Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 12/2020

Open Access 01-12-2020 | Magnetic Resonance Imaging | Breast

Contralateral parenchymal enhancement on breast MRI before and during neoadjuvant endocrine therapy in relation to the preoperative endocrine prognostic index

Authors: Max A. A. Ragusi, Claudette E. Loo, Bas H. M. van der Velden, Jelle Wesseling, Sabine C. Linn, Regina G. Beets-Tan, Sjoerd G. Elias, Kenneth G. A. Gilhuijs

Published in: European Radiology | Issue 12/2020

Login to get access

Abstract

Objectives

To investigate whether contralateral parenchymal enhancement (CPE) on MRI during neoadjuvant endocrine therapy (NET) is associated with the preoperative endocrine prognostic index (PEPI) of ER+/HER2− breast cancer.

Methods

This retrospective observational cohort study included 40 unilateral ER+/HER2− breast cancer patients treated with NET. Patients received NET for 6 to 9 months with MRI response monitoring after 3 and/or 6 months. PEPI was used as endpoint. PEPI is based on surgery-derived pathology (pT- and pN-stage, Ki67, and ER-status) and stratifies patients in three groups with distinct prognoses. Mixed effects and ROC analysis were performed to investigate whether CPE was associated with PEPI and to assess discriminatory ability.

Results

The median patient age was 61 (interquartile interval: 52, 69). Twelve patients had PEPI-1 (good prognosis), 15 PEPI-2 (intermediate), and 13 PEPI-3 (poor). High pretreatment CPE was associated with PEPI-3: pretreatment CPE was 39.4% higher on average (95% CI = 1.3, 91.9%; p = .047) compared with PEPI-1. CPE decreased after 3 months in PEPI-2 and PEPI-3. The average reduction was 24.4% (95% CI = 2.6, 41.3%; p = .032) in PEPI-2 and 29.2% (95% CI = 7.8, 45.6%; p = .011) in PEPI-3 compared with baseline. Change in CPE was predictive of PEPI-1 vs PEPI-2+3 (AUC = 0.77; 95% CI = 0.57, 0.96).

Conclusions

CPE during NET is associated with PEPI-group in ER+/HER2− breast cancer: a high pretreatment CPE and a decrease in CPE during NET were associated with a poor prognosis after NET on the basis of PEPI.

