Subcategorization of suspicious non-mass-like enhancement lesions(BI-RADS-MRI Category4)

Breast non-mass enhancement lesions on contrast-enhanced mammography: modified breast image reporting and data system classification

AIM

To investigate the utility of contrast-enhanced mammography (CEM) in the differential diagnosis of breast non-mass enhancement (NME) lesions, and to compare the diagnostic performance of BI-RADS for NME lesions in MG, US, MRI, and CEM.

MATERIALS AND METHODS

A total of 120 patients were included from April 2019 to April 2022. The independent enhancement descriptors for malignancy of NME were identified through binary logistic regression analysis. The modified BI-RADS in CEM (mBI-RADS (CEM)) was defined after adjusting the BI-RADS (MG) by independent descriptors. The diagnostic performances of BI-RADS in low-energy image, US, MRI, and CEM were evaluated and compared using receiver operating characteristic (ROC) analysis and DeLong's test.

RESULTS

The enhancement descriptors of enhancement morphological distribution, internal enhancement pattern and time-signal intensity curve were identified as independent risk factors for malignancy (all P≤0.001). For all-group NME analyses, the areas under the curve (AUCs) of mBI-RADS (CEM) were higher than those of BI-RADS (MG) (all P<0.050). For sub-group NME analyses, the AUCs of mBI-RADS (CEM) and BI-RADS (MRI) were higher than those of BI-RADS (MG) and BI-RADS (US) (all P<0.001). While in NME with non-micro-calcification sub-group, the area under the receiver operating characteristics curve of mBI-RADS (CEM) was higher than those of BI-RADS (MRI), both of which were higher than those of BI-RADS (MG) and BI-RADS (US) (all P<0.050).

CONCLUSION

The mBI-RADS (CEM), which integrates morphological and enhancement features, can significantly improve the diagnostic accuracy compared with BI-RADS (MG). Furthermore, the mBI-RADS (CEM) demonstrated specific advantages for NME with micro-calcifications compared with BI-RADS (MRI).

Magnetic resonance imaging features and diagnostic value analysis of non-mass enhancement lesions of the breast

Background

Due to the presence of distinctive morphological features and diverse pathological types, evaluation of breast non-mass enhancement (NME) lesions on magnetic resonance imaging (MRI) is challenging, generating more false-positive results as compared to enhancing mass lesions. Our objective was to identify the MRI features capable of distinguishing between benign and malignant NME lesions in the breast.

Methods

A retrospective analysis was conducted, in which the clinical data and MRI manifestations of 101 NME lesions were examined and confirmed through surgical or biopsy pathology. Statistical analyses, including t tests, Wilcoxon rank-sum tests, χ2 tests, Fisher exact tests, and receiver operating characteristic (ROC) curve analyses, were employed to compare the MRI characteristics and clinical features of benign and malignant NME lesions.

Results

The study included 101 NME lesions from 98 patients (34 benign and 67 malignant). No statistically significant differences were observed in terms of clinical characteristics between the benign and malignant groups. However, there were significant differences in lesion maximum diameter (P=0.003), morphological distribution (P=0.003), internal enhancement patterns (P<0.001), time-intensity curve (TIC) types (P<0.001), early and delayed enhancement rates (P=0.001 and P<0.001, respectively), apparent diffusion coefficient (ADC), and T2 ratio (P=0.02). Notably, the diagnostic efficacy of ADC values was highest for the minimum value within a small region of interest (small ROI), yielding an area under the curve as high as 0.884.

Conclusions

A comprehensive analysis of MRI features indicated their significant value for the differential diagnosis of benign and malignant NME lesions of the breast.

Clinical and Imaging Features Associated With Malignant Focal Nonmass Enhancement on Breast MRI

INTRODUCTION

Focal non-mass enhancement (NME) is a common breast MRI finding with limited data to guide management. This study aimed to assess clinical and imaging features of malignant BI-RADS 4 focal NME.

