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3D MRI for Quantitative Analysis of Quadrant Percent Breast Density

Posted Jun 30, 2017 Updated Apr 10, 2023
By Jeon-Hor Chen MD , Fuyi Liao MD , Yang Zhang MS , Yifan Li MS , Chia-Ju Chang BS , Chen-Pin Chou MD , Tsung-Lung Yang MD , Min-Ying Su PhD
10 min read

Rationale and Objectives

Breast cancer occurs more frequently in the upper outer (UO) quadrant, but whether this higher cancer incidence is related to the greater amount of dense tissue is not known. Magnetic resonance imaging acquires three-dimensional volumetric images and is the most suitable among all breast imaging modalities for regional quantification of density. This study applied a magnetic resonance imaging-based method to measure quadrant percent density (QPD), and evaluated its association with the quadrant location of the developed breast cancer.

Materials and Methods

A total of 126 cases with pathologically confirmed breast cancer were reviewed. Only women who had unilateral breast cancer located in a clear quadrant were selected for analysis. A total of 84 women, including 47 Asian women and 37 western women, were included. An established computer-aided method was used to segment the diseased breast and the contralateral normal breast, and to separate the dense and fatty tissues. Then, a breast was further separated into four quadrants using the nipple and the centroid as anatomic landmarks. The tumor was segmented using a computer-aided method to determine its quadrant location. The distribution of cancer quadrant location, the quadrant with the highest QPD, and the proportion of cancers occurring in the highest QPD were analyzed.

Results

The highest incidence of cancer occurred in the UO quadrant (36 out of 84, 42.9%). The highest QPD was also noted most frequently in the UO quadrant (31 out of 84, 36.9%). When correlating the highest QPD with the quadrant location of breast cancer, only 17 women out of 84 (20.2%) had breast cancer occurring in the quadrant with the highest QPD.

Conclusions

The results showed that the development of breast cancer in a specific quadrant could not be explained by the density in that quadrant, and further studies are needed to find the biological reasons accounting for the higher breast cancer incidence in the UO quadrant.

Introduction

Mammographic density (MD) is an independent risk factor for development of breast cancer . The biological basis for the association between increased breast cancer risk and higher MD is not fully understood. Studies of mammographically dense tissues suggest that density may represent increased epithelial cellular concentration, stromal fibrosis, and epithelial hyperplasia . A fundamental question that has yet to be answered is whether cancers tend to arise in mammographically dense tissue. Among several studies exploring the question, two studies showed that tumors occur overwhelmingly in the mammographically dense areas, suggesting that some aspects of glandular or stromal tissue comprising the dense tissue directly influence the carcinogenic process . Another study, however, found that after accounting for overall density, the regional density was not a significant risk factor for subsequently developed cancer .

Many studies have shown the quadrant disparity of cancer risk and noted that the upper outer (UO) quadrant was the most frequent site of carcinoma . A study consisting of 746 consecutive breast core biopsies found that 217 of 349 (62%) malignant lesions (95% confidence interval: 57%–67%) occurred in the UO quadrant . An adequate explanation for this asymmetric occurrence of breast cancer has never been established. Is the disparity of breast cancer in different quadrants related to the amount of breast density? As the first step to answer this question, it is necessary to develop a reliable quantification method to measure quadrant breast density. Most published studies analyzed the cancer risk related to the whole breast density, which did not consider the spatial variation of the dense tissue in the breast.

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Materials and Methods

Subjects

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MR Imaging Acquisition

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Breast and Fibroglandular Tissue Segmentation

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Quadrant Breast Density Assessment

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Figure 1, Correction of the breast orientation based on the centroid-nipple line.

Figure 2, Division of breast tissue and fibroglandular tissue into four quadrants, and the separated upper outer and upper inner quadrants.

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Determination of Tumor Quadrant Location

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Figure 3, Illustration of the tumor segmentation process on one image slice. (a) contrast enhancement map; (b) tumor voxels determined after FCM clustering segmentation; (c) tumor mask after removing scattered voxels; and (d) tumor mask after hole filling. FCM, fuzzy c means.

