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Kai R, Tozaki M, Koike Y, Nagata A, Taruno K, Ohgiya Y. Characteristics of Suspicious Breast Lesions Visible Only on MR Imaging: Is It Possible to Classify into Immediate Biopsy and Careful Observation Groups? Magn Reson Med Sci 2024:mp.2023-0065. [PMID: 38522915 DOI: 10.2463/mrms.mp.2023-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
PURPOSE To investigate the characteristics of suspicious MRI-only visible lesions and to explore the validity of subcategorizing these lesions into the following two groups: lesions that would require immediate biopsy (4Bi) and lesions for which careful clinical follow-up could be recommended (4Fo). METHODS A retrospective review of 108 MRI-only visible lesions in 106 patients who were diagnosed as Breast Imaging Reporting and Data System (BI-RADS) category 4 between June 2018 and June 2022 at our institution was performed by two radiologists. The breast MR images were evaluated according to BI-RADS and additional MRI descriptors (linear ductal, branching, and apparent diffusion coefficient values). The lesions were categorized by previously reported classification systems, and the positive predictive values (PPVs) for the different categories were determined and compared. Subsequently, a new classification system was developed in this study. RESULTS The total malignancy rate was 31% (34/108). No significant differences between benign and malignant lesions were identified for focus and mass lesions. For non-mass lesions, linear ductal and heterogeneous internal enhancement suggested a benign lesion (P = 0.0013 and P = 0.023, respectively), and branching internal enhancement suggested malignancy (P = 0.0066). Segmental distribution suggested malignancy (P = 0.0097). However, the PPV of segmental distribution with heterogeneous enhancement was significantly lower than that of category 4 segmental lesions with other enhancement patterns (11% vs. 59%; P = 0.0198).As a new classification, the distribution of focal, linear, and segmental was given a score of 0, 1, or 2, and the internal enhancement of heterogeneous, linear-ductal, clumped, branching, and clustered-ring enhancement was given a score of 0, 1, 2, 3, and 4, respectively. When categorized using a scoring system, a statistically significant difference in PPV was observed between 4Fo (n = 27) and 4Bi (n = 33) (7% vs. 61%, P = 0.000029). CONCLUSION The new classification system was found to be highly capable of subcategorizing BI-RADS category 4 MRI-only visible non-mass lesions into 4Fo and 4Bi.
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Affiliation(s)
- Ryozo Kai
- Department of Radiology, Division of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Tozaki
- Department of Radiology, Division of Radiology, Showa University School of Medicine, Tokyo, Japan
- Department of Radiology, Sagara Hospital, Kagoshima, Kagoshima, Japan
| | - Yuya Koike
- Department of Radiology, Division of Radiology, Showa University School of Medicine, Tokyo, Japan
- Department of Interventional Radiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Kanagawa, Japan
| | - Aya Nagata
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Kanae Taruno
- Department of Breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Ohgiya
- Department of Radiology, Division of Radiology, Showa University School of Medicine, Tokyo, Japan
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Nguyen DL, Myers KS, Oluyemi E, Mullen LA, Panigrahi B, Rossi J, Ambinder EB. BI-RADS 3 Assessment on MRI: A Lesion-Based Review for Breast Radiologists. JOURNAL OF BREAST IMAGING 2022; 4:460-473. [DOI: 10.1093/jbi/wbac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Unlike mammography and US, limited data exist to establish well-defined criteria for MRI findings that have a ≤2% likelihood of malignancy. Therefore, determining which findings are appropriate for a BI-RADS 3 assessment on MRI remains challenging and variable among breast radiologists. Emerging data suggest that BI-RADS 3 should be limited to baseline MRI examinations (or examinations with less than two years of prior comparisons) performed for high-risk screening and only used for masses with all of the typical morphological and kinetic features suggestive of a fibroadenoma or dominant enhancing T2 hypointense foci that is distinct from background parenchymal enhancement and without suspicious kinetics. This article presents an updated discussion of BI-RADS 3 assessment (probably benign) for breast MRI using current evidence.
