Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response

Objectives

To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC).

Methods

One hundred and forty-six MRI examinations of 73 patients with 80 biopsy-proven breast cancers who underwent breast MRI before and after NAC were retrospectively analysed. All images were reviewed by two blinded readers, who classified BPE into categories (BEC; 1?=?minimal, 2?=?mild, 3?=?moderate, 4?=?marked) before and after NAC. Histopathological and morphological tumour responses were analysed and compared.

Results

The distribution of BEC 1/2/3/4 was 25/46/18/11 % before and 78/20/2/0 % after NAC. On average, BPE decreased by 0.87 BEC. Cohen’s kappa showed substantial agreement (k?=?0.73–0.77) before and moderate agreement (k?=?0.43–0.60) after NAC and moderate agreement (k?=?0.62–0.60) concerning the change in BEC. Correlating the change in BPE with tumour response, the average decrease in BEC was 1.3 in cases of complete remission, 0.83 in cases with partial response, 0.85 in cases with stable disease and 0.40 in cases with progressive disease. Correlation analysis showed a significant correlation between the decrease in BEC and tumour response (r?=??0.24, p?=?0.03).

Conclusions

BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response.

Key Points

? BPE decreases by an average of 0.87 categories under neoadjuvant chemotherapy. ? The reduction of BPE following neoadjuvant chemotherapy correlates with the tumour response. ? The classification of the BPE shows good agreement among trained readers.