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Can supplementary contrast-enhanced MRI of the breast avoid needle biopsies in suspicious microcalcifications seen on mammography? A systematic review and meta-analysis. Breast 2021; 56:53-60. [PMID: 33618160 PMCID: PMC7907894 DOI: 10.1016/j.breast.2021.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the rate of potentially avoidable needle biopsies in mammographically suspicious calcifications if supplementary Contrast-Enhanced MRI (CE-MRI) is negative. Methods Using predefined criteria, a systematic review was performed. Studies investigating the use of supplemental CE-MRI in the setting of mammographically suspicious calcifications undergoing stereotactic biopsy and published between 2000 and 2020 were eligible. Two reviewers extracted study characteristics and true positives (TP), false positives, true negatives and false negatives (FN). Specificity, in this setting equaling the number of avoidable biopsies and FN rates were calculated. The maximum pre-test probability at which post-test probabilities of a negative CE-MRI met with BI-RADS benchmarks was determined by a Fagan nomogram. Random-effects models, I2-statistics, Deek’s funnel plot testing and meta-regression were employed. P-values <0.05 were considered significant. Results Thirteen studies investigating 1414 lesions with a cancer prevalence of 43.6% (range: 22.7–66.9%) were included. No publication bias was found (P = 0.91). CE-MRI performed better in pure microcalcification studies compared to those also including associate findings (P < 0.001). In the first group, the pooled rate of avoidable biopsies was 80.6% (95%-CI: 64.6–90.5%) while the overall and invasive cancer FN rates were 3.7% (95%-CI: 1.2–6.2%) and 1.6% (95%-CI 0–3.6%), respectively. Up to a pre-test probability of 22%, the post-test probability did not exceed 2%. Conclusion A negative supplementary CE-MRI could potentially avoid 80.6% of unnecessary stereotactic biopsies in BI-RADS 4 microcalcifications at a cost of 3.7% missed breast cancers, 1.6% invasive. BI-RADS benchmarks for downgrading mammographic calcifications would be met up to a pretest probability of 22%. A negative breast MRI can downgrade up to 80.6% of suspicious microcalcifications, potentially avoiding vacuum-assisted breast biopsies. Up to a pretest probability of 22% , a negative breast MRI result would not exceed the 2% cancer rate required for a BI-RADS 3 category assignment.
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Hrkac Pustahija A, Ivanac G, Brkljacic B. US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications. ACTA ACUST UNITED AC 2018; 24:187-194. [PMID: 30091708 DOI: 10.5152/dir.2018.17414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to assess diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) in lesions that manifest as mammographic BI-RADS 4 and 5 microcalcifications, in the setting of conjoined use of mammography, US, and MRI. METHODS Patients with mammographic BI-RADS 4 or 5 microcalcifications, without additional findings, were included in this prospective study. All patients subsequently underwent breast US and MRI. Histopathologic diagnosis, obtained by US-guided core-needle biopsy or surgical excision, served as a reference standard. Diagnostic accuracies of US and MRI were calculated, and positive predictive value for different MRI BI-RADS imaging features were determined. RESULTS The study group consisted of 113 women with 125 areas of suspicious microcalcifications. MRI reached sensitivity, specificity, positive predictive value 3 (PPV3), and negative predictive value (NPV) of 100%, 70.1%, 67.6%, and 100%, respectively. Statistically significant differences in MRI morphologic features and kinetic enhancement curves were observed between malignant and benign microcalcifications. Sensitivity, specificity, PPV3, and NPV for US were: 85.4%, 66.2%, 61.2%, and 87.9%. There was statistically significant difference in presentation of malignant and benign microcalcifications at US. CONCLUSION In the setting of conjoined use of mammography, US, and MRI, MRI can reliably exclude malignancy in suspicious microcalcifications. Thus, negative MRI findings may influence the decision to biopsy the microcalcifications.
