Review Article
Background parenchymal enhancement on breast MRI: A comprehensive review
Geraldine J. Liao MD,
Leah C. Henze Bancroft PhD,
Roberta M. Strigel MD, MS,
Rhea D. Chitalia BSE,
Despina Kontos PhD,
Linda Moy MD,
Savannah C. Partridge PhD,
Habib Rahbar MD,
Geraldine J. Liao MD
Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
Department of Radiology, Virginia Mason Medical Center, Seattle, Washington, USA
Search for more papers by this authorLeah C. Henze Bancroft PhD
Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
Search for more papers by this authorRoberta M. Strigel MD, MS
Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA
Search for more papers by this authorRhea D. Chitalia BSE
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorDespina Kontos PhD
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorLinda Moy MD
Department of Radiology, New York University School of Medicine, New York, New York, USA
Search for more papers by this authorSavannah C. Partridge PhD
Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
Search for more papers by this authorCorresponding Author
Habib Rahbar MD
Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
Address reprint requests to: H.R., Seattle Cancer Care Alliance, 1144 Eastlake Ave. East, Room LG-200, Seattle, WA 98109. E-mail: [email protected]Search for more papers by this authorGeraldine J. Liao MD,
Leah C. Henze Bancroft PhD,
Roberta M. Strigel MD, MS,
Rhea D. Chitalia BSE,
Despina Kontos PhD,
Linda Moy MD,
Savannah C. Partridge PhD,
Habib Rahbar MD,
Geraldine J. Liao MD
Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
Department of Radiology, Virginia Mason Medical Center, Seattle, Washington, USA
Search for more papers by this authorLeah C. Henze Bancroft PhD
Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
Search for more papers by this authorRoberta M. Strigel MD, MS
Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA
Search for more papers by this authorRhea D. Chitalia BSE
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorDespina Kontos PhD
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Search for more papers by this authorLinda Moy MD
Department of Radiology, New York University School of Medicine, New York, New York, USA
Search for more papers by this authorSavannah C. Partridge PhD
Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
Search for more papers by this authorCorresponding Author
Habib Rahbar MD
Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
Address reprint requests to: H.R., Seattle Cancer Care Alliance, 1144 Eastlake Ave. East, Room LG-200, Seattle, WA 98109. E-mail: [email protected]Search for more papers by this author[Correction added on April 30, 2019, after first online publication: The second author's name was updated to Leah C. Henze Bancroft.]
Contract grant sponsor: National Cancer Institute (National Institutes of Health); Contract grant numbers: R01 CA203883 (to Rahbar), R01 CA207290 (to Partridge), R01 CA160620 (to Moy), P41EB017183 (to Moy), P30 CA1520 (to Strigel).
Abstract
The degree of normal fibroglandular tissue that enhances on breast MRI, known as background parenchymal enhancement (BPE), was initially described as an incidental finding that could affect interpretation performance. While BPE is now established to be a physiologic phenomenon that is affected by both endogenous and exogenous hormone levels, evidence supporting the notion that BPE frequently masks breast cancers is limited. However, compelling data have emerged to suggest BPE is an independent marker of breast cancer risk and breast cancer treatment outcomes. Specifically, multiple studies have shown that elevated BPE levels, measured qualitatively or quantitatively, are associated with a greater risk of developing breast cancer. Evidence also suggests that BPE could be a predictor of neoadjuvant breast cancer treatment response and overall breast cancer treatment outcomes. These discoveries come at a time when breast cancer screening and treatment have moved toward an increased emphasis on targeted and individualized approaches, of which the identification of imaging features that can predict cancer diagnosis and treatment response is an increasingly recognized component. Historically, researchers have primarily studied quantitative tumor imaging features in pursuit of clinically useful biomarkers. However, the need to segment less well-defined areas of normal tissue for quantitative BPE measurements presents its own unique challenges. Furthermore, there is no consensus on the optimal timing on dynamic contrast-enhanced MRI for BPE quantitation. This article comprehensively reviews BPE with a particular focus on its potential to increase precision approaches to breast cancer risk assessment, diagnosis, and treatment. It also describes areas of needed future research, such as the applicability of BPE to women at average risk, the biological underpinnings of BPE, and the standardization of BPE characterization.
Level of Evidence: 3
Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:43–61.
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