Role of contrast-enhanced breast magnetic resonance angiography in characterizing suspicious breast lesions and evaluating the relationship between prognostic factors

Yıl 2019, , 749 - 753, 01.10.2019

Ali Küpeli , Mehmet Koçak Gürkan Danışan , Furkan Ufuk , Furkan Kaya , İsmail Taşkent

https://doi.org/10.28982/josam.632294

Öz

Aim: Breast cancer is the most commonly diagnosed cancer in women, and mammography and ultrasonography are the most frequently used diagnostic radiological methods. Although they are highly sensitive, their specificity is low. Angiography can be added as a standard breast magnetic resonance imaging (MRI) protocol to increase specificity. In this study, we aimed to investigate the effectiveness of breast vascularity by evaluating the presence of an adjacent vessel sign (AVS) and increased ipsilateral breast vascularity (IIBV) in characterizing breast masses. 

Methods: 135 patients with a mean age of 47 years with radiologically or clinically suspicious breast masses underwent breast MRI before biopsy. The contrast-enhanced three-dimensional MR angiograms of the breasts were investigated for the presence of AVS and IIBV to characterize suspicious breast masses, and their correlation with histopathological prognostic factors were evaluated. 

Results: Patients’ age, tumor size, and the presence of AVS and IIBV were significantly higher in malignant masses than in benign masses (P<0.001). The sensitivity, specificity, and accuracy of AVS and IIBV in predicting malignant masses from benign ones were 75%, 79.3%, 77% and 56.9%, 90.4% and 72.5%, respectively. In malignant masses, AVS and IIBV were both significantly associated with ER (P=0.005, P<0.001) and PR expression (P=0.003, P<0.001). We found no relationship between AVS, IIBV and C-ERBB2 expression (P=0.245 and P=0.085, respectively).

Conclusion: The presence of AVS and IIBV as determined from contrast-enhanced 3D MR angiograms may be reliable parameters for further characterizing suspicious breast masses, both of which seem to be related with ER and PR expression.

Anahtar Kelimeler

Angiography, Breast, Magnetic resonance imaging

Şüpheli meme lezyonlarını karakterize etmede ve prognostik faktörler arasındaki ilişkiyi değerlendirmede kontrastlı meme manyetik rezonans anjiyografisinin rolü

Öz

Amaç: Meme kanseri, kadınlarda en sık tanı alan kanser olup, mamografi ve ultrasonografi en sık kullanılan radyolojik yöntemlerdir. Bu yöntemlerin duyarlılığı yüksek olmasına rağmen, özgüllükleri düşüktür. Anjiyografi, özgüllüğü artırmak için standart bir meme manyetik rezonans görüntüleme (MRG) protokolü olarak eklenebilir. Bu çalışmada amacımız, komşu damar işareti (KDİ) ve artmış ipsilateral meme vaskülaritesi (AİMV) içeren meme damarlanmasının, meme kitlelerini karakterize etmedeki etkinliğini araştırmak ve histopatolojik prognostik faktörlerle korelasyonunu ortaya koymaktır. 

Yöntemler: Mart 2017 - Ocak 2019 tarihleri arasında radyolojik veya klinik olarak şüpheli meme kitleleri olan 135 hastaya (yaş aralığı: 19-79 yıl, ort. Yaş: 47 yıl) biyopsi öncesi meme MRG yapıldı. Kontrastlı 3D meme MR anjiyografileri, KDİ ve AİMV varlığı açısından şüpheli meme kitlelerini karakterize etmek için incelendi. Bu bulgular histopatolojik prognostik faktörler ile korele edildi.