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Affiliation(s)
- Derek L Nguyen
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Kelly S Myers
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Eniola Oluyemi
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Lisa A Mullen
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Babita Panigrahi
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Joanna Rossi
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
| | - Emily B Ambinder
- Johns Hopkins Medicine, Russell H. Morgan Department of Radiology and Radiological Science , Baltimore, MD , USA
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Imaging Features Derived From Dynamic Contrast-Enhanced Magnetic Resonance Imaging to Differentiate Malignant From Benign Breast Lesions: A Systematic Review and Meta-Analysis. J Comput Assist Tomogr 2022; 46:383-391. [DOI: 10.1097/rct.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Cherian S, Vagvala S, Majidi SS, Deitch SG, Dykstra DS, Sullivan JR, Field LR, Wadhwa A. Enhancing foci on breast MRI: Identifying criteria that increase levels of suspicion. Clin Imaging 2022; 84:104-109. [DOI: 10.1016/j.clinimag.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 11/03/2022]
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Abstract
OBJECTIVE. The objective of this study was to determine the outcomes of foci seen on breast MRI and to evaluate imaging features associated with malignancy. MATERIALS AND METHODS. In this institutional review board-approved retrospective study, we reviewed 200 eligible foci in 179 patients that were assigned BI-RADS category of 3 or 4 from December 2004 to August 2018. Clinical and imaging features of all eligible foci were collected, and associations with malignant outcomes were evaluated. Malignancy rates were also calculated. RESULTS. Of 200 eligible foci, 64 were assigned BI-RADS category 3 and 136 were assigned BI-RADS category 4. The malignancy rate was 1.6% (1/64) among BI-RADS 3 foci and 17.6% (24/136) for BI-RADS 4 foci. The majority of malignant foci represented invasive breast cancer (68.0%, 17/25). Focus size and washout kinetics were significantly associated with malignant outcome (p < 0.05). CONCLUSION. Despite the high prevalence of foci on breast MRI, data are limited to guide their management. Foci should not be disregarded, because foci undergoing biopsy had a malignancy rate of 17.6%, with the majority of malignant foci representing invasive cancer. Larger size and washout kinetics were associated with malignancy in our study and should raise the suspicion level for a focus on breast MRI.
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Improved characterization of sub-centimeter enhancing breast masses on MRI with radiomics and machine learning in BRCA mutation carriers. Eur Radiol 2020; 30:6721-6731. [PMID: 32594207 PMCID: PMC7599163 DOI: 10.1007/s00330-020-06991-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/09/2020] [Accepted: 05/28/2020] [Indexed: 01/21/2023]
Abstract
Objectives To investigate whether radiomics features extracted from MRI of BRCA-positive patients with sub-centimeter breast masses can be coupled with machine learning to differentiate benign from malignant lesions using model-free parameter maps. Methods In this retrospective study, BRCA-positive patients who had an MRI from November 2013 to February 2019 that led to a biopsy (BI-RADS 4) or imaging follow-up (BI-RADS 3) for sub-centimeter lesions were included. Two radiologists assessed all lesions independently and in consensus according to BI-RADS. Radiomics features were calculated using open-source CERR software. Univariate analysis and multivariate modeling were performed to identify significant radiomics features and clinical factors to be included in a machine learning model to differentiate malignant from benign lesions. Results Ninety-six BRCA mutation carriers (mean age at biopsy = 45.5 ± 13.5 years) were included. Consensus BI-RADS classification assessment achieved a diagnostic accuracy of 53.4%, sensitivity of 75% (30/40), specificity of 42.1% (32/76), PPV of 40.5% (30/74), and NPV of 76.2% (32/42). The machine learning model combining five parameters (age, lesion location, GLCM-based correlation from the pre-contrast phase, first-order coefficient of variation from the 1st post-contrast phase, and SZM-based gray level variance from the 1st post-contrast phase) achieved a diagnostic accuracy of 81.5%, sensitivity of 63.2% (24/38), specificity of 91.4% (64/70), PPV of 80.0% (24/30), and NPV of 82.1% (64/78). Conclusions Radiomics analysis coupled with machine learning improves the diagnostic accuracy of MRI in characterizing sub-centimeter breast masses as benign or malignant compared with qualitative morphological assessment with BI-RADS classification alone in BRCA mutation carriers. Key Points • Radiomics and machine learning can help differentiate benign from malignant breast masses even if the masses are small and morphological features are benign. • Radiomics and machine learning analysis showed improved diagnostic accuracy, specificity, PPV, and NPV compared with qualitative morphological assessment alone. Electronic supplementary material The online version of this article (10.1007/s00330-020-06991-7) contains supplementary material, which is available to authorized users.
