Rationale and Objectives
Breast magnetic resonance imaging (MRI) is recommended for the screening of women with a history of chest radiotherapy and consequent increased breast cancer risk. The purpose of this study was to evaluate the impact of prior chest radiotherapy on breast tissue background parenchymal enhancement (BPE) at screening breast MRI.
Materials and Methods
A departmental database was reviewed to identify asymptomatic women with either a history of chest radiotherapy for Hodgkin’s lymphoma or age-matched controls who underwent screening breast MRI between 2009 and 2013. MRI studies were analyzed on an automated breast MRI viewing platform to calculate breast BPE and breast density.
Results
A total of 61 cases (mean age 41.6 ± 6.75 years) and 61 controls (mean age 40.8 ± 6.99 years) were included. The age of patients at the time of chest radiotherapy was 22.6 ± 8.17 years. Screening MRI was performed 19.0 ± 7.43 years after chest radiotherapy. BPE was significantly higher in patients who received chest radiotherapy (50% vs. 37%, P < 0.01). A weak to moderate positive correlation (r > 0.3; P < 0.03) was found between BPE and number of years post radiotherapy. There was a trend toward significant difference between the two groups in the correlation of BPE and age ( P = 0.05). Breast density was not significantly different between the two groups.
Conclusions
BPE is significantly greater in women who receive chest radiotherapy for childhood Hodgkin’s lymphoma, and unexpectedly, it positively correlates with the number of years passed after radiation therapy. Long-term biological effects of radiation therapy on breast parenchyma need further research.
Introduction
It is well established that women treated with chest radiotherapy for Hodgkin’s lymphoma (HL) at a young age are at significantly increased risk of developing breast cancer after a latency period . In a recent large multicenter study, Moskowitz et al. reported a 35% cumulative incidence of breast cancer among HL survivors by 50 years of age; this is higher than the cumulative risk of breast cancer among BRCA1 or BRCA2 mutation carriers by age 50 years .
Numerous studies have shown that breast magnetic resonance imaging (MRI) is significantly more sensitive than mammography for breast cancer detection in women with a genetic or familial predisposition to breast cancer . In women with a history of chest radiotherapy for HL, breast MRI adjunctive to annual mammographic screening was recommended largely based on expert opinion and was recently supported by results from a few single-center studies . Despite a very high sensitivity, screening breast MRI is tempered by imperfect specificity because of overlap in the appearances of benign and malignant lesions. Identification of factors associated with low specificity may improve the accuracy and cost efficiency of breast MRI and allow for wider implementation of screening MRI.
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Methods
Patient and Control Selection
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TABLE 1
Indications for MRI Screening in the Control Group
Indication Number of Cases Mean Age, Years BRCA 1 carriers 10 37.7 BRCA 2 carrier 3 38.9 First-degree relative BRCA carrier 5 34.1 Lifetime risk from 25% to 30% \* 32 40.9 Lifetime risk >30% \* 10 46.3 Cowden syndrome 1 46
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Imaging Techniques
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Data Collection
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Statistical Methods
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Results
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TABLE 2
Comparison of background parenchymal enhancement (%) Between Cases and Controls
Descriptive Statistics Independent Samples t Test_N_ Mean Std. Dev_t_ Statistic_P_ Value 1 minute POST Lymphoma 59 47.5 18.9 3.286 0.0013 Control 60 36.9 16.3 2 minutes POST Lymphoma 57 50.0 18.4 3.618 0.00045 Control 58 38.5 15.6 6 minutes POST Lymphoma 59 46.4 16.7 2.797 0.0060 Control 61 38.1 15.9
POST, postcontrast administration; Std. dev, standard deviation.
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TABLE 3
Pearson Correlation ( P Value) Between Years Since Treatment and background parenchymal enhancement
BPE 1 min BPE 2 min BPE 6 min All patients ( n = 61) 0.311
(0.016) 0.392
(0.003) 0.294
(0.024)
BPE, background parenchymal enhancement; 1 min, 1 minute post contrast; 2 min, 2 minutes post contrast; 6 min, 6 minutes post contrast.
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TABLE 4
Pearson Correlation Between Age and background parenchymal enhancement ( P Value)
BPE 1 min BPE 2 min BPE 6 min Lymphoma ( n = 61) 0.185
(0.160) 0.163
(0.227) 0.157
(0.236) Control ( n = 61) −0.114
(0.385) −0.088
(0.513) −0.065
(0.619)
BPE, background parenchymal enhancement; 1 min, 1 minute post contrast; 2 min, 2 minutes post contrast; 6 min, 6 minutes post contrast.
TABLE 5
Fisher r-to-z Transformation Test to Assess the Difference in Correlations Between Breast background parenchymal enhancement and Age in Cases and Controls at Different Time Points
BPE 1 min BPE 2 min BPE 6 min_P_ value 0.05 0.0934 0.117
BPE, background parenchymal enhancement; 1 min, 1 minute post contrast; 2 min, 2 minutes post contrast; 6 min, 6 minutes post contrast.
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Discussion
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