From: The potential of predictive and prognostic breast MRI (P2-bMRI)
Criterion | Acquisition | Assessment | Pathophysiological correlate | Predictive/prognostic value | References | |
---|---|---|---|---|---|---|
Comment | Statistics | |||||
Amount of fibroglandular tissue | DCE, T2WI | Visual (American College of Radiology classes from a to d) or automated | Fibroglandular tissue, stromal matrix, dense connective tissue, collagen, elastin, lobules, and ducts | One of the strongest independent biomarkers of breast cancer incidence. The prognostic value is proven only for mammography. Similar effect for MRI is expected | Relative risk (%: amount of fibroglandular tissue on mammograms) for the four classes: a) 1.79 (< 25%) b) 2.11 (25–50%) c) 2.92 (50–75%) d) 4.64 (> 75%) | |
Background of parenchymal enhancement | DCE | Visual (1st dynamic scan) or automated | Tissue perfusion due to hormonal stimulation and proliferative activity | For high-risk women, positive correlation with BC incidence. No association among women with average risk | High risk and at least mild background parenchymal enhancement: odds ratio 2.1 | |
Adjacent vessel sign | DCE | Visual | Hypervascularisation Neoangiogenesis | Presence of adjacent vessel sign indicates invasive cancer. It is less common in DCIS | Invasive cancer or DCIS? DOR 2.7; specificity 72.6% | |
Destruction of nipple line | DCE | Visual (Fig. 8) | Invasion of the nipple-areola complex | “Destruction of nipple line” is associated with nodal-positive breast cancer | Is this cancer likely to show lymph node metastasis? DOR 2.5; specificity 88.5% | |
Oedema | T2WI | Visual (Fig. 6) Perifocal Prepectoral Subcutaneous Diffuse | Changes in the tumour habitat Cytokine effects Vessel permeability Lymphovascular dissemination Pitfalls: double check with patient history; renal, cardiac origin (possible bilateral diffuse oedema of non-neoplastic origin); treatment-related (surgery, radiation therapy) | Presence of “diffuse unilateral oedema” is a strong predictor of nodal-positive and high-grade breast cancer | Is this cancer likely to show lymph node metastasis? Specificity 94.9%; DOR2.6 Is this cancer high grade (G3) or not (G1 or G2)? Specificity 95.5%; DOR 2.4 | |
Perifocal oedema is also an independent predictor of disease recurrence | Is this patient likely to develop disease recurrence? Hazard ratio 2.48 | |||||
Lesion type | DCE | Visual according to breast imaging reporting and Data system descriptors: mass, non-mass, or “mixed” (mass and non-mass) | Unknown | Cancers revealing both mass and non-mass enhancement (“mixed”) are more often associated with lymphovascular invasion (compared to mass or non-mass) | Is this cancer associated with lymphovascular invasion? DOR 2.4; specificity 82.7% | [58] |
Cancers revealing mass-like enhancement are more likely to be HER2-positive (compared to non-mass and mixed) | Is this cancer HER2-positive? DOR 2.7; specificity 85.7% | |||||
Non-mass invasive ductal cancers are more likely to be low grade (compared to mass and mixed) | Is this invasive ductal cancer low grade (G1) or not (G2 or G3)? DOR 9.3; specificity 85.3% | [59] | ||||
Necrosis sign | T2WI | Visual: hypointense lesion with hyperintense centre | Central colliquative (liquid) necrosis | Presence of necrosis sign indicates high-grade invasive cancers | Is this cancer high grade (G3) or not (G1 or G2)? Specificity 94.3%; DOR 3.7 | [60] |
Skin thickening | Unenhanced T1WI | Visual | Subcutaneous tumour spread, inflammatory tumour | Presence of skin thickening indicates high-grade invasive cancers. It is less common in G1 and G2 cancers Presence of skin thickening is also a strong predictor of lymph node metastasis | Is this cancer likely to show lymph node metastasis? DOR 5.9; specificity 94.5% | |
Rim sign | DCE | Visual | High microvessel density in the peripheral zone of the vital tumour. Connective tissues, fibrosis, and/or necrosis at central part of the tumour centre | Presence of rim sign is associated with an increased risk of lymph node metastasis and high-grade cancer | Is this cancer likely to show lymph node metastasis? DOR 2.7; specificity 57.1% Is this cancer high grade (G3) or not (G1 or G2)? DOR 6.1; specificity 57.5% | [61] |
Signal intensity | T2WI | Visual (Fig. 7): compared to unaffected breast gland parenchyma: hypointense, isointense, or hyperintense | Water content of the lesion | Hyperintensity on T2WI is associated with elevated Ki-67 and increased cellular proliferation | Is this cancer likely to show high (Ki-67 ≥ 14%) or low proliferative activity (Ki-67 < 14)? DOR 2.2; specificity 59.8% | [62] |
Washout | DCE | Visual, region of interest, or computer-assisted | Hypervascularisation Neoangiogenesis Arteriovenous shunts (anarchic vascularisation) | A high washout rate (> 40%) is associated with an increased risk of metachronous metastasis | Is this patient likely to develop metachronous metastasis? Sensitivity 100%; negative predictive value 100% |