From the Department of Radiology (S.H.L., H.Y., Y.L., Y.S.K., A.R.P., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; and the Department of Radiology (S.H.L., S.M.H., S.Y.K., J.M.C., N.C., W.K.M.), Seoul National University College of Medicine, Seoul, Republic of Korea.
Radiology. 2023 Jan;306(1):90-99. doi: 10.1148/radiol.220440. Epub 2022 Aug 30.
Background Background parenchymal enhancement (BPE) is a known risk factor for breast cancer. However, studies on the association between BPE and second breast cancer risk are still lacking. Purpose To investigate whether BPE at surveillance breast MRI is associated with subsequent second breast cancer risk in women with a personal history of breast cancer. Materials and Methods A retrospective search of the imaging database of an academic medical center identified consecutive surveillance breast MRI examinations performed between January 2008 and December 2017 in women who underwent surgery for primary breast cancer and had no prior diagnosis of second breast cancer. BPE at surveillance breast MRI was qualitatively assessed using a four-category classification of minimal, mild, moderate, or marked. Future second breast cancer was defined as ipsilateral breast tumor recurrence or contralateral breast cancer diagnosed at least 1 year after each surveillance breast MRI examination. Factors associated with future second breast cancer risk were evaluated using the multivariable Fine-Gray subdistribution hazard model. Results Among the 2668 women (mean age at baseline surveillance breast MRI, 49 years ± 8 [SD]), 109 developed a second breast cancer (49 ipsilateral, 58 contralateral, and two ipsilateral and contralateral) at a median follow-up of 5.8 years. Mild, moderate, or marked BPE at surveillance breast MRI (hazard ratio [HR], 2.1 [95% CI: 1.4, 3.1]; < .001), young age (<45 years) at initial breast cancer diagnosis (HR, 3.4 [95% CI: 1.7, 6.4]; < .001), positive results from a genetic test (HR, 6.5 [95% CI: 3.5, 12.0]; < .001), and negative hormone receptor expression in the initial breast cancer (HR, 1.6 [95% CI: 1.1, 2.6]; = .02) were independently associated with an increased risk of future second breast cancer. Conclusion Background parenchymal enhancement at surveillance breast MRI was associated with future second breast cancer risk in women with a personal history of breast cancer. © RSNA, 2022 See also the editorial by Niell in this issue.
背景 背景实质强化（BPE）是乳腺癌的已知危险因素。然而，关于 BPE 与乳腺癌复发风险之间的关联的研究仍然缺乏。目的 探讨在有乳腺癌个人病史的女性中，监测性乳腺 MRI 上的 BPE 是否与随后的第二乳腺癌风险相关。材料与方法 回顾性检索一家学术医疗中心的影像数据库，以确定 2008 年 1 月至 2017 年 12 月期间接受过原发性乳腺癌手术且无第二乳腺癌既往诊断的女性的连续监测性乳腺 MRI 检查。使用最小、轻度、中度或明显的四分类法对监测性乳腺 MRI 上的 BPE 进行定性评估。未来的第二乳腺癌定义为同侧乳腺肿瘤复发或对侧乳腺癌，在每次监测性乳腺 MRI 检查后至少 1 年被诊断出。使用多变量 Fine-Gray 亚分布风险模型评估与未来第二乳腺癌风险相关的因素。结果 在 2668 名女性（基线监测性乳腺 MRI 时的平均年龄为 49 岁±8[标准差]）中，有 109 人在中位随访 5.8 年后患上了第二乳腺癌（49 例同侧、58 例对侧、2 例同侧和对侧）。监测性乳腺 MRI 上出现轻度、中度或明显 BPE（风险比[HR]，2.1[95%CI：1.4，3.1]； <.001）、初始乳腺癌诊断时年龄较小（<45 岁）（HR，3.4[95%CI：1.7，6.4]； <.001）、遗传检测结果阳性（HR，6.5[95%CI：3.5，12.0]； <.001）和初始乳腺癌中激素受体表达阴性（HR，1.6[95%CI：1.1，2.6]； =.02）与未来第二乳腺癌风险增加独立相关。结论 在有乳腺癌个人病史的女性中，监测性乳腺 MRI 上的背景实质强化与未来第二乳腺癌风险相关。 ©RSNA，2022 参见本期杂志中 Niell 的社论。
