efficacy of breast magnetic resonance imaging and mammographic screening in survivors of Hodgkin lymphoma.J Clin Oncol. 2013; 31: 2282-2288
- Added cancer yield of breast magnetic resonance imaging screening in women with a prior history of chest radiation therapy.Cancer. 2013; 119: 495-503
- Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency.Radiology. 1997; 203: 137-144
- Undetected malignancies of the breast: dynamic contrast-enhanced MR imaging at 1.0 T.Radiology. 2002; 224: 881-888
- Breast cancers not detected at MRI: review of false-negative lesions.AJR Am J Roentgenol. 2010; 194: 1674-1679
- Does the degree of background enhancement in breast MRI affect the detection and staging of breast cancer?.Eur Radiol. 2011; 21: 2261-2267
- Background parenchymal enhancement on baseline screening breast MRI: impact on biopsy rate and short-interval follow-up.AJR Am J Roentgenol. 2011; 196: 218-224
- Background parenchymal enhancement at breast MR imaging and breast cancer risk.Radiology. 2011; 260: 50-60
- Are quantitative assessments of background parenchymal enhancement, amount of fibroglandular tissue on MR images, and mammography density associated with breast cancer risk?.Radiology. 2015; 276: 371-380
- Breast MRI after conservation therapy: usual findings in routine follow-up examinations.AJR Am J Roentgenol. 2010; 195: 799-807
- Impact of radiotherapy on background parenchymal enhancement in breast magnetic resonance imaging.Asian Pac J Cancer Prev. 2014; 15: 2939-2943
- The effect of acute aromatase inhibition on breast parenchymal enhancement in magnetic resonance imaging: a prospective pilot clinical trial.Menopause. 2012; 19: 420-425
- Background parenchymal enhancement at breast MR imaging: normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation.Radiographics. 2014; 34: 234-247
- A modified fuzzy C-means algorithm for bias field estimation and segmentation of MRI data.IEEE Trans Med Imaging. 2002; 21: 193-199
- Quantification of breast tissue index from MR data using fuzzy clustering.Conf Proc IEEE Eng Med Biol Soc. 2004; 3: 1667-1670
- Should breast MRI be performed with adjustment for the phase in patients' menstrual cycle? Correlation between mammographic density, age, and background enhancement on breast MRI without adjusting for the phase in patients' menstrual cycle.Eur J Radiol. 2012; 81: 1539-1542
- Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training.AJR Am J Roentgenol. 2014; 203: 209-215
- Interobserver variability between breast imagers using the fifth edition of the BI-RADS MRI Lexicon.AJR Am J Roentgenol. 2015; 204: 1120-1124
- Quantification of background enhancement in breast magnetic resonance imaging.J Magn Reson Imaging. 2011; 33: 1229-1234
- Mammographic density and the risk and detection of breast cancer.N Engl J Med. 2007; 356: 227-236
- Is mammographic breast density a breast cancer risk factor in women with BRCA mutations?.J Clin Oncol. 2010; 28: 3779-3783
- Kinetic curves of malignant lesions are not consistent across MRI systems: need for improved standardization of breast dynamic contrast-enhanced MRI acquisition.AJR Am J Roentgenol. 2009; 193: 832-839
Published online: November 03, 2015
Accepted: September 16, 2015
Received in revised form: September 3, 2015
Received: May 8, 2015
© 2015 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.