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Wang S, Wang H, Li Y, Lou J, Zou Q, Jiang Y, Wu F, Tang Y, Wang S. The value of DCE- MRI of the breast as a diagnostic tool in assessing amorphous calcifications in screening mammography. Front Oncol 2023; 13:1151500. [PMID: 37182168 PMCID: PMC10166994 DOI: 10.3389/fonc.2023.1151500] [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: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose To evaluate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging in differentiating benign and malignant amorphous calcifications. Methods This study included 193 female patients with 197 suspicious amorphous calcifications detected on screening mammography. The patients' demographics, clinical follow-up, imaging, and pathology outcomes were reviewed, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DCE-MRI were calculated. Results Of 197 lesions (193 patients) included in the study, 50 (25.4%) were histologically proved to be malignant. DCE-MRI based on breast imaging report and diagnosis system (BI-RADS) had a sensitivity of 94.4%, specificity of 85.7%, PPV of 69.1%, and NPV of 97.7% for the detection of malignant amorphous calcifications. Notably, diagnosis solely based on the presence or absence of DCE-MRI enhancement showed the same sensitivity but significantly decreased specificity (44.8%, p < 0.001) and PPV (44.8%, p < 0.001). In patients with a minimal or mild degree of background parenchymal enhancement (BPE), the sensitivity, specificity, PPV, and NPV increased to 100%, 90.6%, 78.6%, and 100%, respectively. However, in patients with a moderate degree of BPE, MRI resulted in three false negatives of ductal carcinoma in situ (DCIS). Overall, the addition of DCE-MRI detected all invasive lesions and could decrease unnecessary biopsy by 65.5%. Conclusion DCE-MRI based on BI-RADS has the potential to improve the diagnosis of suspicious amorphous calcifications and avoid unnecessary biopsy, especially for those with low-degree BPE.
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Affiliation(s)
- Siqi Wang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Radiology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Yang Li
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianjuan Lou
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qigui Zou
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanni Jiang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feiyun Wu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuxia Tang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shouju Wang
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Pöschke P, Wenkel E, Hack CC, Beckmann MW, Uder M, Ohlmeyer S. Low-Risk Women with Suspicious Microcalcifications in Mammography-Can an Additional Breast MRI Reduce the Biopsy Rate? Diagnostics (Basel) 2023; 13:diagnostics13061197. [PMID: 36980504 PMCID: PMC10047574 DOI: 10.3390/diagnostics13061197] [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: 02/23/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In the German Mammography Screening Program, 62% of ductal carcinoma in situ (DCIS) and 38% of invasive breast cancers are associated with microcalcifications (MCs). Vacuum-assisted stereotactic breast biopsies are necessary to distinguish precancerous lesions from benign calcifications because mammographic discrimination is not possible. The aim of this study was to investigate if breast magnetic resonance imaging (MRM) could assist the evaluation of MCs and thus help reduce biopsy rates. METHODS In this IRB-approved study, 58 women (mean age 58 +/- 24 years) with 59 suspicious MC clusters in the MG were eligible for this prospective single-center trial. Additional breast magnetic resonance imaging (MRI) was conducted before biopsy. RESULTS The breast MRI showed a sensitivity of 86%, a specificity of 84%, a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 91% for the differentiation between benign and malignant in these 59 MCs found with MG. Breast MRI in addition to MG could increase the PPV from 36% to 75% compared to MG alone. The MRI examination led to nine additional suspicious classified lesions in the study cohort. A total of 55% (5/9) of them turned out to be malignant. A total of 32 of 59 (54 %) women with suspicious MCs and benign histology were classified as non-suspicious by MRI. CONCLUSION An additionally performed breast MRI could have increased the diagnostic reliability in the assessment of MCs. Further, in our small cohort, a considerable number of malignant lesions without mammographically visible MCs were revealed.
