| PartⅠ MRI Study of Background Parenchymal Enhancement on Breast MRI and Its Related FactorsObjective: to investigate the correlation between background parenchymal enhancement(BPE) on breast MRI and mammographic breast density(MGD),menopause status, breast lesions、expression status of the ER, PR, Her-2 in breast cancer.Methods: 1.Study Object 318 cases(150 benign and 168 malignant) were collected to meet the following conditions.⑴ MRI examination of premenopausal patients were carried out within 3-5 days after menstruation clean. ⑵ All cases were operated in 3-7 days after MRI examination. ⑶ There were preoperative breast X-ray radiography and MRI examination.⑷ No any hormone therapy was done in 6 months before operation. ⑸All patients with breast cancer were unilateral breast cancer. Among them, 134 patients with breast cancer had immunohistochemical data. 2.Instruments and Inspection techniques Digital mammography was performed(SIEMENS, MAMMOMAT inspiration). Standard two-view mammography(mediolateral oblique and craniocaudal) was performed with additional views as necessary.Transverse T1 WI, T2WI-STIR and T1WI-DCE were scanned routinely by 1.5T MR scanner(SIEMENS, MAGNETOM Espree).Gadolinium contrast agent was shotted by intravenous injection at 2m L/s, and 5 scanning period were carried out at each interval 73 s after administration of the contrast material. 3. MRI and MG analysis According to BI-RADS classification, background parenchymal enhancement(BPE) was qualitatively described, using the early phase images obtained 73 second after administration of the contrast material, as minimal(<25% of the glandular tissue showing enhancement), mild(25–50%), moderate(50–75%) and marked(>75%);MGD was graded as 1 almost entirely fat(<25% glandular), 2 scattered fibro-glandular densities(25-50% glandular), 3 heterogeneously dense(50-75% glandular), and 4 extremely dense(>75% glandular).MGD was divided into low MGD(category1 or 2) and high MGD(category 3 or 4) and BPE was divided into low BPE(minimal or mild) and high BPE(moderate or marked).The correlation between BPE and Breast lesions was analyed by two experienced imaging diagnosis doctors,and the relation BPE of 134 patients with breast cancer between menopausal status,MGD,expression status of ER and PR, Her-2 was analyed. 4. Histopathologic analysis All patients included in our study underwent surgery, and histopathologic information was obtained from pathology reports. Immunohistochemical positive standard :ER and PR positivity was defined as the presence of 10% or more positively stained nuclei in 10 high-power fields. The intensity of human epidermal growth factor receptor(Her-2) staining was semiquantitatively scored as 0, 1+, 2+, or 3+. Tumors with a 2+ or 3+ score were classified as Her-2 positive. 5. Statistical Analysis We used a Chi-square test or Fisher’s exact test for pairwise comparisons.The correlation between BPE and MGD,menopausal status,breast lesions were analysed using Spearman correlation coefficient. Statistical analyses were performed using commercially available software(SPSS,18.0).Statistical significance was assigned if the p-value was less than 0.05.Results: There were significant differences in benign and malignant breast lesions between women with low BPE and women with high BPE(χ2=10.155,p=0.017),and there was no correlations between breast cancer risk and BPE(r=-0.107,p=0.071). There was no correlation between BPE and MGD in either pre- or post-menopausal women. In all 134 cases with breast cancer, there were no significant differences in ER, PR and Her-2 status between women with low BPE and women with high BPE(p>0.05),and there was significant positive association between menopausal status and BPE level of women with breast cancer(χ2=25.023,p=0.000).Conclusion: There was no correlation between the breast BPE of Chinese women and receptor status of ER、PR、Her-2, breast density, benign and malignant breast lesions. The level of BPE can not be is one of the prediction factors of breast cancer risk, and level of BPE of the contralateral breast at breast MRI in patients with unilateral breast cancer was not association with prognostic factors.Part Ⅱ MRI Diagnostic Value of Breast Cancer in Pre- and Post-menopausal Women with Mammographic Dense BreastsObjective: To investigate the MRI diagnosing value of breast cancer in postmenopausal women with Mammographic Dense Breasts by comparing MRI features of breast cancer in postmenopausal and premenopausal women with Mammographic Dense Breasts.Methods: 1.Study Object 318 cases(150 benign and 168 malignant) were collected to meet the following conditions.⑴ MRI examination of premenopausal patients were carried out within 3-5 days after menstruation clean. ⑵ All cases were operated in 3-7 days after MRI examination. ⑶ There were preoperative breast X-ray radiography and MRI examination.⑷ No any hormone therapy was done in 6 months before operation. ⑸All patients with breast cancer were unilateral breast cancer. Among them, 134 patients with breast cancer had immunohistochemical data. 2.Instruments and Inspection techniques Digital mammography was performed(SIEMENS, MAMMOMAT inspiration). Standard two-view mammography(mediolateral oblique and craniocaudal) was performed with additional views as necessary.Transverse T1 WI, T2WI-STIR and T1WI-DCE were scanned routinely by 1.5T MR scanner(SIEMENS, MAGNETOM Espree).Gadolinium contrast agent was shotted by intravenous injection at 2m L/s, and 5 scanning period were carried out at each interval 73 s after administration of the contrast material,and to measure the dynamic enhanced time signal intensity curve(TIC). 