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Affiliation(s)
- Ana Hrkac Pustahija
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Gordana Ivanac
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb, School of Medicine, Zagreb, Croatia
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Eun N, Son E, Gweon H, Youk J, Kim JA. The value of breast MRI for BI-RADS category 4B mammographic microcalcification: based on the 5th edition of BI-RADS. Clin Radiol 2018; 73:750-755. [DOI: 10.1016/j.crad.2018.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 04/25/2018] [Indexed: 11/16/2022]
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Bennani-Baiti B, Baltzer PA. MR Imaging for Diagnosis of Malignancy in Mammographic Microcalcifications: A Systematic Review and Meta-Analysis. Radiology 2017; 283:692-701. [DOI: 10.1148/radiol.2016161106] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Barbara Bennani-Baiti
- From the Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital (AKH), Medical University of Vienna, Währinger-Gürtel 18-20, 1090 Vienna, Austria
| | - Pascal A. Baltzer
- From the Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital (AKH), Medical University of Vienna, Währinger-Gürtel 18-20, 1090 Vienna, Austria
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Diagnostic Performance of Breast Magnetic Resonance Imaging in Non-Calcified Equivocal Breast Findings: Results from a Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0160346. [PMID: 27482715 PMCID: PMC4970763 DOI: 10.1371/journal.pone.0160346] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/18/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the performance of MRI for diagnosis of breast cancer in non-calcified equivocal breast findings. MATERIALS AND METHODS We performed a systematic review and meta-analysis of peer-reviewed studies in PubMed from 01/01/1986 until 06/15/2015. Eligible were studies applying dynamic contrast-enhanced breast MRI as an adjunct to conventional imaging (mammography, ultrasound) to clarify equivocal findings without microcalcifications. Reference standard for MRI findings had to be established by histopathological sampling or imaging follow-up of at least 12 months. Number of true or false positives and negatives and other characteristics were extracted, and possible bias was determined using the QUADAS-2 applet. Statistical analyses included data pooling and heterogeneity testing. RESULTS Fourteen out of 514 studies comprising 2,316 lesions met our inclusion criteria. Pooled diagnostic parameters were: sensitivity (99%, 95%-CI: 93-100%), specificity (89%, 95%-CI: 85-92%), PPV (56%, 95%-CI: 42-70%) and NPV (100%, 95%-CI: 99-100%). These estimates displayed significant heterogeneity (P<0.001). CONCLUSIONS Breast MRI demonstrates an excellent diagnostic performance in case of non-calcified equivocal breast findings detected in conventional imaging. However, considering the substantial heterogeneity with regard to prevalence of malignancy, problem solving criteria need to be better defined.
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Yamashita Y, Murayama S, Okada M, Watanabe Y, Kataoka M, Kaji Y, Imamura K, Takehara Y, Hayashi H, Ohno K, Awai K, Hirai T, Kojima K, Sakai S, Matsunaga N, Murakami T, Yoshimitsu K, Gabata T, Matsuzaki K, Tohno E, Kawahara Y, Nakayama T, Monzawa S, Takahashi S. The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline. Jpn J Radiol 2015; 34:43-79. [DOI: 10.1007/s11604-015-0499-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Identification of Breast Cancer Using Integrated Information from MRI and Mammography. PLoS One 2015; 10:e0128404. [PMID: 26056841 PMCID: PMC4461246 DOI: 10.1371/journal.pone.0128404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/27/2015] [Indexed: 11/27/2022] Open
Abstract
Objectives Integration of information from corresponding regions between the breast MRI and an X-ray mammogram could benefit the detection of breast cancer in clinical diagnosis. We aimed to provide a framework of registration from breast MRI to mammography and to evaluate the diagnosis using the combined information. Materials and Methods 43 patients with 46 lesions underwent both MRI and mammography scans, and the interval between the two examinations was around one month. The distribution of malignant to benign lesions was 31/46 based on histological results. Maximum intensity projection and thin-plate spline methods were applied for image registration for MRI to mammography. The diagnosis using integrated information was evaluated using results of histology as the reference. The assessment of annotations and statistical analysis were performed by the two radiologists. Results For the cranio-caudal view, the mean post-registration error between MRI and mammography was 2.2±1.9 mm. For the medio-lateral oblique view, the proposed approach performed even better with a mean error of 3.0±2.4 mm. In the diagnosis using MRI assessment with information of mammography, the sensitivity was 91.9±2.3% (29/31, 28/31), specificity 70.0±4.7% (11/15, 10/15), accuracy 84.8±3.1% (40/46, 38/46), positive predictive value 86.4±2.1% (29/33, 28/33) and negative predictive value 80.8±5.4% (11/13, 10/13). Conclusion MRI with the aid of mammography shows potential improvements of sensitivity, specificity, accuracy, PPV and NPV in clinical breast cancer diagnosis compared to the use of MRI alone.
