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Identification of the Benignity and Malignancy of BI-RADS 4 Breast Lesions Based on a Combined Quantitative Model of Dynamic Contrast-Enhanced MRI and Intravoxel Incoherent Motion. Tomography 2022; 8:2676-2686. [PMID: 36412682 PMCID: PMC9680473 DOI: 10.3390/tomography8060223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/20/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to explore whether intravoxel incoherent motion (IVIM) combined with a dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative model can improve the ability to distinguish between benign and malignant BI-RADS 4 breast lesions. We enrolled 100 patients who underwent breast MRI at our institution and extracted the quantitative parameters of lesions with a post-processing workstation. Statistical differences in these parameters between benign and malignant BI-RADS 4 lesions were assessed using a two independent samples t-test or a Mann-Whitney U test. Binary logistic regression analysis was performed to establish five diagnostic models (model_ADC, model_IVIM, model_DCE, model_DCE+ADC, and model_DCE+IVIM). Receiver operating characteristic (ROC) curves, leave-one-out cross-validation, and the Delong test were used to assess and compare the diagnostic performance of these models. The model_DCE+IVIM showed the highest area under the curve (AUC) of 0.903 (95% confidence interval (CI): 0.828-0.953, sensitivity: 87.50%, specificity: 85.00%), which was significantly higher than that of model_ADC (p = 0.014) and model_IVIM (p = 0.033). The model_ADC had the lowest diagnostic performance (AUC = 0.768, 95%CI: 0.672-0.846) but was not significantly different from model_IVIM (p = 0.168). The united quantitative model with DCE-MRI and IVIM could improve the ability to evaluate the malignancy in BI-RADS 4 lesions, and unnecessary breast biopsies may be obviated.
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Kim ES, Cho N, Kim SY, Lee SH, Chang JM, Kim YS, Ha SM, Moon WK. Added value of ultrafast sequence in abbreviated breast MRI surveillance in women with a personal history of breast cancer: A multireader study. Eur J Radiol 2022; 151:110322. [DOI: 10.1016/j.ejrad.2022.110322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022]
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Ong A, Azizi A, Ambinder EB, Oluyemi ET, Harvey SC, Hung J. Image-guided Procedure Versus 2-year Follow-up for a BI-RADS 3 Probably Benign Lesion: A Cost Comparison Analysis. JOURNAL OF BREAST IMAGING 2021; 3:57-63. [PMID: 38424837 DOI: 10.1093/jbi/wbaa087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Perform a comparison between the costs of image-guided breast procedures versus 2-year imaging follow-up for findings classified as BI-RADS assessment category 3-probably benign. METHODS The national payment amount costs at non-facility locations were obtained from the Centers for Medicare and Medicaid Services physician fee schedule for breast imaging-related Current Procedural Terminology codes. Total costs were calculated and compared for management algorithms of 2-year imaging follow-up of a BI-RADS 3 lesion from 2018 through 2019 versus performing an image-guided procedure of the lesion in 2018 after the initial diagnostic imaging. RESULTS Two-year mammographic follow-up of a BI-RADS 3 finding costs $484. This was less than a stereotactic-guided breast biopsy, which cost at least $1055. Two-year follow-up for a probably benign US finding cost $615 compared to $1173 for the least expensive US-guided breast biopsy scenario. For breast MRI, 2-year imaging follow-up cost $1510, which was also less than most MRI-guided breast biopsy scenarios. The one exception in which biopsy costs less than 2-year imaging follow-up was in the setting of an MRI-guided biopsy in the average-risk population without a post-benign biopsy follow-up breast MRI; in this setting, MRI biopsy cost $1235. CONCLUSION In 2018-2019, 2-year imaging follow-up of a BI-RADS 3 finding continues to be less costly than an immediate procedure, except for MRI-guided breast biopsy in the average-risk population without a post-benign biopsy follow-up MRI.