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Onishi N, Sadinski M, Gibbs P, Gallagher KM, Hughes MC, Ko ES, Dashevsky BZ, Shanbhag DD, Fung MM, Hunt TM, Martinez DF, Shukla-Dave A, Morris EA, Sutton EJ. Differentiation between subcentimeter carcinomas and benign lesions using kinetic parameters derived from ultrafast dynamic contrast-enhanced breast MRI. Eur Radiol 2019; 30:756-766. [PMID: 31468162 DOI: 10.1007/s00330-019-06392-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 07/15/2019] [Accepted: 07/24/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study aims to evaluate ultrafast DCE-MRI-derived kinetic parameters that reflect contrast agent inflow effects in differentiating between subcentimeter BI-RADS 4-5 breast carcinomas and benign lesions. METHODS We retrospectively reviewed consecutive 3-T MRI performed from February to October 2017, during which ultrafast DCE-MRI was performed as part of a hybrid clinical protocol with conventional DCE-MRI. In total, 301 female patients with 369 biopsy-proven breast lesions were included. Ultrafast DCE-MRI was acquired continuously over approximately 60 s (temporal resolution, 2.7-7.1 s/phase) starting simultaneously with the start of contrast injection. Four ultrafast DCE-MRI-derived kinetic parameters (maximum slope [MS], contrast enhancement ratio [CER], bolus arrival time [BAT], and initial area under gadolinium contrast agent concentration [IAUGC]) and one conventional DCE-MRI-derived kinetic parameter (signal enhancement ratio [SER]) were calculated for each lesion. Wilcoxon rank sum test or Fisher's exact test was performed to compare kinetic parameters, volume, diameter, age, and BI-RADS morphological descriptors between subcentimeter carcinomas and benign lesions. Univariate/multivariate logistic regression analyses were performed to determine predictive parameters for subcentimeter carcinomas. RESULTS In total, 125 lesions (26 carcinomas and 99 benign lesions) were identified as BI-RADS 4-5 subcentimeter lesions. Subcentimeter carcinomas demonstrated significantly larger MS and SER and shorter BAT than benign lesions (p = 0.0117, 0.0046, and 0.0102, respectively). MS, BAT, and age were determined as significantly predictive for subcentimeter carcinoma (p = 0.0208, 0.0023, and < 0.0001, respectively). CONCLUSIONS Ultrafast DCE-MRI-derived kinetic parameters may be useful in differentiating subcentimeter BI-RADS 4 and 5 carcinomas from benign lesions. KEY POINTS • Ultrafast DCE-MRI can generate kinetic parameters, effectively differentiating breast carcinomas from benign lesions. • Subcentimeter carcinomas demonstrated significantly larger maximum slope and shorter bolus arrival time than benign lesions. • Maximum slope and bolus arrival time contribute to better management of suspicious subcentimeter breast lesions.
