Sensitivity of Contrast-Enhanced Breast MRI vs X-ray Mammography Based on Cancer Histology, Tumor Grading, Receptor Status, and Molecular Subtype: A Supplemental Analysis of 2 Large Phase III Studies

Jan Endrikat, Gilda Schmidt, Daniel Haverstock, Olaf Weber, Zuzana Jirakova Trnkova, Jörg Barkhausen, Jan Endrikat, Gilda Schmidt, Daniel Haverstock, Olaf Weber, Zuzana Jirakova Trnkova, Jörg Barkhausen

Abstract

Background: The impact of certain tumor parameters on the sensitivity of imaging tools is unknown. The purpose was to study the impact of breast cancer histology, tumor grading, single receptor status, and molecular subtype on the sensitivity of contrast-enhanced breast magnetic resonance imaging (CE-BMRI) vs X-ray mammography (XRM) to detect breast cancer.

Materials and methods: We ran a supplemental analysis of 2 global Phase III studies which recruited patients with histologically proven breast cancers. The sensitivity of CE-BMRI vs XRM to detect cancer lesions with different histologies, tumor grading, single receptor status, and molecular subtype was compared. Six blinded readers for each study evaluated the images. Results were summarized as the "Mean Reader." For each reader, sensitivity was defined as the proportion of detected lesions vs the total number of lesions identified by the standard of reference. Two-sided 95% confidence intervals were calculated for within-group proportions, and for the difference between CE-BMRI and XRM, using a normal approximation to the binomial distribution.

Results: In 778 patients, 1273 cancer lesions were detected. A total of 435 patients had 1 lesion, 254 had 2 lesions, and 77 had 3 or more lesions. The sensitivity of CE-BMRI was significantly higher compared with XRM irrespective of the histology. The largest difference was seen for invasive lobular carcinoma (22.3%) and ductal carcinoma in situ (19%). Across all 3 tumor grades, the sensitivity advantage of CE-BMRI over XRM ranged from 15.7% to 18.5%. Contrast-enhanced breast magnetic resonance imaging showed higher sensitivity compared with XRM irrespective of single receptor expressions (15.3%-19.4%). The sensitivities for both imaging methods were numerically higher for the more aggressive ER- (estrogen receptor), PR- (progesterone receptor), and HER2+ (human epidermal growth factor receptor 2) tumors. Irrespective of molecular subtype, sensitivity of CE-BMRI was 14.8% to 18.9% higher compared with XRM.

Conclusions: Contrast-enhanced breast magnetic resonance imaging showed significantly higher sensitivity compared with XRM independent of tumor histology, tumor grading, single receptor status, and molecular subtype.Trial Registration: ClinicalTrials.gov: NCT01067976 and NCT01104584.

Keywords: Breast cancer; X-ray mammography; breast MRI; histology; hormone receptors; molecular type; tumor grading.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GS and JB declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. JE, DH, OW and ZJT are Bayer employees.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
Sensitivities of CE-BMRI vs XRM by tumor histology (n = 1231 cancer lesions) (% [±95% CI]). *95% CIs do not overlap. CE-BMRI indicates contrast-enhanced breast magnetic resonance imaging; CI, confidence interval; DCIS, ductal carcinoma in situ; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; XRM, X-ray mammography.
Figure 2.
Figure 2.
Sensitivities of CE-BMRI vs XRM by tumor grading (% [±95% CI]). *95% CIs do not overlap. CE-BMRI indicates contrast-enhanced breast magnetic resonance imaging; CI, confidence interval; XRM, X-ray mammography.
Figure 3.
Figure 3.
Sensitivities of CE-BMRI vs XRM by molecular subtype (% [±95% CI]). *95% CIs do not overlap. CE-BMRI indicates contrast-enhanced breast magnetic resonance imaging; CI, confidence interval; HER2, human epidermal growth factor receptor 2; TN, triple negative; XRM, X-ray mammography.

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