Effects of menstrual cycle on background parenchymal enhancement and detectability of breast cancer on dynamic contrast-enhanced breast MRI: A multicenter study of an Asian population

Publication date: Available online 24 November 2018

Source: European Journal of Radiology

Author(s): Takeshi Kamitani, Hidetake Yabuuchi, Yoshihide Kanemaki, Mitsuhiro Tozaki, Tetsuo Sonomura, Waka Mizukoshi, Waka Nakata, Taro Shimono, Misugi Urano, Toshiko Yamano, Fumi Kato, Megumi Kuchiki, Nobuyuki Shiragami, Hisami Yanagita, Eisuke Katsuda, Masako Kataoka, Ken Yamaguchi, Takuro Horikoshi, Tatsuya Gomi, Miwako Nozaki

Abstract

Purpose

To evaluate the effect of the menstrual cycle on BPE and cancer detectability in an Asian population.

Material and Methods

266 premenopausal patients with regular menstrual cycles from 24 centers were included, and 176 of them were diagnosed by pathology as having breast cancer. Thirty-five patients were examined in the menstrual phase (days 1–4), 105 in the proliferative phase (days 5–14), and 126 in the secretory phase (days 15–30).

Measurement of the following signal intensities (SIs) were obtained: breast tissue on the unaffected side on a pre-contrast image (SI₁) and an early-phase image (SI₂); the SIs of breast tissue on the affected side on a pre-contrast image (SI₃) and an early-phase image (SI₄); and the SIs of breast cancer on a pre-contrast image (SI₅) and an early-phase image (SI₆). We calculated the BPE ratio, i.e., (SI₂– SI₁)/SI₁ and the cancer/background enhancement ratio (C/B) ratio, i.e., (SI₆– SI₅) / (SI₄– SI₃). The BPE was classified as minimal, mild, moderate, or marked, and the cancer detectability was classified as excellent, good, or poor independently by two radiologists.

Results

The average C/B ratio was 20.1, 15.7, and 9.1 at the menstrual, proliferative, and secretory phases (p < 0.001). BPE was determined as moderate or marked in 0% and 5.4% at the menstrual phase, 10.3% and 11.0% at the proliferative phase, and 17.5% and 21.7% at the secretory phase by the two observers, respectively (p = 0.01, p = 0.01). The detectability of breast cancer was classified as poor in 0% and 0%, 1.4% and 13.0%, and 8.0% and 22.1% at the menstrual, proliferative, and secretory phases by the two observers, respectively (p = 0.07, p = 0.02).

Conclusion

The menstrual phase and the proliferative phase seem to be suitable for breast MRI of Asian women.

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