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Jiang Y, Lou J, Wang S, Zhao Y, Wang C, Wang D. Evaluation of the role of dynamic contrast-enhanced MR imaging for patients with BI-RADS 3-4 microcalcifications. PLoS One 2014; 9:e99669. [PMID: 24927476 PMCID: PMC4057215 DOI: 10.1371/journal.pone.0099669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/18/2014] [Indexed: 11/19/2022] Open
Abstract
Objective The purpose of study was to prospectively evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging in the differentiation of malignant lesions from benign ones in patients with BI-RADS 3–4 microcalcifications detected by mammography. Materials and Methods 93 women with 100 microcalcifications had undergone breast MRI from June 2010 to July 2013. Subsequently, 91 received open biopsy and 2 received stereotactic vacuum-assisted biopsy. All results were compared with histological findings. The PPV, NPV and area under curve (AUC) of the mammography and breast MRI were calculated. Results There were 31 (31.0%) BI-RADS 3 microcalcifications and 69 (69.0%) BI-RADS 4. The PPV and NPV of mammography is 65.2% (45/69) and 90.3% (28/31). The PPV and NPV of breast MRI was 90.2% (46/51) and 95.9% (47/49). Among 31 BI-RADS 3 microcalcifications, the PPV and NPV of breast MRI was 100% (3/3) and 100% (28/28). Among 69 BI-RADS 4 microcalcifications, the PPV and NPV of breast MRI was 89.6% (43/48) and 90.5% (19/21). The AUC of mammography and breast MRI assessment were 0.738 (95% CI, 0.639–0.837) and 0.931 (95% CI, 0.874–0.988) (p<0.05). Conclusion Dynamic contrast-enhanced MR imaging of breast is able to be applied to predict the risk of malignance before follow-up for BI-RADS 3 microcalcifications and biopsy for BI-RADS 4 microcalcifications.
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Affiliation(s)
- Yanni Jiang
- Division of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianjuan Lou
- Division of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Siqi Wang
- Division of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Zhao
- Division of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cong Wang
- Division of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dehang Wang
- Division of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail:
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Medeiros LR, Duarte CS, Rosa DD, Edelweiss MI, Edelweiss M, Silva FR, Winnnikow EP, Simões Pires PD, Rosa MI. Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis. Breast Cancer Res Treat 2011; 126:273-85. [PMID: 21221772 DOI: 10.1007/s10549-010-1326-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/20/2010] [Indexed: 12/21/2022]
Abstract
Dynamic contrast-enhanced breast magnetic resonance (MR) is a promising emerging technique for evaluating breast lesions. A quantitative systematic review was performed to estimate the accuracy of breast MR in the diagnosis of high-risk breast lesions and breast cancer. A comprehensive search of the Cochrane Library, MEDLINE, CANCERLIT, LILACS, and EMBASE databases was performed from January 1985 to August 2010. The medical subjects heading (MeSH) and text words for the terms "breast neoplasm", "breast lesions", "breast cancer" and "magnetic resonance" were combined with the MeSH term diagnosis ("sensitivity and specificity"). Studies that compared breast MR with paraffin-embedded sections parameters for the diagnosis of breast lesions (benign, high-risk borderline, and breast cancer) were included. Sixty-nine studies were analyzed, which included 9,298 women with 9,884 breast lesions. Interrater overall agreement between breast MR and paraffin section diagnosis was 79% (κ = 0.55), indicating moderate agreement. Pooled sensitivity and specificity were 90% [95% CI 88-92%] and 75% [95% CI 70-79%], respectively. The pooled likelihood positive ratio was 3.64 (95% CI 3.0-4.2) and the negative ratio was 0.12 (95% CI 0.09-0.15). For breast cancer or high-risk lesions versus benign lesions, the AUC was 0.91 for breast MR and the point Q* was 0.84. In summary, breast MR is a useful pre-operative test for predicting the diagnosis of breast lesions.