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Affiliation(s)
- Andrew Ong
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Armina Azizi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Emily B Ambinder
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Eniola T Oluyemi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Susan C Harvey
- Hologic, Inc., Department of Breast and Skeletal Health, Danbury, CT
| | - Jessica Hung
- Christiana Care Health System, Department of Radiology, Newark, DE
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Panigrahi B, Harvey SC, Mullen LA, Falomo E, Di Carlo P, Lee B, Myers KS. Characteristics and Outcomes of BI-RADS 3 Lesions on Breast MRI. Clin Breast Cancer 2019; 19:e152-e159. [DOI: 10.1016/j.clbc.2018.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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Lee AY, Joe BN, Price ER. The Predicament of the Probably Benign Breast MRI: Should We Rely on Intuition? Breast J 2017; 23:501-503. [PMID: 28914475 DOI: 10.1111/tbj.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Elissa R Price
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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Usefulness of abbreviated breast MRI screening for women with a history of breast cancer surgery. Breast Cancer Res Treat 2017; 167:495-502. [PMID: 29030785 DOI: 10.1007/s10549-017-4530-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We investigated the usefulness of abbreviated breast MRI (AB-MRI), including fat-suppressed T2-weighted imaging, pre- and postcontrast image acquisition, and subtracted maximum-intensity projection imaging, for the screening of women with a history of breast cancer surgery. METHODS Between October 2014 and March 2016, a total of 799 AB-MRI examinations were performed for 725 women with a history of breast cancer surgery. The image acquisition time was 8.5 min. Screening mammography, ultrasound, and AB-MRI were generally performed around the same time. The cancer detection rate, positive predictive values for recall and biopsy, sensitivity and specificity of screening MRI, and rate of malignancy belonging to each breast imaging reporting and data system (BI-RADS) category were assessed. RESULTS AB-MRI detected 12 malignancies in 12 women (15.0 cancers per 1000 cases). Seven of these 12 malignancies were initially invisible on ultrasound and mammography, although subsequent targeted ultrasound revealed lesions corresponding to the MRI-detected lesions. The positive predictive values for recall and biopsy and sensitivity and specificity values for screening MRI were 12.4, 61.5, 100, and 89.2%, respectively. The rates of malignancies belonging to categories 1, 2, 3, and 4 of the BI-RADS were 0, 0, 4.8, and 57.1%, respectively. CONCLUSIONS The diagnostic performance of screening AB-MRI for women with a history of breast cancer surgery is acceptable, with the advantages of short examination and interpretation times and low costs. Thus, it could be used as a main screening modality that may replace conventional imaging in breast cancer survivors.
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Gweon HM, Cho N, Kim SY, Koo HR, Seo M, Chu A, Son EJ. Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients. Eur Radiol 2017; 27:3211-3216. [PMID: 28083693 DOI: 10.1007/s00330-016-4721-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/23/2016] [Accepted: 12/19/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To retrospectively evaluate characteristics of and determine appropriate follow-up recommendations for BI-RADS category 3 lesions detected in preoperative MRI of breast cancer patients. METHODS BI-RADS category 3 assessments were identified from the breast MRI database for 5,110 consecutive breast cancer patients who had undergone preoperative MRI and surgery. Patient and lesion characteristics, malignancy rate, and interval between lesion detection and cancer diagnosis were analysed. Histopathological results or imaging at or after 2-year follow-up were used as reference standards. RESULTS Of the 626 lesions, morphological features included a single focus in 26.5% (n = 166), multiple foci in 47.1% (n = 295), mass in 21.7% (n = 136) and non-mass enhancement in 4.6% (n = 29). Cancer was found in 0.8% (5/626) at a median interval of 50 months (range, 29-66 months). Malignancy rate according to morphological feature was: 1.8% (3/166) in a single focus, 0.7% (1/136) in mass and 3.4% (1/29) in non-mass enhancement. All detected cancers were stage 0 or IA. CONCLUSIONS Annual follow-up might be adequate for BI-RADS category 3 lesions detected at preoperative MRI because of the 0.8% (5/626) malignancy rate, long interval between lesion detection and cancer diagnosis, and early stage of diagnosed cancers. KEY POINTS • BI-RADS category 3 lesions on preoperative MRI had 0.8% malignancy rate. • All cancer diagnoses from BI-RADS 3 occurred after 24-month follow-up. • Annual follow-up might be adequate for BI-RADS 3 detected on preoperative MRI.
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Affiliation(s)
- Hye Mi Gweon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Soo-Yeon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hye Ryoung Koo
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Mirinae Seo
- Department of Radiology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Ajung Chu
- Department of Radiology, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Boisserie-Lacroix M, Ziadé C, Hurtevent-Labrot G, Ferron S, Brouste V, Lippa N. Is a one-year follow-up an efficient method for better management of MRI BI-RADS® 3 lesions? Breast 2016; 27:1-7. [DOI: 10.1016/j.breast.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022] Open
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Machida Y, Tozaki M, Shimauchi A, Yoshida T. Two Distinct Types of Linear Distribution in Nonmass Enhancement at Breast MR Imaging: Difference in Positive Predictive Value between Linear and Branching Patterns. Radiology 2015; 276:686-94. [DOI: 10.1148/radiol.2015141775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gweon HM, Cho N, Han W, Yi A, Moon HG, Noh DY, Moon WK. Breast MR Imaging Screening in Women with a History of Breast Conservation Therapy. Radiology 2014; 272:366-73. [DOI: 10.1148/radiol.14131893] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lourenco AP, Chung MTM, Mainiero MB. Probably benign breast MRI lesions: frequency, lesion type, and rate of malignancy. J Magn Reson Imaging 2013; 39:789-94. [PMID: 24108546 DOI: 10.1002/jmri.24221] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 04/18/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To determine the frequency, malignancy rate, and imaging characteristics of BI-RADS (Breast Imaging Reporting and Data System) 3 MRI detected lesions. MATERIALS AND METHODS A total of 4370 consecutive contrast-enhanced breast MRI exams from March 1, 2004, to March 1, 2009, were retrospectively reviewed. The study was HIPAA (Health Insurance Portability Accountability Act) compliant and Institutional Review Board approved. The frequency of BI-RADS 3 MRI interpretations and lesion type, as well as malignancy rate at follow-up were calculated. RESULTS There were 348/4370 (8%) BI-RADS 3 exams performed on 345 patients. There were 125 foci (35.9%), 52 non-masslike enhancements (14.9%), and 171 masses (49.1%). There were 207 lesions with biopsy or imaging follow-up of at least 24 months (mean, 32 months; range, 6-77 months) of the BI-RADS 3 lesion. Five of these 207 (2.4%) lesions were found to be malignant. CONCLUSION Rate of malignancy among BI-RADS 3 MRI exams with follow-up was 2.4%. Types of lesions assigned as probably benign were 35.9% foci, 14.9% non-masslike enhancements, and 49.1% masses.