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Affiliation(s)
- Patrik Pöschke
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Universitätsstraße 21-23, 91054 Erlangen, Germany
| | - Evelyn Wenkel
- Radiologie München, Burgstraße 7, 80331 München, Germany
- Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Universitätsstraße 21-23, 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Universitätsstraße 21-23, 91054 Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Sabine Ohlmeyer
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany
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Sun SY, Ding Y, Li Z, Nie L, Liao C, Liu Y, Zhang J, Zhang D. Multiparameter MRI Model With DCE-MRI, DWI, and Synthetic MRI Improves the Diagnostic Performance of BI-RADS 4 Lesions. Front Oncol 2021; 11:699127. [PMID: 34722246 PMCID: PMC8554332 DOI: 10.3389/fonc.2021.699127] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate the value of synthetic magnetic resonance imaging (syMRI), diffusion-weighted imaging (DWI), DCE-MRI, and clinical features in breast imaging–reporting and data system (BI-RADS) 4 lesions, and develop an efficient method to help patients avoid unnecessary biopsy. Methods A total of 75 patients with breast diseases classified as BI-RADS 4 (45 with malignant lesions and 30 with benign lesions) were prospectively enrolled in this study. T1-weighted imaging (T1WI), T2WI, DWI, and syMRI were performed at 3.0 T. Relaxation time (T1 and T2), apparent diffusion coefficient (ADC), conventional MRI features, and clinical features were assessed. “T” represents the relaxation time value of the region of interest pre-contrast scanning, and “T+” represents the value post-contrast scanning. The rate of change in the T value between pre- and post-contrast scanning was represented by ΔT%. Results ΔT1%, T2, ADC, age, body mass index (BMI), menopause, irregular margins, and heterogeneous internal enhancement pattern were significantly associated with a breast cancer diagnosis in the multivariable logistic regression analysis. Based on the above parameters, four models were established: model 1 (BI-RADS model, including all conventional MRI features recommended by BI-RADS lexicon), model 2 (relaxation time model, including ΔT1% and T2), model 3 [multi-parameter (mp)MRI model, including ΔT1%, T2, ADC, margin, and internal enhancement pattern], and model 4 (combined image and clinical model, including ΔT1%, T2, ADC, margin, internal enhancement pattern, age, BMI, and menopausal state). Among these, model 4 has the best diagnostic performance, followed by models 3, 2, and 1. Conclusions The mpMRI model with DCE-MRI, DWI, and syMRI is a robust tool for evaluating the malignancies in BI-RADS 4 lesions. The clinical features could further improve the diagnostic performance of the model.
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Affiliation(s)
- Shi Yun Sun
- Department of Radiology, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
| | - Yingying Ding
- Department of Radiology, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
| | - Zhuolin Li
- Department of Radiology, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
| | - Lisha Nie
- Magnetic Resonance Imaging Research, General Electric Healthcare (China), Beijing, China
| | - Chengde Liao
- Department of Radiology, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
| | - Yifan Liu
- Department of Radiology, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
| | - Jia Zhang
- Department of Radiology, Third People's Hospital of Yunnan Province, Kunming, China
| | - Dongxue Zhang
- Department of Radiology, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
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Gweon HM, Eun NL, Youk JH, Jeong J, Bae SJ, Ahn SG, Kim JA, Son EJ. Added value of abbreviated breast magnetic resonance imaging for assessing suspicious microcalcification on screening mammography-a prospective study. Eur Radiol 2021; 32:815-821. [PMID: 34342691 DOI: 10.1007/s00330-021-08196-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/31/2021] [Accepted: 07/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the added diagnostic value of abbreviated breast magnetic resonance imaging (MRI) for suspicious microcalcifications on screening mammography. METHODS This prospective study included 80 patients with suspicious calcifications on screening mammography who underwent abbreviated MRI before undergoing breast biopsy between August 2017 and September 2020. The abbreviated protocol included one pre-contrast and the first post-contrast T1-weighted series. MRI examinations were interpreted as either positive or negative based on the visibility of any significant enhancement. The positive predictive value (PPV) was compared before and after the MRI. RESULTS Of the 80 suspicious microcalcifications, 33.8% (27/80) were malignant and 66.2% (53/80) were false positives. Abbreviated MRI revealed 33 positive enhancement lesions, and 25 and two lesions showed true-positive and false-negative findings, respectively. Abbreviated MRI increased PPV from 33.8 (27 of 80 cases; 95% CI: 26.2%, 40.8%) to 75.8% (25 of 33 cases; 95% CI: 62.1%, 85.7%). A total of 85% (45 of 53) false-positive diagnoses were reduced after abbreviated MRI assessment. CONCLUSIONS Abbreviated MRI added significant diagnostic value in patients with suspicious microcalcifications on screening mammography, as demonstrated by a significant increase in PPV with a potential reduction in unnecessary biopsy. KEY POINTS • Abbreviated breast magnetic resonance imaging increased the positive predictive value of suspicious microcalcifications on screening mammography from 33.8 (27/80 cases) to 75.8% (25/33 cases) (p < .01). • Abbreviated magnetic resonance imaging helped avoid unnecessary benign biopsies in 85% (45/53 cases) of lesions without missing invasive cancer.
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Affiliation(s)
- Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea
| | - Na Lae Eun
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea.
