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Huang K, Dufresne M, Baksh M, Nussbaum S, Abbaszadeh Kasbi A, Mohammed A, Advani P, Morozov A, Bagaria S, McLaughlin S, Gabriel E. How Well Does Non-mass Enhancement Correlate With DCIS/Invasive Cancer? Am Surg 2023; 89:5414-5420. [PMID: 36788122 DOI: 10.1177/00031348231156776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Contiguous non-mass enhancement (NME) often coexists with a solid tumor component on MRI, but it can be challenging to predict whether NME represents invasive breast cancer, ductal carcinoma in situ (DCIS), benign disease, or biopsy site reaction. The purpose of this study was to determine the association between the size/extent of NME and the presence of invasive cancer and/or DCIS on final pathology. METHODS This was a single institution retrospective analysis of a prospectively maintained breast cancer registry (2010-2020). Female patients who underwent surgical resection were included if they had a diagnosis of invasive breast cancer (with or without DCIS) and had an MRI showing both a solid mass and contiguous NME. The size of NME on MRI was compared with the size of invasive cancer and/or DCIS on the final pathology. RESULTS From a total of 3443 patients, 225 patients were included. 86.2% had invasive ductal carcinoma (IDC), and 12.0% had invasive lobular carcinoma 76.9% were ER+, 16.4% were HER2+, and 13.3% were triple negative breast cancer (TNBC). 18.7% received neoadjuvant chemotherapy (NCT) of whom 31% achieved a complete radiographic/pathologic response. Pearson correlation coefficients (r) between the size of NME and invasive cancer/DCIS showed a strong and positive correlation of MRI NME with DCIS on pathology in patients without NCT. Subgroup analysis showed the strongest correlations for NME and DCIS among non-white (r = .70) and HER2 + patients (r = .74) who did not receive NCT. CONCLUSIONS Strong correlations between NME and DCIS were found for HER2 + disease and non-white patients, but only modest correlations were found for other patient/disease characteristics. These correlations may impact decisions in surgical approach.
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Affiliation(s)
- Kai Huang
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Maria Dufresne
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mizba Baksh
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Samuel Nussbaum
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Ashary Mohammed
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Pooja Advani
- Department of Hematology/Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrey Morozov
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sanjay Bagaria
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sarah McLaughlin
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Emmanuel Gabriel
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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Motanagh SA, Dwan D, Azizgolshani N, E Muller K, diFlorio-Alexander RM, Marotti JD. Sixteen-Year Institutional Review of Magnetic Resonance Imaging-Guided Breast Biopsies: Trends in Histologic Diagnoses With Radiologic Correlation. Breast Cancer (Auckl) 2023; 17:11782234231215193. [PMID: 38034324 PMCID: PMC10685755 DOI: 10.1177/11782234231215193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Breast magnetic resonance imaging (MRI) is an important imaging tool for the management of breast cancer patients and for screening women at high risk for breast cancer. Objectives To examine long-term trends in the distribution of histologic diagnoses obtained from MRI-guided breast biopsies. Design Retrospective analysis. Methods We retrospectively reviewed the distribution of histologic diagnoses of MRI-guided breast biopsies from 2004 to 2019. All cases underwent central pathology review and lesions were classified based on the most prominent histologic finding present. Magnetic resonance imaging features were extracted from radiology reports when available and correlated with pathology diagnoses. Results Four hundred ninety-four MRI-guided biopsies were performed on 440 patients; overall, 73% of biopsies were benign and 27% were malignant. The annual percentages of benign and malignant diagnoses remained similar throughout the 16-year period. Of the benign entities commonly identified, the percentage of benign papillary and sclerosing lesions detected in the benign biopsies increased significantly (13% in 2004-2011 vs 31% in 2012-2019, P = .03). The mean size of malignant lesions was larger than benign lesions (30.1 mm compared with 14.2 mm, P = .045); otherwise, there were no distinguishing radiologic features between benign and malignant lesions. Conclusion The specificity of breast MRI remained constant over a 16-year period; however, there was a shift in the distribution of benign diagnoses with increased detection and biopsy of benign papillary and sclerosing lesions. Monitoring the distribution of breast MRI biopsy diagnoses over time with radiology-pathology correlation might improve the suboptimal specificity of breast MRI.