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Affiliation(s)
- Ana P Lourenco
- Alpert Medical School of Brown University, Providence, Rhode Island
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Affiliation(s)
- Jessica W T Leung
- Breast Health Center, California Pacific Medical Center, San Francisco, CA, USA.
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Oliveira TM, Brasileiro Sant'Anna TK, Mauad FM, Elias J, Muglia VF. Breast imaging: is the sonographic descriptor of orientation valid for magnetic resonance imaging? J Magn Reson Imaging 2012; 36:1383-8. [DOI: 10.1002/jmri.23776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/17/2012] [Indexed: 11/07/2022] Open
Affiliation(s)
- Tatiane M.G. Oliveira
- Internal Medicine Department, Imaging and Medical Physics Center, Hospital Clinicas, Ribeirao Preto School of Medicine, University of Sao Paulo, Brazil
| | - Tatiana Kelly Brasileiro Sant'Anna
- Internal Medicine Department, Imaging and Medical Physics Center, Hospital Clinicas, Ribeirao Preto School of Medicine, University of Sao Paulo, Brazil
| | - Fernando M. Mauad
- Internal Medicine Department, Imaging and Medical Physics Center, Hospital Clinicas, Ribeirao Preto School of Medicine, University of Sao Paulo, Brazil
| | - Jorge Elias
- Internal Medicine Department, Imaging and Medical Physics Center, Hospital Clinicas, Ribeirao Preto School of Medicine, University of Sao Paulo, Brazil
| | - Valdair F. Muglia
- Internal Medicine Department, Imaging and Medical Physics Center, Hospital Clinicas, Ribeirao Preto School of Medicine, University of Sao Paulo, Brazil
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Lourenco AP, Chung MTM, Mainiero MB. Utility of targeted sonography in management of probably benign breast lesions identified on magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1033-1040. [PMID: 22733852 DOI: 10.7863/jum.2012.31.7.1033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the utility of targeted sonography in the management of probably benign breast lesions detected on magnetic resonance imaging (MRI). METHODS A total of 4370 consecutive contrast-enhanced breast MRI examinations from March 1, 2004, to March 1, 2009, were retrospectively reviewed. The study was Health Insurance Portability and Accountability Act compliant and Institutional Review Board approved. When targeted sonography was recommended for a Breast Imaging Reporting and Data System (BI-RADS) category 3 examination, results of the sonography and any subsequent breast pathologic examinations were recorded. The frequency of identifying the MRI-detected lesions and the rate at which the BI-RADS category was changed by sonography were calculated for mass and non-mass-like lesions. RESULTS Of the 4370 examinations, 349 (8%) had BI-RADS 3 findings in 346 patients. One hundred eighteen lesions underwent targeted sonography for evaluation of 85 masses and 33 areas of non-mass-like enhancement. Of these 118 lesions, 54 (46%) were seen on sonography. No cancers were detected on sonography in the areas of non-mass-like enhancement. Two of the 85 masses (2.4%) evaluated with targeted sonography had a malignant diagnosis before initiation of follow-up. CONCLUSIONS Selective use of targeted sonography, particularly in masses, may help identify some malignancies before initiating short-interval follow-up for MRI-detected BI-RADS 3 lesions.
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Affiliation(s)
- Ana P Lourenco
- Alpert Medical School, Brown University, Providence, Rhode Island, USA.
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Thomassin-Naggara I, Trop I, Chopier J, David J, Lalonde L, Darai E, Rouzier R, Uzan S. Nonmasslike Enhancement at Breast MR Imaging: The Added Value of Mammography and US for Lesion Categorization. Radiology 2011; 261:69-79. [DOI: 10.1148/radiol.11110190] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leung JW. Utility of Second-Look Ultrasound in the Evaluation of MRI-Detected Breast Lesions. Semin Roentgenol 2011; 46:260-74. [DOI: 10.1053/j.ro.2011.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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