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Affiliation(s)
- Lidia Rosi Medeiros
- Postgraduate Program in Medicine, Medical Sciences at Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography? Eur Radiol 2009; 19:2089-96. [PMID: 19350244 DOI: 10.1007/s00330-009-1396-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 01/13/2009] [Accepted: 02/15/2009] [Indexed: 10/20/2022]
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Van Goethem M, Tjalma W, Schelfout K, Verslegers I, Biltjes I, Parizel P. Magnetic resonance imaging in breast cancer. Eur J Surg Oncol 2006; 32:901-10. [DOI: 10.1016/j.ejso.2006.06.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 06/26/2006] [Indexed: 11/16/2022] Open
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Uematsu T, Yuen S, Kasami M, Uchida Y. Dynamic contrast-enhanced MR imaging in screening detected microcalcification lesions of the breast: is there any value? Breast Cancer Res Treat 2006; 103:269-81. [PMID: 17063274 DOI: 10.1007/s10549-006-9373-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 08/10/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To prospectively evaluate whether dynamic contrast-enhanced magnetic resonance (MR) imaging findings can help predict the presence of malignancy when screening detected microcalcification lesions, and its contribution to patient management of stereotactic vacuum-assisted breast biopsy (SVAB). MATERIALS AND METHODS Dynamic contrast-enhanced breast MR imaging was performed when screening 100 detected microcalcification lesions not visualized by ultrasonography with 11-gauge SVAB. Definitive surgery was performed on all patients with the biopsy resulting in the diagnosis of breast cancer or atypical ductal hyperplasia (ADH). Positive predictive values (PPVs) and negative predictive values (NPVs) were calculated on the basis of a BI-RADS (Breast Imaging Reporting and Data System) category and the absence or presence of contrast uptake in the area of microcalcification. RESULTS The BI-RADS mammography category correlated with the diagnosis of breast cancer (ADH excluded): category 3 = 7% (4/55); category 4 = 48% (13/27); category 5 = 94% (17/18). After dynamic contrast-enhanced MR imaging, three of four malignancies with BI-RADS mammography category 3 were diagnosed as true positive. Therefore, the PPV of BI-RADS mammography category 3 with MR imaging was 1.8% (1/55). The PPV of contrast uptake of MR imaging was 86% (32/37), significantly higher than the 67% (30/45) PPV of BI-RADS mammography 4 and 5 (P = 0.033). The NPV of BI-RADS mammography 3 was 93% (51/55) versus 97% (61/63) NPV of MR imaging (P = 0.167). CONCLUSION In the evaluation of screening detected microcalcification lesions, dynamic contrast-enhanced breast MR imaging provides additional information with high PPV and NPV, and may therefore offer an alternative to SVAB for women who do not want to undergo SVAB with equivocal findings following full diagnostic mammographic assessment, but breast MR imaging with imperfect PPV and NPV cannot replace SVAB. CLINICAL RELEVANCE Dynamic contrast-enhanced breast MR imaging can demonstrate malignant microcalcifications detected by screening mammography and can be recommended in the evaluation of equivocal microcalcifications prior to SVAB.
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Affiliation(s)
- Takayoshi Uematsu
- Department of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Naga-Izumi, Shizuoka, Japan.
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Shimauchi A, Yamada T, Sato A, Takase K, Usami S, Ishida T, Moriya T, Takahashi S. Comparison of MDCT and MRI for Evaluating the Intraductal Component of Breast Cancer. AJR Am J Roentgenol 2006; 187:322-9. [PMID: 16861533 DOI: 10.2214/ajr.05.0876] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to compare the accuracy of MDCT and MRI for evaluating the intraductal component of breast cancer. MATERIALS AND METHODS Sixty-nine patients with histologically proven invasive carcinoma underwent MDCT and MRI. Retrospectively, two radiologists performed a blinded review of the MDCT and MRI. Cases with intraductal component enhancement were classified into two morphologic types: ductal extension and segmental distribution. The lengths of the main tumor and of the intraductal component were measured in cases with ductal extension. For cases with segmental distribution, only the maximum length of the tumor was measured. RESULTS The sensitivity, specificity, and accuracy in detecting the intraductal component were 61%, 88%, and 71%, respectively, using MDCT; and 75%, 88%, and 80%, respectively, using MRI. MRI revealed the presence of the intraductal component with significantly higher sensitivity than did MDCT (p = 0.031). In the analysis of the length of the intraductal component in cases with ductal extension, which had relatively small intraductal components, underestimation by 15 mm or more was significantly less frequent with MRI than with MDCT (p = 0.008). There was no significant difference between MDCT and MRI in the evaluation of the maximum length of tumors in cases with segmental distribution, which had relatively large intraductal components. CONCLUSION Compared with MDCT, MRI revealed the presence of the intraductal component with higher sensitivity and equivalent specificity. In cases with ductal extension, MRI is more precise than MDCT for determination of the margin for surgical removal, with less underestimation of the extent of the intraductal component.
