Journal Article
. 2014 Mar;272(1).
doi: 10.1148/radiol.14131384.

The effects of applying breast compression in dynamic contrast material-enhanced MR imaging

Riham H El Khouli 1 Katarzyna J Macura  Ihab R Kamel  David A Bluemke  Michael A Jacobs  
  • PMID: 24620911
  •     40 References
  •     8 citations


Purpose: To evaluate the effects of breast compression on breast cancer masses, contrast material enhancement of glandular tissue, and quality of magnetic resonance (MR) images in the identification and characterization of breast lesions.

Materials And Methods: This was a HIPAA-compliant, institutional review board-approved retrospective study, with waiver of informed consent. Images from 300 MR imaging examinations in 149 women (mean age ± standard deviation, 51.5 years ± 10.9; age range, 22-76 years) were evaluated. The women underwent diagnostic MR imaging (no compression) and MR-guided biopsy (with compression) between June 2008 and February 2013. Breast compression was expressed as a percentage relative to the noncompressed breast. Percentage enhancement difference was calculated between noncompressed- and compressed-breast images obtained in early and delayed contrast-enhanced phases. Breast density, lesion type (mass vs non-masslike enhancement [NMLE]), lesion size, percentage compression, and kinetic curve type were evaluated. Linear regression, receiver operating characteristic (ROC) curve analysis, and κ test were performed.

Results: Mean percentage compression was 31.3% ± 9.2 (range, 5.8%-53.2%). Percentage enhancement was higher in noncompressed- versus compressed-breast studies in early (146% ± 66 vs 107% ± 42, respectively; P < .001) and delayed (158% ± 68 vs 107% ± 42, respectively; P = .1) phases. Among breast lesions, 12% (seven of 59) were significantly smaller when compressed, which led to underestimation of TNM classification (P < .001). Breast masses (n = 35) showed significantly higher early percentage enhancement (157% ± 71) than lesions with NMLE (n = 15, 120% ± 40; P = .02) and a percentage enhancement difference (47.5% ± 64 vs 17% ± 28, respectively; P = .023). Kinetic curve performance for identifying invasive cancer decreased after compression (area under ROC curve = 0.53 vs 0.71, respectively; P = .02). Breast compression resulted in complete loss of enhancement of nine of 210 lesions (4%).

Conclusion: Breast compression during biopsy affected breast lesion detection, lesion size, and dynamic contrast-enhanced MR imaging interpretation and performance. Limiting the application of breast compression is recommended, except when clinically necessary.

