Background Parenchymal Enhancement on MRI

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Nettles
Nettles Member Posts: 3
edited July 2018 in High Risk for Breast Cancer

I was diagnosed with LCIS in 2014 (discovered with stereotactic and excision biopsies after 2014 mammogram detected increased calcifications in my right breast) and my mother had DCIS so I am now considered high risk. Since 2014 in addition to an annual mammogram, I have bi-annual office visits with my breast surgeon and I have had two MRI mammograms.

My annual mammogram in late March 2017 found an asymmetry in the right breast and I was called back for a diagnostic mammogram and an ultrasound. The asymmetry could only be found on one view on the mammogram and apparently was not evident on the ultrasound. The radiologist recommended that I return in six months for a follow up diagnostic mammogram but after talking with my breast surgeon I was referred for a second MRI, the results of which I have copied below:

FINDINGS:

Comparison made to prior MRI (2014) and mammography exams (2017-2014).

There is heterogenous fibroglandular tissue.

There is mild to moderate background parenchymal enhancement.

There are innumerable foci of non mass enhancement scattered about both breasts with low suspicion kinetics that look similar to prior. Post surgical changes at the right breast are stable. No evidence for dominant mass, abnormal enhancement or suspicious appearing kinetic curves. No evidence for skin thickening, lymphadenopathy or lesions of the visible anterior chest wall.

After the MRI was read it was been recommended that I still return in six months for another diagnostic mammogram.

The term “mild to moderate background parenchymal enhancement” is new to me. I did a bit of research and it seems that this is yet another high risk marker for breast cancer for someone already determined to be high risk. I am wondering if anyone has had a similar finding on her MRI mammogram and if so how was it followed?

Thank!

Nettles




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  • pattimay
    pattimay Member Posts: 72
    edited September 2017

    I came upon the forum searching also for current thinking on risk factors for parenchymal enhancement on mri. I'm 59 and about 7 years ago had excision surgery for severe ADH. My surgeon sent tissue sample out for another opinion whether it was borderline DCIS. Relieved when diagnosed with just the ADH and to a lesser extent LDH. My surgeon wanted another MRI three months later which led to another biopsy. This turned out to be more ADH. My surgeon said he can't keep taking such large areas of breast tissue out for the biopsies since I have small breasts. So one more time and he'll recommend a mastectomy. Even though I have no family history or gene for breast cancer surgeon said I'm high risk. This leads to alternating breast exam and mammo's with mri every six months. My surgeon gets annoyed every time I mention at 6 month appt. that maybe it would be okay to stop the MRI's since it's been 7 years and all clear. Well last MRI I got the copy and it said THAT TERM..MODERATE PARENCHYMAL ENHANCEMENT. Surgeon always said I have dense breast and I believed that was the reason for the yearly mri's. But according to some of the things I have been reading about having parenchymal enhancement on mri it gives an even higher risk of developing breast cancer then even my ADH. Now do I combine the risks and now have a MUCH higher risk. I have my six month appt. for the feeling my breasts thingy next week. I'm going to ask him about this and let you know what he says. Thanks for writing.

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  • Nettles
    Nettles Member Posts: 3
    edited September 2017

    Hi Pattimay,

    It's been awhile since I posted the above, I nearly forgot about it, but as the every six month return to my oncologist and imaging approaches my mind cannot help but turn to the what ifs. I am due back the first week of October, first for a mammo to follow up on the asymmetry; I suppose to see if it's grown, and then next day to review the results with my oncologist. I will also have a chance to talk with her about the significance (or hopefully lack thereof) of the parenchymal enhancement found in my last MRI mammogram. I'll be sure to let you know what I learn about this finding.

    I should add that I am 57 and have always been diagnosed with heterogeneously dense breasts.

    Sending you hugs!