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Affiliation(s)
- Akiko Shimauchi
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
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Bazzocchi M, Zuiani C, Panizza P, Del Frate C, Soldano F, Isola M, Sardanelli F, Giuseppetti GM, Simonetti G, Lattanzio V, Del Maschio A. Contrast-Enhanced Breast MRI in Patients with Suspicious Microcalcifications on Mammography: Results of a Multicenter Trial. AJR Am J Roentgenol 2006; 186:1723-32. [PMID: 16714666 DOI: 10.2214/ajr.04.1898] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to test dynamic MRI in evaluating mammographically detected suspicious microcalcifications. MATERIALS AND METHODS One hundred twelve patients with mammographically detected microcalcifications with BI-RADS category 5 (n = 78) or 4 (n = 34) lesions were studied at 17 centers a using 3D gradient-echo dynamic coronal technique (< or = 3 mm thickness) and 0.1 mmol/kg of gadoteridol. A pathologic sample was obtained in all cases. Agreement between the major diameter measured on mammography, MRI, or both and the major diameter measured at pathologic examination was calculated in 62 cases. RESULTS Of the 112 lesions, pathologic examination revealed 37 benign lesions, 33 ductal carcinoma in situ (DCIS), and 42 invasive carcinomas. The specificity of MRI for benign lesions was 68%. Considering the subgroups of calcifications alone and calcifications associated with masses, the specificity values became 79% and 33%, respectively. The sensitivity of MRI for DCIS was 79%. Analysis of the two subgroups showed sensitivity values of 68% for calcifications alone and of 1% for calcifications associated with masses. The sensitivity for invasive carcinomas was 93%. Analysis of the two subgroups showed sensitivity values to be 92% for calcifications alone and 94% for calcifications associated with masses. Considering the overall results, the sensitivity of MRI was 87%; specificity, 68%; positive predictive value, 84%; negative predictive value, 71%; and accuracy, 80%. Considering the subgroups of calcifications alone and calcifications associated with masses, the sensitivity values became 80% and 97%; the positive predictive values, 86% and 82%; the negative predictive values, 71% and 75% (95% confidence interval [CI], 0.19-0.99); and the accuracy values, 80% and 82% (95% CI, 0.66-0.92), respectively. An odds ratio (OR) of 13.54 (95% CI, 5.20-35.28) showed a raised risk of malignant breast tumor in subjects with positive MR examination of mammographically detected suspicious clusters of microcalcifications. The statistical analysis on each subgroup showed an OR of 15.07 (95% CI, 4.73-48.08) for calcifications alone and an OR of 14.00 (95% CI, 1.23-158.84) for calcifications associated with masses. Any significant improvement in the predictive ability of dynamic MRI depending on the extent of calcifications on mammography was not proved. Considering the 62 cases of proved malignancy with measured maximal diameter at pathologic examination, both mammography and MR examination seem to overestimate tumor extent. CONCLUSION The not-perfect sensitivity of MRI (87%), when applying our interpretation criteria and imaging sequences, is a crucial point that prevents us from clinical use of MRI in the diagnosis of mammographically detected microcalcifications.
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Affiliation(s)
- Massimo Bazzocchi
- Institute of Radiology, University of Udine, Via Colugna 50, Udine 33100, Italy
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Hylton N. Magnetic Resonance Imaging of the Breast: Opportunities to Improve Breast Cancer Management. J Clin Oncol 2005; 23:1678-84. [PMID: 15755976 DOI: 10.1200/jco.2005.12.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nola Hylton
- Department of Radiology, Magnetic Resonance Science Center, University of California San Francisco, 1 Irving St, Room AC-109, San Francisco, CA 94143-1290, USA.