Bulgular: Hastaların yaşı, tümör boyutu, KDİ ve AİMV bulunsı malign kitlelerde benign kitlelere göre anlamlı derecede yüksekti (P<0,001). KDİ %75 duyarlılık, %79,3 özgüllük ve %77 doğrulukla, AİMV varlığı ise %56,9 duyarlılık, %90,4 özgüllük ve %72,5 doğrulukla benign kitleleri malign olanlardan ayırt etmiştir. Malign kitlelerde KDİ ve AİMV, ER (sırasıyla P=0,005, P<0,001) ve PR ekspresyonuyla (sırasıyla P<0,001, P=0,003) ilişkiliydi. Ancak çalışmamızda, KDİ, AİMV ile C-ERBB2 ekspresyonu arasında ilişki saptanmadı (P=0,245 ve P=0,085, sırasıyla).

Sonuç: Kontrastlı 3D MR anjiyogramlarından elde edilen KDİ ve AİMV varlığı, şüpheli meme kitlelerinin karakterize edilmesi için güvenilir bir yöntemdir ve ER ve PR ekspresyonu ile ilişkili görünmektedir.

Anahtar Kelimeler

Anjiyografi, Meme, Manyetik rezonans görüntüleme

Kaynakça

• 1. Jatoi I, Miller AB. Why is breast-cancer mortality declining? Lancet Oncol. 2003;4(4):251-4.
• 2. Berry DA, Ravdin PM. Breast cancer trends: a marriage between clinical trial evidence and epidemiology. J Natl Cancer Inst. 2007;99(15):1139-41.
• 3. Brancato B, Crocetti E, Bianchi S, Catarzi S, Risso GG, Bulgaresi P, et al. Accuracy of needle biopsy of breast lesions visible on ultrasound: audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes. Breast. 2012;21(4):449-54.
• 4. Zhou JY, Tang J, Wang ZL, Lv FQ, Luo YK, Qin HZ, et al. Accuracy of 16/18G core needle biopsy for ultrasound-visible breast lesions. World J Surg Oncol. 2014;12:7.
• 5. Weidner N, Folkman J, Pozza F, Bevilacqua P, Allred EN, Moore DH, et al. Tumor angiogenesis: a new significant and independent prognostic indicator in early-stage breast carcinoma. J Natl Cancer Inst. 1992;84(24):1875-87.
• 6. Goede V, Fleckenstein G, Dietrich M, Osmers RG, Kuhn W, Augustin HG. Prognostic value of angiogenesis in mammary tumors. Anticancer Res. 1998;18(3C):2199-202.
• 7. Mungan İ, Doğru O, Aygen E, Dağlı AF. The relations of vascular endothelial growth factor–C and lymph node metastasis in breast cancer patients. J Surg Med. 2019;3(2):124-7.
• 8. Frouge C, Guinebretière JM, Contesso G, Di Paola R, Bléry M. Correlation between contrast enhancement in dynamic magnetic resonance imaging of the breast and tumor angiogenesis. Invest Radiol. 1994;29(12):1043-9.
• 9. Mussurakis S, Buckley DL, Horsman A. Prediction of axillary lymph node status in invasive breast cancer with dynamic contrast-enhanced MR imaging. Radiology. 1997;203(2):317-21.
• 10. Szabó BK, Aspelin P, Kristoffersen Wiberg M, Tot T, Boné B. Invasive breast cancer: correlation of dynamic MR features with prognostic factors. Eur Radiol. 2003;13(11):2425-35.
• 11. Sardanelli F, Fausto A, Menicagli L, Esseridou A. Breast vascular mapping obtained with contrast-enhanced MR imaging: implications for cancer diagnosis, treatment, and risk stratification. Eur Radiol. 2007;17:F48-51.
• 12. Kul S, Cansu A, Alhan E, Dinc H, Reis A, Çan G. Contrast-enhanced MR angiography of the breast: Evaluation of ipsilateral increased vascularity and adjacent vessel sign in the characterization of breast lesions. AJR Am J Roentgenol. 2010;195(5):1250-4.
• 13. Fischer DR, Malich A, Wurdinger S, Boettcher J, Dietzel M, Kaiser WA. The adjacent vessel on dynamic contrast-enhanced breast MRI. AJR Am J Roentgenol. 2006;187(2):147-51.