Key Points

• Change in contralateral breast parenchymal enhancement on MRI during neoadjuvant endocrine therapy distinguished between patients with a good and intermediate/poor prognosis at final pathology.
• Patients with a poor prognosis at final pathology showed higher baseline parenchymal enhancement on average compared to patients with a good prognosis.
• Patients with an intermediate/poor prognosis at final pathology showed a higher average reduction in parenchymal enhancement after 3 months of neoadjuvant endocrine therapy.
Appendix
Available only for authorised users
Literature
1.
Selli C, Dixon JM, Sims AH (2016) Accurate prediction of response to endocrine therapy in breast cancer patients: current and future biomarkers. Breast Cancer Res 18:118CrossRef
2.
Miller WR, Larionov A, Renshaw L et al (2009) Gene expression profiles differentiating between breast cancers clinically responsive or resistant to letrozole. J Clin Oncol 27:1382–1387CrossRef
3.
Fontein DBY, Charehbili A, Nortier JWR et al (2014) Efficacy of six month neoadjuvant endocrine therapy in postmenopausal, hormone receptor-positive breast cancer patients - a phase II trial. Eur J Cancer 50:2190–2200CrossRef
4.
Fowler AM, Mankoff DA, Joe BN (2017) Imaging neoadjuvant therapy response in breast cancer. Radiology 285:358–375CrossRef
5.
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRef
6.
Liao GJ, Henze Bancroft LC, Strigel RM et al (2020) Background parenchymal enhancement on breast MRI: a comprehensive review. J Magn Reson Imaging 51:43–61CrossRef
7.
Gampenrieder SP, Peer A, Weismann C et al (2019) Radiologic complete response (rCR) in contrast-enhanced magnetic resonance imaging (CE-MRI) after neoadjuvant chemotherapy for early breast cancer predicts recurrence-free survival but not pathologic complete response (pCR). Breast Cancer Res 21:19CrossRef
8.
Santamaría G, Bargalló X, Fernández PL, Farrús B, Caparrós X, Velasco M (2017) Neoadjuvant systemic therapy in breast cancer: association of contrast-enhanced MR imaging findings, diffusion-weighted imaging findings, and tumor subtype with tumor response. Radiology 283:663–672
9.
Goorts B, Dreuning KMA, Houwers JB et al (2018) MRI-based response patterns during neoadjuvant chemotherapy can predict pathological (complete) response in patients with breast cancer. Breast Cancer Res 20:1–10CrossRef
10.
Shin SU, Cho N, Lee HB et al (2018) Neoadjuvant chemotherapy and surgery for breast cancer: preoperative MRI features associated with local recurrence. Radiology 289:30–38CrossRef
11.
Partridge SC, Zhang Z, Newitt DC et al (2018) Diffusion-weighted MRI findings predict pathologic response in neoadjuvant treatment of breast cancer: the ACRIN 6698 multicenter trial. Radiology 289:618–627CrossRef
12.
Takeda K, Kanao S, Okada T et al (2012) MRI evaluation of residual tumor size after neoadjuvant endocrine therapy vs. neoadjuvant chemotherapy. Eur J Radiol 81:2148–2153CrossRef
13.
Hilal T, Covington M, Kosiorek HE et al (2018) Breast MRI phenotype and background parenchymal enhancement may predict tumor response to neoadjuvant endocrine therapy. Breast J 24:1–5
14.
van der Velden BH, Dmitriev I, Loo CE, Pijnappel RM, Gilhuijs KG (2015) Association between parenchymal enhancement of the contralateral breast in dynamic contrast-enhanced MR imaging and outcome of patients with unilateral invasive breast cancer. Radiology 276:675–685
15.
van der Velden BHM, Sutton EJ, Carbonaro LA, Pijnappel RM, Morris EA, Gilhuijs KGA (2018) Contralateral parenchymal enhancement on dynamic contrast-enhanced MRI reproduces as a biomarker of survival in ER-positive/HER2-negative breast cancer patients. Eur Radiol 28:4705–4716
16.
Pierce BL, Ballard-Barbash R, Bernstein L et al (2009) Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. J Clin Oncol 27:3437–3444CrossRef
17.
Dowsett M, Nielsen TO, A’Hern R et al (2011) Assessment of Ki67 in breast cancer: recommendations from the international Ki67 in breast cancer working group. J Natl Cancer Inst 103:1656–1664CrossRef
18.
Von Minckwitz G, Untch M, Blohmer JU et al (2012) Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol 30:1796–1804CrossRef
19.
Cortazar P, Zhang L, Untch M et al (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384:164–172CrossRef
20.
Spring LM, Gupta A, Reynolds KL et al (2016) Neoadjuvant endocrine therapy for estrogen receptor-positive breast cancer: a systematic review and meta-analysis. JAMA Oncol 2:1477–1486CrossRef
21.
Ellis MJ, Tao Y, Luo J et al (2008) Outcome prediction for estrogen receptor-positive breast cancer based on postneoadjuvant endocrine therapy tumor characteristics. J Natl Cancer Inst 100:1380–1388CrossRef
22.
Ellis MJ, Suman VJ, Hoog J et al (2017) Ki67 proliferation index as a tool for chemotherapy decisions during and after neoadjuvant aromatase inhibitor treatment of breast cancer: results from the American College of Surgeons Oncology Group Z1031 trial (alliance). J Clin Oncol 35:1061–1069CrossRef
23.
Yaniv Z, Lowekamp BC, Johnson HJ, Beare R (2018) SimpleITK image-analysis notebooks: a collaborative environment for education and reproducible research. J Digit Imaging 31:290–303CrossRef
24.
Green MC, Buzdar AU, Smith T et al (2005) Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol 23:5983–5992CrossRef
25.