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MRI as a complementary tool for the assessment of suspicious mammographic calcifications: Does it have a role? Clin Imaging 2021; 74:76-83. [PMID: 33454580 DOI: 10.1016/j.clinimag.2021.01.001] [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: 08/17/2020] [Revised: 11/22/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Mammography remains the standard imaging modality for the identification and characterization of breast calcifications. However, its low specificity results in high biopsy rates in cases of suspicious calcifications. OBJECTIVES To evaluate the diagnostic performance of MRI as an additional tool in the assessment of suspicious mammographic calcifications and to identify the enhancement patterns most related to malignancy. METHODS An observational, prospective, cross-sectional, bi-centre study was conducted including consecutive patients with suspicious calcification groups on mammography (BI-RADS® 4 and 5). Anatomopathological results obtained from biopsies were considered the reference standard, and the patients were followed up for at least two years. MRI examinations were interpreted by two radiologists in consensus. The chi-square test was used to evaluate the correlation between MRI features and histological results. The overall diagnostic performance of MRI for malignancy was calculated. RESULTS 162 female patients were included (mean age, 53 years; range 34-82 years), with 163 mammographic lesions, of which 77 (47.2%) were benign, 64 (39.3%) malignant, and 22 (13.5%) precursor lesions on histopathology. Malignant lesions demonstrated a significantly higher presence of enhancement (56/64; 87.5%) than benign lesions (17/77; 22.1%) (p < 0.001). Non-mass enhancement (NME) was the morphology most related to malignant lesions (38/56; 67.9%). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRI for malignancy were 81.5%, 87.5%, 77.8%, 71.8%, and 90.5%, respectively. CONCLUSION MRI performed as an adjunct tool allows to increase imaging specificity for malignancy in suspicious calcifications, which may contribute to reduce the need for biopsy.
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Taskin F, Kalayci CB, Tuncbilek N, Soydemir E, Kurt N, Kaya H, Aribal E. The value of MRI contrast enhancement in biopsy decision of suspicious mammographic microcalcifications: a prospective multicenter study. Eur Radiol 2020; 31:1718-1726. [PMID: 32939619 DOI: 10.1007/s00330-020-07265-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/23/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the inclusion of breast MRI in radiological assessment of suspicious, isolated microcalcifications detected with mammography. METHODS In this prospective, multicenter study, cases with isolated microcalcifications in screening mammography were examined with dynamic contrast-enhanced MRI (DCE-MRI) before biopsy, and contrast enhancement of the relevant calcification localization was accepted as a positive finding on MRI. Six experienced breast radiologists evaluated the images and performed the biopsies. Imaging findings and histopathological results were recorded. Sensitivity, specificity, NPV, and PPV of breast MRI were calculated and compared with histopathological findings. RESULTS Suspicious microcalcifications, which were detected by screening mammograms of 444 women, were evaluated. Of these, 276 (62.2%) were diagnosed as benign and 168 (37.8%) as malignant. Contrast enhancement was present in microcalcification localization in 325 (73.2%) of the cases. DCE-MRI was positive in all 102 invasive carcinomas and in 58 (87.9%) of 66 DCIS cases. MRI resulted in false negatives in eight DCIS cases; one was high grade and the other seven were low-to-medium grade. The false-negative rate of DCE-MRI was 4.76%. The sensitivity, specificity, PPV, and NPV for DCE-MRI for mammography-detected suspicious microcalcifications were 95.2%, 40.2%, 49.2%, and 93.3%, respectively. CONCLUSIONS In this study, all invasive cancers and all DCIS except eight cases (12.1%) were detected with DCE-MRI. DCE-MRI can be used in the decision-making algorithm to decrease the number of biopsies in mammography-detected suspicious calcifications, with a tradeoff for overlooking a small number of DCIS cases that are of low-to-medium grade. KEY POINTS • All invasive cancer cases and 87.8% of all in situ cancer cases were detected with MRI, showing a low false-negative rate of 4.7%. • Dynamic contrast-enhanced MRI can be used in the decision-making algorithm to decrease the number of biopsies in mammography-detected suspicious calcifications, with a tradeoff for overlooking a small number of DCIS cases that are predominantly low-to-medium grade. • If a decision for biopsy were made based on MRI findings in mammography-detected microcalcifications in this study, biopsy would not be performed to 119 cases (26.8%).