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Affiliation(s)
- Natsuko Onishi
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meredith Sadinski
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Gibbs
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine M Gallagher
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary C Hughes
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eun Sook Ko
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brittany Z Dashevsky
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - Theodore M Hunt
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Danny F Martinez
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amita Shukla-Dave
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth J Sutton
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Are Mammographically Occult Additional Tumors Identified More Than 2 Cm Away From the Primary Breast Cancer on MRI Clinically Significant? Acad Radiol 2019; 26:502-507. [PMID: 29891105 DOI: 10.1016/j.acra.2018.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the clinical significance of mammographically occult additional tumors identified more than 2cm away from the primary breast cancer on preoperative magnetic resonance imaging (MRI). MATERIALS AND METHODS An Institutional Review Board approved review of consecutive preoperative breast MRIs performed from 1/1/08 to 12/31/14, yielded 667 patients with breast cancer. These patients underwent further assessment to identify biopsy proven mammographically occult breast tumors located more than 2cm away from the edge of the primary tumor. Additional MRI characteristics of the primary and secondary tumors and pathology were reviewed. Statistical analysis was performed using SPSS (v. 24). RESULTS Of 667 patients with breast cancer, 129 patients had 150 additional ipsilateral mammographically occult tumors that were more than 2cm away from the edge of the primary tumor. One hundred twelve of 129 (86.8%) patients had one additional tumor and 17/129 (13.2%) had two or more additional tumors. In 71/129 (55.0%), additional tumors were located in a different quadrant and in 58/129 (45.0%) additional tumors were in the same quadrant but ≥2cm away. Overall, primary tumor size was significantly larger (mean 1.87± 1.25 cm) than the additional tumors (mean 0.79 ± 0.61cm, p < 0.001). However, in 20/129 (15.5%) the additional tumor was larger and in 26/129 (20.2%) the additional tumor was ≥1cm. The primary tumor was significantly more likely to be invasive (81.4%, 105/129) compared to additional tumors (70%, 105/150, p = 0.03). In 9/129 (7.0%) patients, additional tumors yielded unsuspected invasive cancer orhigher tumor grade. The additional tumor was more likely to be nonmass lesion type (37.3% vs 24% p = 0.02) and focus lesion type (10% vs 0.08%, p < 0.001) compared to primary tumor. CONCLUSION Mammographically occult additional tumors identified more than 2cm away from the primary breast tumor on MRI are unlikely to be surgically treated if undiagnosed and may be clinically significant.
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Papalouka V, Kilburn-Toppin F, Gaskarth M, Gilbert F. MRI-guided breast biopsy: a review of technique, indications, and radiological-pathological correlations. Clin Radiol 2018; 73:908.e17-908.e25. [PMID: 30041954 DOI: 10.1016/j.crad.2018.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
Breast magnetic resonance imaging (MRI) is the technique of choice in detection, local staging, and monitoring of breast cancer; however, breast MRI results in the detection of more indeterminate/suspicious lesions that need to be histopathologically proven to guide patient management than any other breast imaging method. If such abnormalities are not detectable in any of the conventional imaging tools (mammography (MMG) or ultrasound) then an MRI-guided biopsy needs to be performed to obtain a diagnosis. Breast MRI-guided biopsy is a time-consuming and complex procedure that requires specific equipment and experienced, well-trained staff. This review article explores and illustrates the indications, the currently available technologies, and the technique of breast MRI-guided biopsy, and explains the importance of careful imaging review and selection of cases. We correlate the radiological-pathological findings and highlight the impact on patient management in a multidisciplinary setting.
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Affiliation(s)
- V Papalouka
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Kilburn-Toppin
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - M Gaskarth
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
| | - F Gilbert
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK
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Meissnitzer M, Dershaw DD, Feigin K, Bernard-Davila B, Barra F, Morris EA. MRI appearance of invasive subcentimetre breast carcinoma: benign characteristics are common. Br J Radiol 2017; 90:20170102. [PMID: 28452624 DOI: 10.1259/bjr.20170102] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study was undertaken to examine the characteristics of cancers detected at the earliest possible point on MRI and to determine their significance. METHODS This institutional review board-approved Health Insurance Portability and Accountability Act-compliant retrospective study evaluated invasive breast cancers ≤1 cm histologically. MRI was performed within 6 months before diagnosis. Between 1 January 2005 and 31 December 2015, 163 cancers in 161 patients were evaluated. Breast Imaging-Reporting and Data System lesion characteristics were assessed by two radiologists independently. In cases of disagreement, arbitration by a third reader was performed. RESULTS Cancers ≤1 cm became more obviously malignant as they enlarged with regard to shape (p = 0.021), margin (p = 0.0006), internal enhancement (p = 0.0158) and kinetics (p = 0.0001). Cancers ≤5 mm had benign characteristics of circumscribed margins in 71% (71/100), round/oval shape in 67% (67/100) and persistent enhancement in 41% (41/100). High T2 signal was found in 17% (28/62), distributed equally among different sizes (p = 0.3920). In ≤5-mm cancers (59%, 12/29), a comparison study to show interval growth was more often needed to determine the need for biopsy. When interval growth determined biopsy, this was evident within 24 months and cancers remained node negative despite this delay. CONCLUSION Benign characteristics are present in most invasive cancers ≤5 mm. Small cancers on MRI may need to demonstrate growth to determine need for biopsy. Advances in knowledge: MR lesion characteristics may not be helpful in determining whether small lesions on MR are benign or malignant. However, as 97% of cancers in our study showed interval change when a prior MR for comparison was available, new lesions or increasing size should lead to consideration of biopsy.