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Affiliation(s)
- Samaneh A Motanagh
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Dennis Dwan
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nasim Azizgolshani
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kristen E Muller
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Roberta M diFlorio-Alexander
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jonathan D Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Moreno G, Molina M, Wu R, Sullivan JR, Jorns JM. Unveiling the histopathologic spectrum of MRI-guided breast biopsies: an institutional pathological-radiological correlation. Breast Cancer Res Treat 2021; 187:673-680. [PMID: 34043124 DOI: 10.1007/s10549-021-06251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Breast magnetic resonance imaging (MRI) has high sensitivity but suffers from low specificity, resulting in many benign breast biopsies for MRI-detected lesions. We sought to compare histologic findings between patients who underwent MRI-guided breast biopsy versus biopsy via other imaging modalities as well as to examine features associated with malignancy in the MRI cohort to help inform MRI-biopsy practice. METHODS A 2-year (2018-2019) retrospective review of breast biopsies at our enterprise was conducted. Biopsies were categorized as stereotactic, ultrasound, MRI, or palpation guided. Pathology was categorized as benign (further divided into nine categories), atypical, or malignant (subdivided into in situ and invasive carcinoma). Pathology was compared between biopsy groups. Clinical, pathologic, and imaging features were compared between pathology groups within the MRI cohort. RESULTS 5828 biopsies from 4154 patients were reviewed, including 548 MRI-guided biopsies with stratification of MRI-biopsy pathology as follows: 69% benign, 13.8% atypical, and 17.2% malignant. Among benign MRI biopsies, there was higher frequency of "clustered cysts with papillary apocrine metaplasia" (56/548; 10.2%) and lower rate of fibroadenoma/fibroadenomatous change (55/548; 10%) compared to other modalities (158 or 3% and 1144 or 21.7% of 5280 biopsies, respectively). Multivariate analysis revealed indication of breast cancer (p < .0001), ipsilateral cancer (p < .0001) and rapid initial phase kinetics (p = .017) to remain significantly associated with malignant MRI-biopsy pathology. CONCLUSIONS A concurrent or recent breast cancer diagnosis was most predictive of malignancy on MRI-guided breast biopsy. Combined MRI feature evaluation and radiologic-pathologic concordance activities may allow for prognostic refinement and improved risk stratification.
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Affiliation(s)
- Gustavo Moreno
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Lab Building, Lower Level, Room L69, Milwaukee, WI, 53226, USA
| | - Mariel Molina
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Lab Building, Lower Level, Room L69, Milwaukee, WI, 53226, USA
| | - Ruizhe Wu
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julie R Sullivan
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julie M Jorns
- Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Lab Building, Lower Level, Room L69, Milwaukee, WI, 53226, USA.
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Bartels AK, Fadare O, Hasteh F, Zare SY. Nonmass enhancement lesions of the breast on core needle biopsy: outcomes, frequency of malignancy, and pathologic findings. Hum Pathol 2021; 111:92-97. [PMID: 33722650 DOI: 10.1016/j.humpath.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
Nonmass enhancement (NME) on breast magnetic resonance imaging (MRI) is defined as an area whose internal enhancement characteristics can be distinguished from the normal surrounding breast parenchyma, without an associated mass in the Breast Imaging Reporting and Data System lexicon. In this study, we evaluated the pathologic correlates of NME lesions of the breast identified on MRI at our institution, including the frequency of atypical or malignant lesions in the core needle biopsies (CNBs), performed after such a radiologic finding. A retrospective study was performed on all CNBs performed for NME on breast MRI between 2010 and 2019. A total of 443 biopsies from 411 patients were identified, comprising 5.5% of all CNBs over the study period. The pathologic diagnoses were benign in the majority of the biopsies (68.0%), whereas 11.5% and 20.5% of the cases were atypical and malignant lesions, respectively. Of the malignant cases, 69.2% were ductal carcinoma in situ (DCIS) and 30.8% were invasive carcinomas. The most common invasive cancer was invasive ductal carcinoma (50%), followed by invasive lobular carcinoma (39.3%). NME identified on breast MRI carried a significant (32%) risk of atypia and malignancy in our cohort, which confirms that biopsy evaluation of these lesions is warranted. DCIS was the most commonly identified malignancy. Notably, among invasive cancers, invasive lobular carcinoma was identified at a substantially higher frequency that would be expected for that histotype.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Large-Core Needle
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/pathology
- Female
- Humans
- Magnetic Resonance Imaging
- Middle Aged
- Retrospective Studies
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Affiliation(s)
- Anne K Bartels
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States
| | - Oluwole Fadare
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States
| | - Farnaz Hasteh
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States
| | - Somaye Y Zare
- Department of Pathology, University of California San Diego, La Jolla, CA, 92037, United States.
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Hoda SA, Swistel AJ. "Data! Data! Data!": charting the course for mammary magnetic resonance imaging. Breast J 2014; 20:451-2. [PMID: 25187513 DOI: 10.1111/tbj.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Syed A Hoda
- Department of Pathology, Weill Cornell Medical College, New York
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