Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
Department of Radiology, Showa University, School of Medicine, Tokyo, Japan.
J Magn Reson Imaging. 2024 May;59(5):1742-1757. doi: 10.1002/jmri.29015. Epub 2023 Sep 19.
Background parenchymal enhancement (BPE) is an established breast cancer risk factor. However, the relationship between BPE levels and breast cancer risk stratification remains unclear.
To evaluate the clinical relationship between BPE levels and breast cancer risk with covariate adjustments for age, ethnicity, and hormonal status.
Retrospective.
954 screening breast MRI datasets representing 721 women divided into four cohorts: women with pathogenic germline breast cancer (BRCA) mutations (Group 1, N = 211), women with non-BRCA germline mutations (Group 2, N = 60), women without high-risk germline mutations but with a lifetime breast cancer risk of ≥20% using the Tyrer-Cuzick model (Group 3, N = 362), and women with <20% lifetime risk (Group 4, N = 88).
FIELD STRENGTH/SEQUENCE: 3 T/axial non-fat-saturated T1, short tau inversion recovery, fat-saturated pre-contrast, and post-contrast T1-weighted images.
Data on age, body mass index, ethnicity, menopausal status, genetic predisposition, and hormonal therapy use were collected. BPE levels were evaluated by two breast fellowship-trained radiologists independently in accordance with BI-RADS, with a third breast fellowship-trained radiologist resolving any discordance.
Propensity score matching (PSM) was utilized to adjust covariates, including age, ethnicity, menopausal status, hormonal treatments, and prior bilateral oophorectomy. The Mann-Whitney U test, chi-squared test, and univariate and multiple logistic regression analysis were performed, with an odds ratio (OR) and corresponding 95% confidence interval. Weighted Kappa statistic was used to assess inter-reader variation. A P value <0.05 indicated a significant result.
In the assessment of BPE, there was substantial agreement between the two interpreting radiologists (κ = 0.74). Patient demographics were not significantly different between patient groups after PSM. The BPE of Group 1 was significantly lower than that of Group 4 and Group 3 among premenopausal women. In estimating the BPE level, the OR of gene mutations was 0.35.
Adjusting for potential confounders, the BPE level of premenopausal women with BRCA mutations was significantly lower than that of non-high-risk women.
3 TECHNICAL EFFICACY: Stage 3.
背景实质增强（BPE）是一种已确立的乳腺癌危险因素。然而，BPE 水平与乳腺癌风险分层之间的关系尚不清楚。
评估 BPE 水平与乳腺癌风险的临床关系，并针对年龄、种族和激素状态进行协变量调整。
回顾性。
954 例代表 721 名女性的筛查性乳腺 MRI 数据集，分为四组：携带致病性种系乳腺癌（BRCA）突变的女性（组 1，N=211）、携带非 BRCA 种系突变的女性（组 2，N=60）、无高风险种系突变但使用 Tyrer-Cuzick 模型终生乳腺癌风险≥20%的女性（组 3，N=362）和终生风险<20%的女性（组 4，N=88）。
磁场强度/序列：3T/轴向非脂肪饱和 T1、短 tau 反转恢复、脂肪饱和预对比和对比后 T1 加权图像。
收集了年龄、体重指数、种族、绝经状态、遗传易感性和激素治疗使用的数据。BPE 水平由两位经过乳腺专科培训的放射科医生独立按照 BI-RADS 进行评估，第三位乳腺专科培训的放射科医生解决任何分歧。
采用倾向评分匹配（PSM）调整协变量，包括年龄、种族、绝经状态、激素治疗和双侧卵巢切除术。采用 Mann-Whitney U 检验、卡方检验、单变量和多变量逻辑回归分析，计算比值比（OR）和相应的 95%置信区间。采用加权 Kappa 统计评估两位解读放射科医生之间的差异。P 值<0.05 表示差异具有统计学意义。
在评估 BPE 时，两位解读放射科医生之间存在高度一致性（κ=0.74）。PSM 后，各患者组的患者人口统计学特征无显著差异。在未绝经女性中，组 1 的 BPE 明显低于组 4 和组 3。在估计 BPE 水平时，基因突变的 OR 为 0.35。
在调整潜在混杂因素后，BRCA 突变的绝经前妇女的 BPE 水平明显低于非高危妇女。
3 级技术效能。