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Affiliation(s)
- Matthias Meissnitzer
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - D David Dershaw
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kimberly Feigin
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Blanca Bernard-Davila
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Filipe Barra
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Outcomes of Preoperative MRI-Guided Needle Localization of Nonpalpable Mammographically Occult Breast Lesions. AJR Am J Roentgenol 2016; 207:676-84. [PMID: 27275652 DOI: 10.2214/ajr.15.15913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE MRI-guided needle localization allows access to MRI-detected mammographically occult breast lesions that are not amenable to MRI-guided biopsy. The purpose of this study was to examine the safety and outcomes of MRI-guided needle localization. MATERIALS AND METHODS Ninety-nine consecutive breast lesions that underwent preoperative MRI-guided needle localization were identified. Clinical indications for breast MRI, reasons for performing MRI-guided needle localization, and surgical pathology results were recorded. Lesion characteristics, procedure time, and complications were assessed. RESULTS Of 99 lesions, 60 (60.6%) were in a location inaccessible for MRI biopsy, necessitating MRI-guided needle localization. Histologic evaluation revealed 38 (38.4%) carcinomas, 31 (31.3%) high-risk lesions, and 30 (30.3%) benign lesions. Carcinoma was more likely to be found in women with known cancer (31/61 [50.8%]; p = 0.003) than in women undergoing imaging for high-risk screening (2/18 [11.1%]) or problem solving (6/20 [30%]). Masses (p = 0.013) and foci (p < 0.001) were more likely to be malignant than were lesions with nonmass enhancement. Foci were significantly more often malignant compared with all other lesion types (9/10 [90%]; p < 0.001). The mean (± SD) procedure time was 32.9 ± 9.39 minutes. All lesions were occult on specimen radiographs. There were no procedure-related complications. CONCLUSION The positive predictive value of MRI-guided needle localization (38.4%) is comparable to that of mammography- and tomosynthesis-guided localizations and is highest in women with a known diagnosis of cancer. It is highly accurate in targeting small enhancing lesions, thereby improving surgical management. MRI-guided needle localization is a safe, accurate, and time-efficient procedure.
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Clauser P, Cassano E, De Nicolò A, Rotili A, Bonanni B, Bazzocchi M, Zuiani C. Foci on breast magnetic resonance imaging in high-risk women: cancer or not? Radiol Med 2016; 121:611-7. [PMID: 27169908 PMCID: PMC4942496 DOI: 10.1007/s11547-016-0644-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/18/2016] [Indexed: 12/01/2022]
Abstract
Purpose To assess how frequently foci are identified on MRI in high-risk patients, and their association with malignancy, breast density, and background parenchymal enhancement (BPE). Materials and methods In this multicentric study, two readers, in consensus, retrospectively reviewed screening breast MRI of 245 high-risk women, performed between 2009 and 2014. Eligible patients had at least two consecutive screening MRI, and a follow-up of at least 1 year after a lesion was first detected; histology was available for all suspicious findings. Breast density, BPE (both using BI-RADS lexicon), presence, and changes at follow-up for foci were evaluated. Clinical history of the patients was reviewed. Chi-square test was used to define significant correlations. Results 166 women (mean age 43 years), who underwent a median of 4 MRI (range 2–6) during the study period, were included. 68 foci were found in 58 women [34.9 %, 95 % confidence interval (CI) 28.1–42.5 %]. Foci were more frequent in dense breasts (P = 0.079) and with moderate or marked BPE (P < 0.001). During follow-up, two foci increased in size (2.9 %, 95 % CI 0.8–10.1 %) and at biopsy, a cancer was found (1 high-grade ductal carcinoma in situ, 1 tubular carcinoma). Breast cancer was diagnosed in the other three cases, not initially appearing as foci, and it was more frequent in women with dense breasts (P = 0.04); no correlation between cancer and BPE was found (P = 0.145). Conclusions Foci are relatively frequent in screening MRI, and they are usually benign. An increase in size is the most reliable criteria to suspect malignancy.
