Invasive Breast Cancer Preferably and Predominantly Occurs at the Interface Between Fibroglandular and Adipose Tissue Wenlian Zhu, Susan Harvey, Katarzyna.

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Invasive Breast Cancer Preferably and Predominantly Occurs at the Interface Between Fibroglandular and Adipose Tissue Wenlian Zhu, Susan Harvey, Katarzyna J. Macura, David M. Euhus, Dmitri Artemov Clinical Breast Cancer Volume 17, Issue 1, Pages e11-e18 (February 2017) DOI: 10.1016/j.clbc.2016.07.009 Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 Unifocal Breast Tumors (Red) of Different Sizes, Receptor Status, and Types at Fibroglandular (Dark) and Adipose (Cyan) Tissue Interface, Demonstrated by Breast DCE-MRI Enhancement at Plateau and Overlaid on T1-Weighted Precontrast Images Without Fat Saturation. Enhanced Tumors Are Indicated by Arrows. (A) Forty-One-Year-Old Patient With Breast Density of 39.8% and Stage 1 ER-Positive IDC Tumor; (B) 44-Year-Old Patient With Breast Density of 6.6% and Stage 1 ER-Positive IMC Tumor; (C) 35-Year-Old Patient With Breast Density of 30.9% and Stage 2 Triple-Negative IDC Tumor; (D) 80-Year-Old Patient With Breast Density of 9% and Stage 2 ER- and HER-2-Positive ILC Tumor; (E) 44-Year-Old Patient With Breast Density of 56.3% and Stage 3 ER-Positive IDC Tumor; (F) 46-Year-Old Patient With Breast Density of 6.5% and ER-Positive IDC Tumor > 7 cm Abbreviations: DCE-MRI = dynamic contrast-enhanced magnetic resonance imaging; ER = estrogen receptor; HER-2 = human epidermal growth factor receptor 2; IDC = invasive ductal carcinoma; ILC = infiltrating lobular carcinoma; IMC = invasive mammary carcinoma. Clinical Breast Cancer 2017 17, e11-e18DOI: (10.1016/j.clbc.2016.07.009) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 2 Isolated Unifocal Breast Tumor (Red), Demonstrated by Breast DCE-MRI Enhancement at Plateau and Overlaid on T1-Weighted Precontrast Images Without Fat Saturation Surrounded by Adipose Tissue (Cyan) Apart From Main Breast Fibroglandular Parenchyma (Dark). Enhanced Tumor Is Indicated by Arrows. (A) ER–Positive Stage 1 IDC Tumor at Fibroglandular and Adipose Interface in 61-Year-Old Patient With Breast Density of 21.6%, Apart From (B) Main Fibroglandular Parenchyma of Same Patient Abbreviations: DCE-MRI = dynamic contrast-enhanced magnetic resonance imaging; IDC = invasive ductal carcinoma. Clinical Breast Cancer 2017 17, e11-e18DOI: (10.1016/j.clbc.2016.07.009) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 3 Multifocal Breast Tumors (Red) at Fibroglandular (Dark) and Adipose (Cyan) Tissue Interface Demonstrated by Breast DCE-MRI Enhancement at Plateau and Overlaid on T1-Weighted Precontrast Images Without Fat Saturation. Enhanced Tumors Are Indicated by Arrows. (A and B) Stage 2 Multifocal ER-Positive IDC Tumors in 38-Year-Old Patient With Breast Density of 21.5%; (C and D) stage 1 ER-Positive Multifocal ILC Tumors in 50-Year-Old Patient With Breast Density of 32.1% Abbreviations: DCE-MRI = Dynamic Contrast-Enhanced Magnetic Resonance Imaging; ER = estrogen Receptor; ILC = Infiltrating Lobular Carcinoma. Clinical Breast Cancer 2017 17, e11-e18DOI: (10.1016/j.clbc.2016.07.009) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 