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Statistics

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Results

Quadrant BV, FV, and PD

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Table 1

Breast Volume, Fibroglandular Tissue Volume, and Percent Density in the Four Quadrants in Asian and Western Women

Upper Outer Upper Inner Lower Outer Lower Inner Breast volume (cm 3 ) Asian women ( n = 47) Mean201.8 120.9 199.1 119.2 STD 119.4 66.4 121.1 68.0 Median 170.9 108.7 171.9 109.3 Western women ( n = 37) Mean308.8 269.4 287.5 279.4 STD 135.6 119.0 123.2 123.3 Median 287.1 256.9 281.3 260.5 Fibroglandular tissue volume (cm 3 ) Asian women ( n = 47) Mean 29.5 17.033.1 16.3 STD 19.1 13.3 22.3 14.9 Median 27.2 12.0 28.8 11.2 Western women ( n = 37) Mean44.2 31.4 34.2 27.9 STD 29.6 22.8 20.8 19.4 Median 33.2 26.2 38.8 24.0 Percent density (%) Asian women ( n = 47) Mean 17.5 15.919.6 14.5 STD 12.5 11.5 13.8 11.8 Median 15.3 13.0 15.8 10.0 Western women ( n = 37) Mean14.4 12.2 11.4 10.2 STD 9.3 8.9 6.8 7.7 Median 12.0 9.5 9.6 8.3

STD, standard deviation. The bold value in each row of the Mean indicates the highest measured value among the four quadrants.

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Quadrant Location of Tumor and Highest QPD

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Table 2

Distribution of Breast Cancer in the Different Quadrants of the Breast

Upper Outer Upper Inner Lower Outer Lower Inner All subjects ( N = 84) 36(42.9%) 20(23.8%) 17(20.2%) 11(13.1%) Asian women( n = 47) 21(44.7%) 9(19.1%) 7(14.9%) 10(21.3%) Western women( n = 37) 15(40.6%) 11(29.7%) 10(27.0%) 1(2.7%)

Table 3

Distribution of Highest QPD and the Lesions Occurring in the Highest QPD Quadrant

Upper Outer Upper Inner Lower Outer Lower Inner Asian women ( n = 47) Highest QPD 11(23.4%) 8(17.0%) 19(40.4%) 9(19.2%) Lesions in highest QPD 5(45.5%) 0(0%) 2(10.5%) 1(11.1%) Western women( n = 37) Highest QPD 20(54.1%) 7(18.9%) 8(21.6%) 2(5.4%) Lesions in highest QPD 6(30.0%) 2(28.6%) 1(12.5%) 0(0%)

QPD, quadrant percent density.

Figure 4, A 65-year-old woman with a 2.5 cm invasive cancer in the UO quadrant of the left breast. The quadrant density in the right normal breast is highest in the UO quadrant (16.7%) and lowest in the LI quadrant (9.3%). LI, lower inner; UO, upper outer.

Figure 5, A 56-year-old woman with a 1.3 cm invasive cancer in the UI quadrant of the left breast. The quadrant density in the right normal breast is highest in the UI quadrant (12.0%) and the lowest in the LO quadrant (1.4%). LO, lower outer; UI, upper inner.

Figure 6, A 38-year-old woman with a 2.9 cm invasive cancer predominantly in the LO quadrant of the right breast. The LO quadrant contained 69.1% of the total tumor volume, whereas the remaining tumor (30.9%) was in the UO quadrant. The quadrant breast density in the left normal breast was highest in the UI quadrant (21.9%) and lowest in the LI and LO quadrant (7.2% and 7.2%). The quadrant breast density in the UO quadrant was 14.0%. LI, lower inner; LO, lower outer; UI, upper inner; UO, upper outer.

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Discussion

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Acknowledgments

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Academic Radiology, Volume 24, Issue 7
Journals General Radiology
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