METHODS

This IRB-approved, retrospective study included breast MRI exams between August 1, 2013 and September 1, 2022 yielding BI-RADS 4 focal NME lesions that underwent core biopsy or excision with available pathology result or demonstrated decrease or resolution during follow-up MRI or at least 2 years of MRI stability.

RESULTS

A total of 296 BI-RADS 4 focal NME lesions in 246 patients were included in the study. The overall malignancy rate of BI-RADS 4 focal NME was 36/296 (12.2%). Focal NME in a patient presenting for evaluation of extent of disease or other diagnostic concern was 5.5 and 3.4 times more likely, respectively, to be malignant compared to focal NME seen on a high-risk screening exam. There was also a significant association between malignancy and focal NME that was brighter than background parenchymal enhancement (BPE) on maximum intensity projection (MIP) images. There was no significant association between malignancy and lesion size, internal enhancement pattern, amount of BPE, amount of fibroglandular tissue, or signal intensity on T2-weighted images.

CONCLUSION

Our study yielded a malignancy rate of 12.2% for BI-RADS 4 focal NME lesions. Indication for MRI and signal intensity compared to BPE on MIP images were features associated with malignancy that may provide guidance on the management for focal NME.

Prognostic Molecular Biomarkers in Breast Cancer Lesions with Non-Mass Enhancement on MR

Clustered ring enhancement (CRE) is a new lexicon for non-mass enhancement (NME) of breast MR in the 5th BIRADS, indicating a high suspicion of malignancy. We wonder if the presence of CRE correlates with expression of prognostic molecular biomarkers of breast cancer. A total of 58 breast lesions, which MRI reported with NME, were collected between July 2013 and December 2018. The patterns of enhancement including CRE were reviewed and the pathological results with expression of molecular biomarkers were collected. The association between MRI NME, pathological, and IHC stain findings were investigated under univariate analysis. A total of 58 breast lesions were pathologically proven to have breast cancer, comprising 31 lesions with CRE and 27 lesions without CRE on breast MRI. The expression of the estrogen receptor (ER) (p = 0.017) and the progesterone receptor (PR) (p = 0.017) was significantly lower in lesions with CRE as compared with those without CRE. The expression of Ki-67 (≥25%) was significantly higher in lesions with CRE (p = 0.046). The lesions with CRE had a lower expression ratio of ER (50.71 ± 45.39% vs. 74.26 ± 33.59%, p = 0.028). Our study indicated that lesions with CRE may possess different features from those without CRE in molecular expression, bearing a more aggressive behavior.

Breast MRI-the Importance of Type II and III Dynamic Curves Evaluation and Framing in BI-RADS 4C and 5 Score

BACKGROUND

Breast Magnetic Resonance Imaging (MRI) offers the highest sensitivity in detecting breast cancer among existing clinical and imaging techniques, making it a crucial component of breast imaging protocols. This study aims to investigate MRI importance in correlation with previous imaging discordant procedures performed as echography and/or mammography to evaluate characteristics and framing in high-risk BI-RADS 4C or 5 categories based on morphological features and kinetic curves of masses found in the breasts of patients from our database.

METHODS

A retrospective study with related statistical analysis was performed on a group of 33 cases, selected from a total of 488 patients who underwent breast MRI examinations at SPAD Imaging International S.R.L. Craiova, between 01.01.2021 and 31.12.2023, aged between 33 and 75 years. In all patients, MRI images parameters were analysed.

RESULTS

In 33 patients, 23 had a single lesion and 10 had multiple lesions, 9 of them in the ipsilateral breast and, as a particularity, one of them, located in the contralateral breast. In 21 of the total patients with multiple or single lesions they had type III curves, which were classified in the BI-RADS 5 category, considering both criteria-morphology and type of curve, where the other previous techniques had not mentioned an increased risk, hence revealing that the situation in a percentage of 63.63 in the case of MRI investigation proved to be clearly superior.

CONCLUSION

Combining both kinetic and morphologic criteria can enhance the diagnostic accuracy of MRI in breast lesion evaluation.