title: Enhancement parameters on dynamic contrast enhanced breast MRI: do they correlate with prognostic factors and subtypes of breast cancers?
abstract: OBJECTIVE
  To correlate the enhancement parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with prognostic factors and immunohistochemical subtypes of breast cancer.
  
  
  METHODS
  A total of 81 breast carcinomas were included in our study. We obtained the following enhancement parameters: 1) analysis of background parenchymal enhancement (BPE) and BPE coefficients (BEC) from bilateral breasts, 2) the number of vessels per breast as a representation of ipsilateral whole-breast vascularity. Additionally, in 50 patients, 3) semiquantitative parameters of tumors (the initial enhancement percentage (E1), the peak enhancement percentage (Epeak), the time to peak enhancement (TTP), the signal enhancement ratio (SER)) and 4) perfusion parameters (K(trans), kep, ve and iAUC) from tumors and ipsilateral breasts were also obtained. Correlations among parameters and prognostic factors, including tumor size, axillary node status, nuclear grade, histologic grade, estrogen receptor (ER) expression, progesterone receptor (PR) expression, Ki-67, human epidermal growth factor receptor 2 (HER-2) expression, epidermal growth factor receptor (EGFR) expression, bcl-2, CK5/6 and subtypes categorized as luminal (ER or PR positive), triple negative (ER or PR negative, HER-2 negative) and HER2 (ER and PR negative with HER-2 overexpression) were analyzed.
  
  
  RESULTS
  BPE was significantly correlated with EGFR expression (p=0.040). BEC was significantly higher in tumors larger than 2cm than in tumors smaller than 2cm (p=0.001). The vessel numbers in ipsilateral breasts were higher in tumors larger than 2cm than in tumors smaller than 2cm (p=0.034), with higher nuclear grades (grade 3) than with lower nuclear grades (grade 1,2) (p=0.001) and with PR-negative rather than with PR-positive (p=0.010) results. The mean K(trans) was higher in Ki-67-positive tumors than Ki-67 negative tumors (p=0.002). The mean kep was higher in Ki-67-positive tumors than in Ki-67-negative tumors (p=0.005) and in CK5/6-positive tumors than in CK5/6-negative tumors (p=0.015). The mean K(trans) was lower in the ipsilateral breast parenchyma with HER-2-positive tumors compared to HER-2-negative tumors (p=0.012).
  
  
  CONCLUSIONS
  BPE, BEC and ipsilateral whole-breast vascularity, higher K(trans) and kep of the cancer and lower K(trans) and iAUC of ipsilateral breast parenchyma may serve as additional predictors of a poor breast cancer prognosis.
authors.affiliation: Department of Radiology, St. Mary's Hospital, The College of Medicine, The Catholic University of Korea.
authors.forename: Ji Youn
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea. Electronic address: rad-ksh@catholic.ac.kr.
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea.
authors.forename: Yun Ju
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea.
authors.forename: Bong Joo
authors.initials: BJ
authors.lastname: Kang
authors.affiliation: Department of Radiology, St. Vincent's Hospital, The College of Medicine, The Catholic University of Korea.
authors.forename: Yeong Yi
authors.initials: YY
authors.lastname: An
authors.affiliation: Department of Hospital Pathology, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea.
authors.forename: A Won
authors.initials: AW
authors.lastname: Lee
authors.affiliation: Department of General Surgery, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea.
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Song
authors.affiliation: The College of Medicine, The Catholic University of Korea.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: The College of Medicine, The Catholic University of Korea.
authors.forename: Han Bi
authors.initials: HB
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019540:Area Under Curve; D001940:Breast / Q000473:pathology*; D003287:Contrast Media / Q000737:chemistry*; D066246:ErbB Receptors / Q000378:metabolism; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism
chemical_list: D003287:Contrast Media; D066246:ErbB Receptors; D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human
keywords: Angiogenesis; Breast cancer; Dynamic contrast-enhanced MRI; Prognostic factor