Pinder SE, Provenzano E, Earl H, Ellis IO (2007) Laboratory handling and histology reporting of breast specimens from patients who have received neoadjuvant chemotherapy. Histopathology 50:409–417CrossRef
26.
Verbeke G, Molenberghs G (2004) A review on linear mixed models for longitudinal data, possibly subject to dropout. Stat Model 1:235–269
27.
Bates D, Mächler M, Bolker BM, Walker SC (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1–51
28.
Kuznetsova A, Brockhoff PB, Christensen RHB (2017) lmerTest package: tests in linear mixed effects models. J Stat Softw 82:1–26
29.
Vandenbroucke JP, von Elm E, Altman DG et al (2014) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 12:1500–1524CrossRef
30.
Choi JS, Ko ES, Ko EY, Han B-K, Nam SJ (2016) Background parenchymal enhancement on preoperative magnetic resonance imaging: association with recurrence-free survival in breast cancer patients treated with neoadjuvant chemotherapy. Medicine (United States) 95:e3000
31.
Chen JH, Yu HJ, Hsu C, Mehta RS, Carpenter PM, Su YM (2015) Background parenchymal enhancement of the contralateral normal breast: association with tumor response in breast cancer patients receiving neoadjuvant chemotherapy. Transl Oncol 8:204–209
32.
You C, Gu Y, Peng W et al (2018) Decreased background parenchymal enhancement of the contralateral breast after two cycles of neoadjuvant chemotherapy is associated with tumor response in HER2-positive breast cancer. Acta Radiol 59:806–812CrossRef
33.
Preibsch H, Wanner L, Bahrs SD et al (2016) Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response. Eur Radiol 26:1590–1596CrossRef
34.
Müller-Schimpfle M, Ohmenhaüser K, Stoll P, Dietz K, Claussen CD (1997) Menstrual cycle and age: influence on parenchymal contrast medium enhancement in MR imaging of the breast. Radiology 203:145–149
35.
Delille J-P, Slanetz PJ, Yeh ED, Kopans DB, Halpern EF, Garrido L (2007) Hormone replacement therapy in postmenopausal women: breast tissue perfusion determined with MR imaging—initial observations. Radiology 235:36–41
36.
Pfleiderer SOR, Sachse S, Sauner D et al (2004) Changes in magnetic resonance mammography due to hormone replacement therapy. Breast Cancer Res 6:R232–R238CrossRef
37.
Sung JS, Corben AD, Brooks JD et al (2018) Histopathologic characteristics of background parenchymal enhancement (BPE) on breast MRI. Breast Cancer Res Treat 172:487–496CrossRef
38.
van der Velden BHM, Bismeijer T, Canisius S et al (2019) Are contralateral parenchymal enhancement on dynamic contrast-enhanced MRI and genomic ER-pathway activity in ER-positive/HER2-negative breast cancer related? Eur J Radiol 121:108705CrossRef
39.
Loo CE, Straver ME, Rodenhuis S et al (2011) Magnetic resonance imaging response monitoring of breast cancer during neoadjuvant chemotherapy: relevance of breast cancer subtype. J Clin Oncol 29:660–666CrossRef
40.
Boughdad S, Champion L, Becette V et al (2020) Early metabolic response of breast cancer to neoadjuvant endocrine therapy: comparison to morphological and pathological response. Cancer Imaging 20:1–9
41.
Dowsett M, Ebbs SR, Dixon JM et al (2005) Biomarker changes during neoadjuvant anastrozole, tamoxifen, or the combination: influence of hormonal status and HER-2 in breast cancer - a study from the IMPACT trialists. J Clin Oncol 23:2477–2492CrossRef
42.
Drisis S, Metens T, Ignatiadis M, Stathopoulos K, Chao SL, Lemort M (2016) Quantitative DCE-MRI for prediction of pathological complete response following neoadjuvant treatment for locally advanced breast cancer: the impact of breast cancer subtypes on the diagnostic accuracy. Eur Radiol 26:1474–1484
43.
Van Der Velden BHM, Elias SG, Bismeijer T et al (2017) Complementary value of contralateral parenchymal enhancement on DCE-MRI to prognostic models and molecular assays in high-risk ER+/HER2−breast cancer. Clin Cancer Res 23:6505–6515CrossRef
44.
Haacke EM, Filleti CL, Gattu R et al (2007) New algorithm for quantifying vascular changes in dynamic contrast-enhanced MRI independent of absolute T1 values. Magn Reson Med 58:463–472CrossRef
45.
Yeo B, Dowsett M (2015) Neoadjuvant endocrine therapy: patient selection, treatment duration and surrogate endpoints. Breast 24:S78–S83CrossRef
Metadata
Title
Contralateral parenchymal enhancement on breast MRI before and during neoadjuvant endocrine therapy in relation to the preoperative endocrine prognostic index
Authors
Max A. A. Ragusi
Claudette E. Loo
Bas H. M. van der Velden
Jelle Wesseling
Sabine C. Linn
Regina G. Beets-Tan
Sjoerd G. Elias
Kenneth G. A. Gilhuijs
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07058-3

Other articles of this Issue 12/2020

European Radiology 12/2020 Go to the issue

Chest

Emphysema quantification using low-dose computed tomography with deep learning–based kernel conversion comparison

Magnetic Resonance

MR elastography frequency–dependent and independent parameters demonstrate accelerated decrease of brain stiffness in elder subjects

Computed Tomography

A fully automated software platform for structural mitral valve analysis

Correction

Correction to: The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview

Neuro

Perfusion recovery on TTP maps after endovascular stroke treatment might predict favorable neurological outcomes

Computed Tomography

COVID-19 impact assessment on the French radiological centers: a nationwide survey