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  • pattimay
    pattimay Member Posts: 72
    edited September 2017

    Thank's for the quick reply. I'm confused by what I read about the parenchymal enhancement findings. I'm not sure if it means a higher risk just because of this finding or that it makes finding cancer harder even with mri? Thank you for sharing what you onc tells you regarding this and I hope your results are good news.I'll ask my surgeon about this also next week and share what he says.

    Pat

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  • ChelseaAcres
    ChelseaAcres Member Posts: 4
    edited December 2017

    Hi Nettles and Pattimay,

    I've just received results from my annual mammo and MRI. The mammo was fine, nothing new noted, but the MRI has stated the following:

    Findings: Breasts demonstrate significant amount of fibroglandular tissue with moderate stippled-type of background parenchymal enhancement, without significant interval changes. It may limit MRI sensitivity.

    No MRI evidence of malignancy.
    Of note, low and intermediate DCIS could not be depicted by MRI. Therefore, screening mammogram with 
    adjunctive MRI is recommended in one years time.

    A little history for you may provide some info about my journey. I'm a high risk patient for BC, due to having ADH found in both breast 5 years ago. I had the lumpectomies and am now monitored each year with a mammo and MRI. If something detected, I usually will go every 6 months, then usually back to yearly. But the results of the MRI last week showed this "background parenchymal enhancement". Like you when I looked it up, it appears to increase our risk for BC. My question to you both is, were you able to get any answers about the risk factor increasing even more because of also previously having ADH?

    Sometimes, I really feel I'm playing a very dangerous game with myself, by continuing to continually monitor, instead of having a double mastectomy. The oncologist suggest I just keep getting monitored, and would consider it a drastic measure to have the surgery.

    Your input would be greatly appreciated.

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  • Nettles
    Nettles Member Posts: 3
    edited December 2017

    Hi ChelseaAcres,

    My oncologist did not make much of the use of the term "background parenchymal enhancement“ and was focused more on the fact the the asymmetry they found six months prior was less distinct on the current mammogram. I am back for a six month follow up mammogram to continue tracking it.

    I understand what you’re saying. I sometimes feel like I am playing Russian roulette, just waiting for the diagnostic test that will result in a mastectomy but I do take comfort in the fact I am being so well monitored so if/when something is found it is so likely to be at the early stage. So I go back the beginning of April, which is still far enough away that I don’t think about it every day!

    Take good care!

    Nettles



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  • ChelseaAcres
    ChelseaAcres Member Posts: 4
    edited December 2017

    Thank you for your response Nettles. I do agree with you about the care we receive and if anything is found it would/should be in the early stages. I try to remind myself of this everyday, so I don't worry myself silly. I actually have a follow up app't at Princess Margaret (Toronto, Canada - It's our Cancer Hospital) on Monday, where I'll be sure to have a great chat with my oncologist.

    Take care,

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  • Nati275946
    Nati275946 Member Posts: 15
    edited July 2018

    My recent breast mri showed glandular enhancement.I am not sure if this is the same thing.Once my breast surgeon is in town I know she will address this !

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  • Kerri_Oz
    Kerri_Oz Member Posts: 91
    edited July 2018

    I had an MRI which showed a "marked degree" of background parenchymal enhancement, which is the highest degree. This, however, has never been brought up with me by my GP or breast surgeon. I have many other risk factors, including heterogenously dense breast, family history and LCIS/ALH, for which I am scheduled to have a PBMX in October. I guess the reason the enhancement hasn't been brought up is because it doesn't affect the decision one way or the other, and will be taken care of with the mastectomy that is already going to be done for other reasons. The MRI was ordered to look at my nodes prior to surgery to see if any showed anything significant which would require them to be biopsied or excised at the time of the mastectomy. Thankfully my nodes looked clear, so they won't be touched.

    The reading I did about enhancement kind of led me to believe the main reason it was a risk is because it makes it hard to see if there's anything bad lurking there, a bit like the density of breast tissue. I have to admit that I didn't look into it too deeply, though, because it's not going to make any difference to my plan going forward.

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