Emerging research suggests that the difference between lesion time to enhancement (TTE) and background parenchymal enhancement (BPE) TTE on ultrafast breast magnetic resonance imaging (MRI) may be a key parameter for differentiating malignant and benign foci.
For the retrospective study, recently published in the American Journal of Roentgenology, researchers reviewed ultrafast MRI (UFMRI) findings for 124 women (mean age of 53) who had biopsy for 124 foci. Over 65 percent of the cohort had a family history of breast cancer and 57.3 percent had a personal history of breast cancer, according to the study. Mild BPE was present on MRI for 57.3 percent of the cohort.
Out of the 124 foci, the researchers noted 21 cases of malignancy, 16 invasive foci, five foci that were ductal carcinoma in situ (DCIS), and five cases involving lymph node metastasis.
For every one second increase in the difference between lesion TTE and BPE TTE on UFMRI, the study authors noted a 5 percent increase in the odds of malignancy.
“Our study found that odds of malignancy of foci increased with increasing difference in TTE of the lesion compared with that of BPE, lower levels of BPE, and older age,” wrote lead study author Helaina C. Regen-Tuero, M.D., who is affiliated with the Department of Radiology at New York University (NYU) Langone Health in New York City, and colleagues.
While noting other research that suggested a link between higher levels of BPE and increased malignancy risk, the study authors found that those with minimal or mild BPE on UFMRI had over an 11-fold higher malignancy risk than women with moderate or marked BPE.
“This finding may reflect the relative difficulty of differentiating malignant foci from background in the setting of higher levels of BPE (masking effect) and may point toward potential utility for assessing lesion enhancement versus BPE on ultrafast sequences,” posited Regen-Tuero and colleagues.
Three Key Takeaways
1. TTE difference as a malignancy marker. A greater time-to-enhancement (TTE) difference between a lesion and background parenchymal enhancement (BPE) on ultrafast MRI is associated with a higher likelihood of malignancy — each one-second increase in TTE difference raises the odds of malignancy by 5 percent.
2. BPE level and malignancy risk. Contrary to some previous studies, lower levels of BPE (minimal or mild) were linked to significantly higher malignancy risk — over 11 times greater —compared to moderate or marked BPE, possibly due to the masking effect in higher BPE.
3. Potential diagnostic utility. The TTE difference parameter may enhance diagnostic accuracy in distinguishing benign from malignant foci, especially in high-risk patients and in the absence of clear morphologic predictors, highlightin
While conceding that further research is needed, the study authors suggested that the ultrafast MRI TTE parameter could play a key role in detecting smaller malignant lesions.
“The difference of focus TTE and BPE TTE may serve as a useful parameter for classifying foci as malignant or benign. This finding is particularly important given the lack of consistent morphologic imaging predictors of focus malignancy. Improving the clinical differentiation of benign from malignant lesions identified on MRI is important; MRI plays a key role in detecting smaller cancers in high-risk populations, which may contribute to the improved overall survival rates seen with MRI screening,” added Regen-Tuero and colleagues.
(Editor’s note: For related content, see “Can Pre-Op Ultrafast MRI Predict Upgrade of DCIS Lesions to Invasive Breast Cancer?,” “Surveillance Breast MRI Associated with Lower Risks of Advanced Second Breast Cancers” and “Can Diffusion MRI Predict Patient Response to Neoadjuvant Chemotherapy for Breast Cancer?”)
Beyond the inherent limitations of a single-center retrospective study, the authors acknowledged the small predominantly non-Hispanic White cohort that may limit extrapolation of the outcomes to broader populations. The researchers also noted possible selection bias with the exclusion of lesions from cases in which percutaneous biopsy was bypassed in favor of proceeding directly to surgery.