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Affiliation(s)
- Paola Clauser
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, P.le Santa Maria della misericordia, Udine, 33100, Italia. .,Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Enrico Cassano
- Division of Breast Radiology, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy
| | - Arianna De Nicolò
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, P.le Santa Maria della misericordia, Udine, 33100, Italia.,Radiology Department, APSS-Trento, Via Degasperi 79, 38123, Trento, Italy
| | - Anna Rotili
- Division of Breast Radiology, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy
| | - Massimo Bazzocchi
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, P.le Santa Maria della misericordia, Udine, 33100, Italia
| | - Chiara Zuiani
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, P.le Santa Maria della misericordia, Udine, 33100, Italia
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Chevrier MC, David J, Khoury ME, Lalonde L, Labelle M, Trop I. Breast Biopsies Under Magnetic Resonance Imaging Guidance: Challenges of an Essential but Imperfect Technique. Curr Probl Diagn Radiol 2016; 45:193-204. [DOI: 10.1067/j.cpradiol.2015.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
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Validation des biopsies mammaires sous IRM. Critères de validation guidés par la corrélation radiopathologique. IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Breast MRI-Detected Cystic Apocrine Metaplasia: Imaging Features With Microvessel Analysis and Histologic Correlation. AJR Am J Roentgenol 2015; 204:211-8. [DOI: 10.2214/ajr.14.12869] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ha R, Sung J, Lee C, Comstock C, Wynn R, Morris E. Characteristics and outcome of enhancing foci followed on breast MRI with management implications. Clin Radiol 2014; 69:715-20. [DOI: 10.1016/j.crad.2014.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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Palestrant S, Comstock CE, Moy L. Approach to Breast Magnetic Resonance Imaging Interpretation. Radiol Clin North Am 2014; 52:563-83. [DOI: 10.1016/j.rcl.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Ha R, Comstock CE. Breast magnetic resonance imaging: management of an enhancing focus. Radiol Clin North Am 2014; 52:585-9. [PMID: 24792658 DOI: 10.1016/j.rcl.2014.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An enhancing focus is a commonly encountered type of lesion on breast magnetic resonance (MR) imaging. No set criteria for appropriate management are available. Often management of these lesions depends on the interpreting radiologist, with varying recommendations for biopsy, short-term follow-up, or routine surveillance. This article reviews published studies in order to develop a strategy for the management of enhancing foci identified on breast MR imaging.
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Affiliation(s)
- Richard Ha
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 10th Floor, New York, NY 10032, USA.
| | - Christopher E Comstock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
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Kinner S, Herbrik M, Maderwald S, Umutlu L, Nassenstein K. Preoperative MR-guided wire localization for suspicious breast lesions: Comparison of manual and automated software calculated targeting. Eur J Radiol 2014; 83:e80-3. [DOI: 10.1016/j.ejrad.2013.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/06/2013] [Accepted: 11/13/2013] [Indexed: 12/23/2022]
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Chopier J, Dratwa C, Antoine M, Gonin J, Thomassin Naggara I. Radiopathological correlations: masses, non-masslike enhancements and MRI-guided biopsy. Diagn Interv Imaging 2014; 95:213-25. [PMID: 24456894 DOI: 10.1016/j.diii.2013.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MRI-guided biopsy is a recent interventional breast technique. Validating the procedure poses a new problem because the signal targeted is created by the injection of a paramagnetic contrast agent and is thus transitory. In the first instance, the procedure is validated by the radiologist, who checks that targeting is accurate and inserts a clip at the end of the procedure, and secondly by analysis of the histopathological results, which should be representative of the lesion. The pathologist needs to know the nature of the image, i.e. whether it is of mass or non-masslike enhancement, and its BI-RADS classification. The objective is that the image and the pathological result should concur. If the result is non-specific and benign, a follow-up MRI is required six months later.
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Affiliation(s)
- J Chopier
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France.
| | - C Dratwa
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France
| | - M Antoine
- Histopathology Department, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - J Gonin
- Histopathology Department, hôpital Tenon, 4, rue de Chine, 75020 Paris, France
| | - I Thomassin Naggara
- Radiology Department, hôpital Tenon, 56, avenue Gambetta, 75020 Paris, France
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