3. MRI and MG analysis According to BI-RADS classification, MGD was graded as 1 almost entirely fat(<25% glandular), 2 scattered fibro-glandular densities(25-50% glandular), 3 heterogeneously dense(50-75% glandular), and 4 extremely dense(>75% glandular). MGD was divided into low MGD(category1 or 2) and high MGD(category 3 or 4).Comparing with pathological diagnosis,MG and breast MRI were analyzed by two experienced diagnosis doctors to evaluate MRI diagnostic efficiency,to analyze the correlation between MGD and breast lesion under the different menopausal status and Immunohistochemical subtype,and to investigate the edge, appearance, enhancement degree and TIC type of breast cancer of pre- and post- menopausal women with dense breast whether to be different. 4. Histopathologic analysis All patients included in our study underwent surgery, and histopathologic information was obtained from pathology reports. Immunohistochemical positive standard :ER and PR positivity was defined as the presence of 10% or more positively stained nuclei in 10 high-power fields. The intensity of human epidermal growth factor receptor(Her-2) staining was semiquantitatively scored as 0, 1+, 2+, or 3+. Tumors with a 2+ or 3+ score were classified as Her-2 positive.5. Statistical Analysis We used a Chi-square test or Fisher’s exact test for pairwise comparison,and Spearman correlation coefficient for pairwise comparisons. Statistical analyses were performed using software(SPSS,18.0).Statistical significance was assigned if the p-value was less than 0.05.Results: In all 318 cases,189 cases(59.43%) were premenopausal, and 129 cases(40.57%) postmenopausal. Among 107 cases premenopausal women with dense breast,54 cases were malignant, and 42 cases benign;Among 83 cases postmenopausal women with dense breast,56 cases were malignant,and 27 cases benign. The constituent ratio of benign lesions and malignant lesions of breasts was no significant difference in different breast density types of premenopausal women(p=0.162). Breast cancer of postmenopausal women were positively correlated with dense breast(r=0.348,p=0.000),and be more common in dense breasts(OR=4.48,95%CI:2.089,9.610).ER positivity(p=0.011) and PR positivity(p=0.000) were associated with mammographically dense breasts. No association between Her-2 positivity and mammographically dense breasts was observed(p=0.216).The diagnostic accuracy of MRI for breast cancer in premenopausal and postmenopausal women with dense breasts was 75.93% and 92.86% respectively, and the difference was statistically significant(c2=6.031,p=0.014). There was no difference in the appearance, enhancement degree and TIC type of breast cancer of breast cancer of pre- and post- menopausal women with dense breast(p>0.05).There was significant difference on the edge of breast cancer of pre- and postmenopausal women with dense breast(c2=14.617,p=0.001).The edge burr or irregular of the lesions of post- menopausal women with dense breast was positively associated with breast cancer(p=0.001,r=0.307).Conclusion: Breast cancer of postmenopausal women was more common in dense breasts, and MRI could be an effective screening method in postmenopausal women with mammographic dense breast.Part Ⅲ MRI Diagnostic Value of “Focal Asymmetry of Breast” Signs on MammographyObjective To evaluate the diagnostic value of MRI in sign with Focal Asymmetry of Breast(FAB) on mammography.Methods 1.Study Object 46 cases(35 benign and 11 malignant) were collected to meet the following conditions.⑴Before operation,the "FAB" signs were confirmed by X-ray photography。⑵ All cases were operated in 3-7 days after MRI examination. ⑶ There were preoperative breast X-ray radiography and MRI examination,and MRI examination of premenopausal patients were carried out within 3-5 days after menstruation clean. ⑷ No any hormone therapy was done in 6 months before operation. 2.Instruments and Inspection techniques Full digital breast X-ray camera(SIEMENS, MAMMOMAT inspiration) was applied to acquire regular breasts mediolateral oblique(MLO) and craniocaudal(CC).Transverse T1 WI, T2WI-STIR and T1WI-DCE were scanned routinely by 1.5T MR scanner(SIEMENS, MAGNETOM Espree).Gadolinium contrast agent was shotted by intravenous injection at 2m L/s, and 5 scanning period were carried out at each interval 73 s after administration of the contrast material,and measure the dynamic enhanced time signal intensity curve(TIC). 3. MRI and MG analysis Based on BI-RADS and Kuhl’s research,A type Ⅱ and Ⅲ TIC was indicator of malignancy and A typeⅠbenign. On the basis of MRI morphological features and the TIC types of the breast lesions observed,MG and breast MRI was analyzed by two experienced diagnosis doctors. Comparing with pathological diagnosis,MRI diagnostic efficiency was evaluated. 4. Statistical Analysis We used a Chi-square test or Fisher’s exact test for pairwise comparisons.Statistical analyses were performed using commercially available software(SPSS,18.0).Statistical significance was assigned if the p-value was less than 0.05.Results In all 46 patients, MRI had detected 46 lesions in the corresponding areas of FAB on mammography. 35 cases of benign lesions and 11 cases of malignant lesions were confirmed by pathology. The accuracy, positive predictive value and negative predictive value of the sub-leaf shape and edge burr of the breast 1esions were 82.61%, 66.67%, 86.49% and 86.96%, 85.71%, 87.18% respectively.Time-signal intensity curve display: all 17 cases I type curve are benign;InⅡtype curves,4 cases are benign,and 2 malignant;In Ⅲtype curves,9cases are all malignant. The diagnostic accuracy of MRI for the benign and malignant breast lesions was 86.96%.The positive predictive value and negative predictive values were 81.82% and 96.88% respectively. In present study, there were significant differences in the edge,enhancement degree and enhancement pattern of benign and malignant lesions of the FAB signs of the breast(p<0.05). Obvious enhancement of lesions of the breast FAB signs strongly suggests the presence of breast cancer(p=0.002,OR=20,95%CI:2.114,189.176).Conclusion By MRI analysis of morphological features and TIC types of lesions with FAB on mammography, MRI can definitely estimate whether to have potential lesions in FAB,and more accurately discriminate malignant and benign breast lesions. |
PDF Full Text Request