• 14. Dietzel M, Baltzer PA, Vag T, Herzog A, Gajda M, Camara O, et al. The adjacent vessel sign on breast MRI: new data and a subgroup analysis for 1,084 histologically verified cases. Korean J Radiol. 2010;11(2):178-86.
• 15. Mahfouz AE, Sherif H, Saad A, Taupitz M, Filimonow S, Kivelitz D, et al. Gadolinium-enhanced MR angiography of the breast: is breast cancer associated with ipsilateral higher vascularity? Eur Radiol. 2001;11(6):965-9.
• 16. Wright H, Listinsky J, Quinn C, Rim A, Crowe J, Kim J. Increased ipsilateral whole breast vascularity as measured by contrast-enhanced magnetic resonance imaging in patients with breast cancer. Am J Surg. 2005;190(4):576-9.
• 17. Kang DK, Kim EJ, Kim HS, Sun JS, Jung YS. Correlation of whole-breast vascularity with ipsilateral breast cancers using contrast-enhanced MDCT. AJR Am J Roentgenol. 2008;190(2):496-504.
• 18. Pavlakovic H, Havers W, Schweigerer L. Multiple angiogenesis stimulators in a single malignancy: implications for anti-angiogenic tumour therapy. Angiogenesis. 2001;4(4):259-62.
• 19. Kupeli A, Kul S, Eyuboglu I, Oguz S, Mungan S. Role of 3D power Doppler ultrasound in the further characterization of suspicious breast masses. Eur J Radiol. 2016;85(1):1-6.
• 20. Wilson CB, Lammertsma AA, McKenzie CG, Sikora K, Jones T. Measurements of blood flow and exchanging water space in breast tumors using positron emission tomography: a rapid and noninvasive dynamic method. Cancer Res. 1992;52(6):1592-7.
• 21. Herborn CU, Lauenstein TC, Ruehm SG, Bosk S, Debatin JF, Goyen M. Intraindividual comparison of gadopentetate dimeglumine, gadobenate dimeglumine, and gadobutrol for pelvic 3D magnetic resonance angiography. Invest Radiol. 2003;38(1):27-33.
• 22. Carriero A, Di Credico A, Mansour M, Bonomo L. Maximum intensity projection analysis in magnetic resonance of the breast. J Exp Clin Cancer Res. 2002;21(3):77-81.
• 23. Schmitz AC, Peters NH, Veldhuis WB, Gallardo AM, van Diest PJ, Stapper G, et al. Contrast-enhanced 3.0-T breast MRI for characterization of breast lesions: increased specificity by using vascular maps. Eur Radiol. 2008;18(2):355-64.
• 24. Ando Y, Fukatsu H, Ishiguchi T, Ishigaki T, Endo T, Miyazaki M. Diagnostic utility of tumor vascularity on magnetic resonance imaging of the breast. Magn Reson Imaging. 2000;18(7):807-13.
• 25. Verardi N, DiLeo G, Carbonaro LA, Fedeli MP, Sardanelli F. Contrast-enhanced MR imaging of thebreast: association between asymmetric increased breast vascularity and ipsilateral cancer in a consecutive series of 197 patients. Radiol Med. 2013;118(2):239-50.
• 26. Mussurakis S, Gibbs P, Horsman A. Peripheral enhancement and spatial contrast uptake heterogeneity of primary breast tumours: quantitative assessment with dynamic MRI. J Comput Assist Tomogr. 1998;22(1):35-46.
• 27. Han M, Kim TH, Kang DK, Kim KS, Yim H. Prognostic role of MRI enhancement features in patients with breast cancer: value of adjacent vessel sign and increased ipsilateral whole-breast vascularity. AJR Am J Roentgenol. 2012;199(4):921-8.
• 28. Jackson JR, Seed MP, Kircher CH, Willoughby DA, Winkler JD. The codependence of angiogenesis and chronic inflammation. FASEB J. 1997;11(6):457-65.