Tumor angiogenesis, vascularization, and contrast-enhanced magnetic resonance imaging.
Z M Bhujwalla, D Artemov, J Glockner.
Top Magn Reson Imaging, 1999 Nov 07; 10(2). PMID: 10551624
3-T dynamic contrast-enhanced MRI of the breast: pharmacokinetic parameters versus conventional kinetic curve analysis.
Riham H El Khouli, Katarzyna J Macura, +2 authors, David A Bluemke.
AJR Am J Roentgenol, 2011 Nov 24; 197(6). PMID: 22109308    Free PMC article.
Mechanisms of angiogenesis and their use in the inhibition of tumor growth and metastasis.
A Saaristo, T Karpanen, K Alitalo.
Oncogene, 2001 Jan 13; 19(53). PMID: 11156525
A combined architectural and kinetic interpretation model for breast MR images.
M D Schnall, S Rosten, +2 authors, L W Nunes.
Acad Radiol, 2001 Jul 14; 8(7). PMID: 11450959
Angiogenesis, thrombospondin, and ductal carcinoma in situ of the breast.
A Rice, C M Quinn.
J Clin Pathol, 2002 Jul 31; 55(8). PMID: 12147647    Free PMC article.
Staging system for breast cancer: revisions for the 6th edition of the AJCC Cancer Staging Manual.
S Eva Singletary, Craig Allred, +17 authors, Frederick L Greene.
Surg Clin North Am, 2003 Jul 24; 83(4). PMID: 12875597
Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival.
Wendy A Woodward, Eric A Strom, +8 authors, Thomas A Buchholz.
J Clin Oncol, 2003 Aug 30; 21(17). PMID: 12947058
Measuring response in solid tumors: comparison of RECIST and WHO response criteria.
Joon Oh Park, Soon Il Lee, +9 authors, Keunchil Park.
Jpn J Clin Oncol, 2003 Nov 19; 33(10). PMID: 14623923
Differentiation of benign and malignant sub-1 cm breast lesions using dynamic contrast enhanced MRI.
P Gibbs, G P Liney, +2 authors, L W Turnbull.
Breast, 2004 Mar 17; 13(2). PMID: 15019691
Detection of breast malignancy: diagnostic MR protocol for improved specificity.
Wei Huang, Paul R Fisher, +3 authors, Terry M Button.
Radiology, 2004 Jun 19; 232(2). PMID: 15205478
The measurement of observer agreement for categorical data.
J R Landis, G G Koch.
Biometrics, 1977 Mar 01; 33(1). PMID: 843571
Highly Cited.
Breast cancer: relationship between the size of the primary tumour and the probability of metastatic dissemination.
S Koscielny, M Tubiana, +4 authors, D Sarrazin.
Br J Cancer, 1984 Jun 01; 49(6). PMID: 6733019    Free PMC article.
MR imaging of the breast using gadolinium-DTPA.
S H Heywang, D Hahn, +4 authors, J Lissner.
J Comput Assist Tomogr, 1986 Mar 01; 10(2). PMID: 3950145
MR imaging of the breast: fast imaging sequences with and without Gd-DTPA. Preliminary observations.
W A Kaiser, E Zeitler.
Radiology, 1989 Mar 01; 170(3 Pt 1). PMID: 2916021
Highly Cited.
The natural history of human breast cancer. The relationship between involvement of axillary lymph nodes and the initiation of distant metastases.
S Koscielny, M G Le, M Tubiana.
Br J Cancer, 1989 May 01; 59(5). PMID: 2736212    Free PMC article.
Growth rate, kinetics of tumor cell proliferation and long-term outcome in human breast cancer.
M Tubiana, M H Pejovic, +2 authors, E Malaise.
Int J Cancer, 1989 Jul 15; 44(1). PMID: 2744888
Pharmacokinetic parameters in CNS Gd-DTPA enhanced MR imaging.
G Brix, W Semmler, +3 authors, W J Lorenz.
J Comput Assist Tomogr, 1991 Jul 01; 15(4). PMID: 2061479
Highly Cited.
Application of a quantitative model to differentiate benign from malignant breast lesions detected by dynamic, gadolinium-enhanced MRI.
F Kelcz, G E Santyr, G O Cron, S J Mongin.
J Magn Reson Imaging, 1996 Sep 01; 6(5). PMID: 8890012
Measuring response in solid tumors: unidimensional versus bidimensional measurement.
K James, E Eisenhauer, +4 authors, P Therasse.
J Natl Cancer Inst, 1999 Mar 24; 91(6). PMID: 10088622
Highly Cited.
Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions?
C K Kuhl, P Mielcareck, +4 authors, H H Schild.
Radiology, 1999 Apr 06; 211(1). PMID: 10189459
Highly Cited.
Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging.
L Esserman, N Hylton, +3 authors, E Sickles.
J Clin Oncol, 1999 Aug 24; 17(1). PMID: 10458224
Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols.
P S Tofts, G Brix, +10 authors, R M Weisskoff.
J Magn Reson Imaging, 1999 Oct 03; 10(3). PMID: 10508281
Highly Cited. Review.
Magnetic resonance imaging of the breast prior to biopsy.
David A Bluemke, Constantine A Gatsonis, +14 authors, Mitchell D Schnall.
JAMA, 2004 Dec 09; 292(22). PMID: 15585733
Highly Cited.
MRI-guided 9-gauge vacuum-assisted breast biopsy: initial clinical experience.
Laura Liberman, Nanette Bracero, +2 authors, D David Dershaw.
AJR Am J Roentgenol, 2005 Jun 24; 185(1). PMID: 15972421
Dynamic bilateral contrast-enhanced MR imaging of the breast: trade-off between spatial and temporal resolution.
Christiane K Kuhl, Hans H Schild, Nuschin Morakkabati.
Radiology, 2005 Aug 25; 236(3). PMID: 16118161
Characterization of pure high-grade DCIS on magnetic resonance imaging using the evolving breast MR lexicon terminology: can it be differentiated from pure invasive disease?
Ashley M Groves, Ruth M L Warren, Sarah Godward, Pauline S Rajan.