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Ishikawa T, Momiyama N, Hamaguchi Y, Takeuchi M, Iwasawa T, Yoshida T, Shimada H. Evaluation of dynamic studies of MR mammography for the diagnosis of intraductal lesions with nipple discharge. Breast Cancer 2004; 11:288-94. [PMID: 15550848 DOI: 10.1007/bf02984551] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the utility of dynamic magnetic resonance imaging (MRI) in differentiating benign from malignant lesions of the breast and then applied MRI to diagnose intraductal breast tumors with nipple discharge. METHODS Gadolinium (Gd)-enhanced MR mammography was performed on 74 patients with breast tumors and 8 patients with nipple discharge. RESULTS The steepest slopes of the contrast medium uptake (S slope) s from time-intensity curves were significantly different between malignant and benign lesions. At S slope threshold of 0.95% /second, malignancy was predicted with a sensitivity and specificity of 75% . Six of 8 cases with nipple discharge were successfully identified by MR ductography by injecting Gd-DTPA into discharging ducts. Among them, 2 non-invasive ductal carcinomas were differentiated from benign lesions by the S slope value. CONCLUSIONS Dynamic MR mammography is an useful modality for differentiating breast lesions and has potential for evaluating intraductal lesions with nipple discharge.
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Affiliation(s)
- Takashi Ishikawa
- Second Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
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Kato M, Oda K, Kubota T, Kato M, Akiyama F, Nimura Y. Mucocele-like tumor of the breast caused by ductal carcinoma in situ: a case report. Breast Cancer 2003; 10:157-62. [PMID: 12736570 DOI: 10.1007/bf02967642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A mucocele-like tumor (MLT) of the breast caused by clinging and micropapillary carcinoma in situ is reported. The tumor was a smooth-contoured mass located near the nipple in the lower inner quadrant of the left breast. Ultrasonography showed a cystic tumor and distended ducts. An aspiration specimen contained abundant mucinous material and a small amount of epithelial cell components, but was insufficient for cytological diagnosis. An excisional biopsy specimen disclosed multiple cysts containing mucin with extravasation into the stroma. Additional pathologic diagnosis using consecutive microscopic sections demonstrated ductal carcinoma in situ. Subcutaneous mastectomy was subsequently performed. Histopathologic findings in the resected and biopsy specimens indicated a diagnosis of MLT caused by widely spreading clinging and micropapillary ductal carcinoma in situ. The ductal epithelium of the MLT in an open biopsy specimen must be carefully examined using consecutive microscopic sections to detect occult DCIS.
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Affiliation(s)
- Masamichi Kato
- Kato Surgery Gynecology Obstetrics Breast Clinic, 5-8 Tanabe St., Mizuho-ku, Nagoya 467-0027, Japan.
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Nakahara H, Namba K, Watanabe R, Furusawa H, Matsu T, Akiyama F, Sakamoto G, Tamura S. A comparison of mr imaging, galactography and ultrasonography in patients with nipple discharge. Breast Cancer 2003; 10:320-9. [PMID: 14634510 DOI: 10.1007/bf02967652] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study is to assess the usefulness of three-dimensional contrast-enhanced magnetic resonance (MR) imaging, compared with galactography and ultrasonography(US). METHODS Fifty-five patients with bloody nipple discharge were investigated retrospectively. All patients were examined by galactography, ultrasonography and MR imaging. These three sets of findings were compared with the histopathological results from 16 intraductal biopsies, 3 excisional biopsies, 24 microdochectomies and 12 mastectomies. RESULTS Contrast enhanced MR imaging demonstrated all malignant lesions including ductal carcinoma in situ (DCIS). Four cases of DCIS were not visualized by ultrasonography and three malignant lesions were missed by galactography. In the MR study, segmental clumped enhancement (positive predictive value =100 %), and focal mass with smooth border (negative predictive value =87.5 %) were the statistically significant predictive factors. CONCLUSIONS Among the three modalities, contrast-enhanced three-dimensional MR imaging demonstrated the location and distribution of the lesions most clearly, especially in cases of ductal carcinoma in situ. It has the potential to be a useful diagnostic tool for patients with nipple discharge.
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Affiliation(s)
- Hiroshi Nakahara
- Department of Radiology, Miyazaki Medical College, 5200 Ohaza Kihara, Kiyotake, Miyazaki 889-1692, Japan
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