Association of Clinical Factors and Degree of Early Background Parenchymal Enhancement on Contrast-Enhanced Mammography.

Please see the Editorial Comment by Ingolf Karst discussing this article. Chinese (audio/PDF) and Spanish (audio/PDF) translations are available for this article's abstract. To listen to the podcast associated with this article, please select one of the following: iTunes, Google Play, or direct download. Background parenchymal enhancement (BPE) may impact contrast-enhanced mammography (CEM) interpretation, although factors influencing the degree of BPE on CEM are poorly understood. To evaluate relationships between clinical factors and the degree of early BPE on CEM. This retrospective study included 207 patients (median age, 46 years) who underwent CEM between April 2020 and September 2021. Two radiologists independently assessed the degree of BPE on CEM as minimal, mild, moderate, or marked based on two criteria (criteria 1: using the first of four obtained views; criteria 2: using the first two of four obtained views). The radiologists reached consensus for breast density on CEM. The EMR was reviewed for clinical factors. Radiologists' agreement for degree of BPE was assessed using weighted kappa coefficients. Univariable and multivariable analyses were performed to assess relationships between clinical factors and degree of BPE, treating readers' independent assessments as repeated measurements. Interreader agreement for degree of BPE, expressed as kappa, was 0.80 for both criteria. For both criteria, univariable analyses found degree of BPE to be negatively associated with age (OR=0.94-0.94), personal history of breast cancer (OR=0.22-0.30), history of chemotherapy (OR=0.18-0.21), history of radiation therapy (OR=0.20-0.21), perimenopausal status (OR=0.22-0.34), and postmenopausal status (OR=0.10-0.11); and positively associated with dense breasts (OR=4.13-4.26) and premenopausal status with irregular menstrual cycles (OR=7.94-14.02). Among premenopausal patients with regular menstrual cycles, degree of BPE was lowest (using postmenopausal patients as reference) for patients in menstrual cycle days 8-14 (OR=2.56-14.17). In multivariable analysis for both criteria, the only independent predictors of degree of BPE related to menstrual status and time of menstrual cycle (e.g., using premenopausal patients in days 1-7 as reference: OR=0.21-0.21 for premenopausal patients in days 8-14 and OR=0.04-0.03 for postmenopausal patients). Clinical factors, including history of breast cancer or breast cancer treatment, breast density, menstrual status, and time of menstrual cycle, are associated with degree of early BPE on CEM. In premenopausal patients, degree of BPE is lowest on days 8-14 of the menstrual cycle. Given potential impact of BPE on diagnostic performance, the findings have implications for CEM scheduling and interpretation.