Magn Reson Imaging, 2005 Oct 04; 23(6). PMID: 16198828
Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer.
Christiane K Kuhl, Simone Schrading, +5 authors, Hans H Schild.
J Clin Oncol, 2005 Nov 19; 23(33). PMID: 16293877
Highly Cited.
Diagnostic architectural and dynamic features at breast MR imaging: multicenter study.
Mitchell D Schnall, Jeffrey Blume, +14 authors, Constantine A Gatsonis.
Radiology, 2005 Dec 24; 238(1). PMID: 16373758
Highly Cited.
Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size.
Laura Liberman, Gary Mason, Elizabeth A Morris, D David Dershaw.
AJR Am J Roentgenol, 2006 Jan 21; 186(2). PMID: 16423948
Breast cancer staging: working with the sixth edition of the AJCC Cancer Staging Manual.
S Eva Singletary, James L Connolly.
CA Cancer J Clin, 2006 Feb 02; 56(1). PMID: 16449185
Patterns of enhancement on breast MR images: interpretation and imaging pitfalls.
Katarzyna J Macura, Ronald Ouwerkerk, Michael A Jacobs, David A Bluemke.
Radiographics, 2006 Nov 15; 26(6). PMID: 17102046    Free PMC article.
MRI measurements of tumor size and pharmacokinetic parameters as early predictors of response in breast cancer patients undergoing neoadjuvant anthracycline chemotherapy.
Hon J Yu, Jeon-Hor Chen, +2 authors, Min-Ying Su.
J Magn Reson Imaging, 2007 Aug 31; 26(3). PMID: 17729334
Outcome of MRI-guided breast biopsy.
Boo-Kyung Han, Mitchell D Schnall, Susan G Orel, Mark Rosen.
AJR Am J Roentgenol, 2008 Nov 21; 191(6). PMID: 19020252
New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).
E A Eisenhauer, P Therasse, +13 authors, J Verweij.
Eur J Cancer, 2008 Dec 23; 45(2). PMID: 19097774
Highly Cited.
Impact of tumour size on axillary involvement and distant dissemination in breast cancer.
S Koscielny, R Arriagada, +2 authors, J Bergh.
Br J Cancer, 2009 Aug 20; 101(6). PMID: 19690546    Free PMC article.
Dynamic contrast-enhanced MRI of the breast: quantitative method for kinetic curve type assessment.
Riham H El Khouli, Katarzyna J Macura, +4 authors, David A Bluemke.
AJR Am J Roentgenol, 2009 Sep 23; 193(4). PMID: 19770298    Free PMC article.
Relationship of temporal resolution to diagnostic performance for dynamic contrast enhanced MRI of the breast.
Riham H El Khouli, Katarzyna J Macura, +3 authors, David A Bluemke.
J Magn Reson Imaging, 2009 Oct 27; 30(5). PMID: 19856413    Free PMC article.
The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM.
Stephen B Edge, Carolyn C Compton.
Ann Surg Oncol, 2010 Feb 25; 17(6). PMID: 20180029
Highly Cited.
Monitoring of neoadjuvant chemotherapy using multiparametric, ²³Na sodium MR, and multimodality (PET/CT/MRI) imaging in locally advanced breast cancer.
Michael A Jacobs, Ronald Ouwerkerk, +6 authors, Vered Stearns.
Breast Cancer Res Treat, 2011 Apr 02; 128(1). PMID: 21455671    Free PMC article.
Dynamic high-spatial-resolution MR imaging of suspicious breast lesions: diagnostic criteria and interobserver variability.
K Kinkel, T H Helbich, +4 authors, N M Hylton.
AJR Am J Roentgenol, 2000 Jul 06; 175(1). PMID: 10882243
Relating Doses of Contrast Agent Administered to TIC and Semi-Quantitative Parameters on DCE-MRI: Based on a Murine Breast Tumor Model.
Menglin Wu, Li Lu, +4 authors, Xuening Zhang.
PLoS One, 2016 Feb 24; 11(2). PMID: 26901876    Free PMC article.
Focal brachial enhancement deficit: a normal anatomic variant?
Nicholas Beckmann, Benjamin Saverino, Chunyan Cai.
Skeletal Radiol, 2016 Jul 30; 45(10). PMID: 27470236
Separation of benign and malignant breast lesions using dynamic contrast enhanced MRI in a biopsy cohort.
Sungheon Gene Kim, Melanie Freed, +3 authors, Linda Moy.
J Magn Reson Imaging, 2016 Oct 22; 45(5). PMID: 27766710    Free PMC article.
Quantification of breast stiffness using MR elastography at 3 Tesla with a soft sternal driver: A reproducibility study.
Jeffrey R Hawley, Prateek Kalra, +3 authors, Arunark Kolipaka.
J Magn Reson Imaging, 2016 Oct 26; 45(5). PMID: 27779802    Free PMC article.
Comparison of conventional DCE-MRI and a novel golden-angle radial multicoil compressed sensing method for the evaluation of breast lesion conspicuity.
Laura Heacock, Yiming Gao, +6 authors, Linda Moy.
J Magn Reson Imaging, 2016 Nov 20; 45(6). PMID: 27859874    Free PMC article.
Correcting time-intensity curves in dynamic contrast-enhanced breast MRI for inhomogeneous excitation fields at 7T.
Michael J van Rijssel, Josien P W Pluim, +5 authors, Dennis W J Klomp.
Magn Reson Med, 2019 Dec 28; 84(2). PMID: 31880346    Free PMC article.
Lipid-weighted intraoperative photoacoustic tomography of breast tumors: Volumetric comparison to preoperative MRI.
Ivan Kosik, Muriel Brackstone, +3 authors, Jeffrey J L Carson.
Photoacoustics, 2020 May 20; 18. PMID: 32426228    Free PMC article.
Integrated Multiparametric Radiomics and Informatics System for Characterizing Breast Tumor Characteristics with the OncotypeDX Gene Assay.
Michael A Jacobs, Christopher B Umbricht, +5 authors, Antonio C Wolff.
Cancers (Basel), 2020 Oct 01; 12(10). PMID: 32992569    Free PMC article.