Comparative Study Between Dynamic Contrast Enhanced MRI And Pathological Findings In Breast Cancer

part IBreast cancer diagnosis: evaluation by combining breast imaging reporting and dada system and dynamic contrast enhanced MRI derived parameters ObjectiveTo evaluate diagnosis accuracy in dynamic contrast enhanced MRI (DCE-MRl)of the breast cancer by combined breast imaging reporting and dada system (BI-RADS ) of American College of Radiology and enhancement parameters. The MR characteristics of benign and malignant breast masses were discussed.MethodsSixty-seven patients with suspicious mammographic or palpable mass findings underwent preoperative DCE-MR imaging of the breast. Each lesion was prospectively analyzed by two independent radiologists for morphologic and dynamic enhancement characteristics in terms of BI-RADS. DCE-MRI parameters such as steepest slope (Smax), peak height (PH), time of peak signal change(Tmax), maximum enhancement(Emax) and the change in signal intensity in percent at 1(E₁),2(E₂), 3(E₃),4(E₄),5(E₅)and 6(E₆) minutes were calculated based on time-signal intensity curves(TIC). All patients were operated in 10 days after MR examination. Only those with breast mass identified in operation were included in the study. Both indexes from BI-RADS and parameters derived from DCE-MRI were compared between benign and malignant breast masses.ResultsThirty-four cases of breast cancer and nineteen cases of benign breast lesion with breast mass were included in the study. There was no statistical significant difference between malignancy and benign in the edge or shape of mass (P＝0.0571, P=0.1322). The difference in the enhancement pattern, TIC and initial enhancement between the benign and the malignant group was statistically significant (x²=15.566, P=0.001; x²=26.198, P=0.001: x²=6.176, P=0.0456). Of them, wash-out curve and peripheral enhancement and late inhomogeneous contrast enhancement were suggestive of malignant. Flow-in TIC and late homogeneous contrast enhancement were suggestive of benign. According to BI—RADS criteria, 34 cases of breast cancer were categorized as grade V(n=21), gradeâ…£(n=10),gradeâ…¢(n=3) and 19 cases of benign breast lesion were categorized as gradeâ… (n=6), gradeâ…¡(n=5), gradeâ…¢(n=6), gradeâ…£(n=2), respectively. Plateau type of TIC was gotten in 31.6%(6/19) benign and 38.2%(13/34) malignant breast masses, which showed no statistically significantly difference.The difference in the DCE-MRI parameters such as S_max,E_max,E₁,E₂,T_peak, between the benign and the malignant group was statistically significant(P＜0.05), respectively. The DCE-MRI diagnostic accuracy was much improved by combined BI-RADS and dynamic parameters with a sensitivity of 97.1%(33/34) and a specificity of 89.4%(17/19).Conclusion1,BI—RADS diagnostic criteria based on a multifactorial analysis is a suitable and comprehensive diagnostic method in the interpretation of DCE-MRI of breast cancer. The possibility of malignancy becomes more indicative with the grade increase derived from BI—RADS. However, there is an overlap to some extent in the morphology and TIC type between benign and malignancy.2,The difference in some enhancement parameters of DCE-MRI was statistically significant between benign and malignant breast mass. Combining BI-RADS of American College of Radiology and enhancement parameters derived from TIC is very helpful to improve the diagnostic accuracy of breast cancer.Partâ…¡Correlative study of enhancement parameter of dynamic contrast-enhanced MR/and angiogenesis in breast cancerObjective1,To evaluate the tumor angiogenesis in breast cancer by comparing the difference of microvessel density (MVD) and vascular endothelial growth factor (VEGF) among the patients with breast cancer, with breast fibroadenomas, with breast mastopathy and the normal tissue beside the cancer.2,To explore the relationship between dynamic contrast-enhanced MRI (DCE-MRI)-derived parameters and tumor angiogenesis in breast cancer and the clinical value of DCE-MRI in monitoring the breast cancer's angiogenesis.MethodsTwenty-nine patients with breast cancer underwent DCE-MRI using Philips Intera 1.5 T MR system and dedicated breast coil prospectively before operation. DCE-MRI derived parameters such as steepest slope (S_max), maximum enhancement (E_max), peak height(PH), and the enhancement rates of signal intensity at first(E₁), second (E₂), third(E₃), forth(E₄), fifth(E₅)and sixth(E₆) minutes of time-signal intensity curve were calculated. MVD were counted and VEGF expression were assessed in these patients with immunohistochemical staining method. The parameters were correlated statistically with MVD counts and VEGF expression in breast cancer. The MVD counts and VEGF expression were also compared among the patients with breast cancer, with fibroadenoma, mastopathy and the normal tissue beside the cancer.Results The mean value of MVD(65.09±15.81/200×) in patients with breast cancer were significantly higher than those with fibroadenoma, mastopathy and the normal tissue beside the cancer (P=0.0426, 0.0177, 0.0023).Twenty cases of breast cancer demonstrated positive VEGF expression, which were significantly more than the cases of fibroadenoma, mastopathy and the normal tissue besidethe cancer (P=0.0351, 0.0071, 0.0013) . Moreover, the MVD counts at cancer peripheral region were more than those at central region (t=2.6347, P=0.0157). There was a significant difference between MVD counts of breast cancers with metastasis(73.23±23.02) to axillary lymph nodes and MVD counts of those without metastasis(59.34±18.03, t=2.3029, P=0.0310).The enhancement parameters Smax,Emax,PH,E₁,E₂,E₃,E₄,E₅,E₆correlated positively with MVD respectively. Of them, the highest correlation was found between S_max and MVD (r= 0.807, P＜0. 001). Tpeak correlated negatively with MVD counts(r=-0.425, P＜0.05).Conclusion1. The MVD counts and VEGF expression in patients with breast cancer were significantly higher than those with benign breast lesions. Tumor angiogenesis in breast cancer reflects its pathophysiological basis of the enhancement patterns on dynamic contrast-enhanced MR imaging.2. The DCE-MRI derived parameters such as S_max,E_max,PH,E₁,E₂,E₃,E₄,E₅,E₆ correlated positively with MVD counts and VEGF expression in patients with breast cancer. DCE-MR imaging as a non-invasive method can accurately monitor tumor angiogenesis, which is helpful to evaluate the biological behavior and the prognosis of breast cancer.