4 Breast Tumors (Red) at Fibroglandular (Cyan) and Adipose (Dark) Tissue Interface Demonstrated by Breast DCE-MRI Enhancement at Plateau and Overlaid on T1-Weighted Precontrast Images With Fat Saturation. Enhanced Tumors Are Indicated by Arrows. (A) ER-Positive IDC Tumor in 35-Year-Old Patient With Breast Density of 37.0%; (B) ER- and HER-2-Positive IDC Tumor in 51-Year-Old Patient With Breast Density of 43.6%; (C) ER-Positive Multicentric IDC Tumors in 44-Year-Old Patient With Breast Density of 24.6% Abbreviations: DCE-MRI = dynamic contrast-enhanced magnetic resonance imaging; ER = estrogen receptor; HER-2 = human epidermal growth factor receptor 2; IDC = invasive ductal carcinoma. Clinical Breast Cancer 2017 17, e11-e18DOI: (10.1016/j.clbc.2016.07.009) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 5 Effect of Body Adiposity on Breast Adipose Tissue Expansion in Women 31 to 32 Years Old. (Top Row) UAAL on T1-Weighted Precontrast Images, (Middle Row) Central Breast on T1-Weighted Precontrast Images; (Bottom Row) Breast Tumors (Red) at Fibroglandular (Dark) and Adipose (Cyan) Tissue Interface Demonstrated by Breast DCE-MRI Enhancement at Plateau and Overlaid on T1-Weighted Precontrast Images Without Fat Saturation. Enhanced Tumors Are Indicated by Arrows. Images From Left to Right: 32-Year-Old Patient With UAAL Thickness of 2 mm, Breast Density of 68.0%, and ER-Positive IMC Tumor; 32-Year-Old Patient With UAAL Thickness of 5 mm, Breast Density of 24.5%, and ER-Positive IMC Tumor; 31-Year-Old Patient With UAAL Thickness of 13 mm, Breast Density of 22.4%, and Triple-Negative IDC Tumor; and 32-Year-Old Patient With UAAL Thickness of 18 mm, Breast Density of 5.2%, and ER-Positive IDC Tumor Abbreviations: ER = estrogen receptor; IDC = invasive ductal carcinoma; IMC = invasive mammary carcinoma; UAAL = upper abdominal adipose layer. Clinical Breast Cancer 2017 17, e11-e18DOI: (10.1016/j.clbc.2016.07.009) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 6 Effect of Age on Breast Adipose Tissue Expansion in Women With Fixed UAAL Thickness of 10 mm. (Top Row) UAAL on T1-Weighted Precontrast Images, (Middle Row) Central Breast on T1-Weighted Precontrast Images; (Bottom Row) Breast Tumors (Red) at Fibroglandular (Dark) and Adipose (Cyan) Tissue Interface Demonstrated by Breast DCE-MRI Enhancement at Plateau and Overlaid on T1-Weighted Precontrast Images Without Fat Saturation. Enhanced Tumors Are Indicated by Arrows. Images From Left to Right: 27-Year-Old Patient With Breast Density of 37.4% and ER- and HER-2-Positive IDC Tumor; 36-Year-Old Patient With Breast Density of 24.0% and ER-Positive IMC Tumor; 47-Year-Old Patient With Breast Density of 9.5% and ER-Positive IDC With Medullary Features Tumor; and 69-Year-Old Patient With Breast Density of 9.6% and ER-Positive ILC Tumor Abbreviations: DCE-MRI = dynamic contrast-enhanced magnetic resonance imaging; ER = estrogen receptor; HER-2 = human epidermal growth factor receptor 2; IDC = invasive ductal carcinoma; ILC = infiltrating lobular carcinoma; IMC = invasive mammary. Clinical Breast Cancer 2017 17, e11-e18DOI: (10.1016/j.clbc.2016.07.009) Copyright © 2016 Elsevier Inc. Terms and Conditions