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Affiliation(s)
- Fusun Taskin
- Department of Radiology, Acibadem M.A.A. University School of Medicine, Atakent University Hospital, 34755, Istanbul, Turkey. .,Acibadem M.A.A. University Senology Research Institute, 34457, Sarıyer, Istanbul, Turkey.
| | - Cem Burak Kalayci
- Acibadem M.A.A. University Vocational School of Health Services Department of Diagnostic Radiology, Acibadem M.A.A. University Atakent Hospital, Kucukcekmece, 34303, Istanbul, Turkey
| | - Nermin Tuncbilek
- Department of Radiology, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Efe Soydemir
- Department of Radiology, Pendik Research Training Hospital, Marmara University School of Medicine, Muhsin Yazicioglu Cad 10, Pendik, 34899, Istanbul, Turkey
| | - Nazmi Kurt
- Department of Radiology, Trakya University School of Medicine, 22030, Edirne, Turkey
| | - Handan Kaya
- Department of Pathology, Pendik Research Training Hospital, Marmara University, Muhsin Yazicioglu Cad. No: 10, Pendik, 34899, Istanbul, Turkey
| | - Erkin Aribal
- Department of Radiology, Acibadem M.A.A University School of Medicine, 32, Kayisdagi Cad. Atasehir, Istanbul, Turkey.,Acibadem Altunizade Hospital, Breast Center, Tophanelioglu Cad 13, Altunizade, 34662, Istanbul, Turkey
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Chen S, Guan X, Shu Z, Li Y, Cao W, Dong F, Zhang M, Shao G, Shao F. A New Application of Multimodality Radiomics Improves Diagnostic Accuracy of Nonpalpable Breast Lesions in Patients with Microcalcifications-Only in Mammography. Med Sci Monit 2019; 25:9786-9793. [PMID: 31860635 PMCID: PMC6936317 DOI: 10.12659/msm.918721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to assess a radiomic scheme that combines image features from digital mammography and dynamic contrast-enhanced MRI to improve classification accuracy of nonpalpable breast lesion (NBL) with Breast Imaging-Reporting and Data System (BI-RADS) 3–5 microcalcifications-only in mammography. Material/Methods This retrospective study was approved by the Internal Research Review and Ethical Committee of our hospital. We included 81 patients who underwent a three-dimensional digital breast X-ray wire positioning for local resection between October 2012 and November 2016. All patients underwent breast MRI and mammography before the treatment, and all obtained pathological confirmation. According to the pathological results, 41 patients with benign lesions were assigned to the benign group and 40 patients with malignant lesions were assigned to the malignant group. We used the random forest algorithm to select significant features and to test the single and multimodal classifiers using the Leave-One-Out-Cross-Validation method. An area under the receiver operating characteristic curve was also used to evaluate its discriminating performance. Results The multimodal classifier achieved AUC of 0.903, with a sensitivity of 82.5% and a specificity of 80.48%, which was better than any single modality. Conclusions Multimodal radiomics classification shows promising power in discriminating malignant lesions from benign lesions in NBL patients with BI-RADS 3–5 microcalcifications-only in mammography.
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Affiliation(s)
- Shujun Chen
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Xiaojun Guan
- Department of Radiology, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland)
| | - Yongfeng Li
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Breast Surgery, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Wenming Cao
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Breast Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Department of Breast Oncology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland)
| | - Fei Dong
- Department of Radiology, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Minming Zhang
- Department of Radiology, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Guoliang Shao
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Feng Shao
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Gynecological Oncology, Cancer Hospital of The University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China (mainland).,Department of Gynecological Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
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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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10
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Shimauchi A, Machida Y, Maeda I, Fukuma E, Hoshi K, Tozaki M. Breast MRI as a Problem-solving Study in the Evaluation of BI-RADS Categories 3 and 4 Microcalcifications: Is it Worth Performing? Acad Radiol 2018; 25:288-296. [PMID: 29191685 DOI: 10.1016/j.acra.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/20/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES We aimed to investigate the utility of problem-solving breast magnetic resonance imaging (MRI) for mammographic Breast Imaging Reporting and Data System (BI-RADS) categories 3 and 4 microcalcifications. MATERIALS AND METHODS Between January 1, 2010 and December 31, 2011, 138 women with 146 areas of categories 3 and 4 microcalcifications without sonographic correlates underwent breast MRI and had a stereotactic core biopsy using an 11-gauge needle or follow-up at least for 24 months. Positive predictive value (PPV), negative predictive value, sensitivity, and specificity were calculated on the basis of BI-RADS category, with categories 1-3 being considered benign and categories 4 and 5 being considered malignant. RESULTS Twenty-four cases (16.4%) were malignant (18 ductal carcinoma in situ, 6 invasive). MRI increased PPV and specificity from 43% to 68% and from 80% to 93% (P = .054 and .005) compared to mammography. Within 102 category 3 microcalcifications, 5 carcinomas were assessed correctly as category 4 by MRI. Within 44 category 4 microcalcifications, a correct diagnosis was made by MRI in 77% (34 of 44) as opposed to 43% (19 of 44) by mammography, and 80% (20 of 25) of unnecessary biopsies could have been avoided. Within the 24 carcinomas, 5 were negative at MRI. MRI-negative carcinomas have a significantly higher possibility of being low grade (ductal carcinoma in situ or invasive) (P = .0362). CONCLUSIONS Breast MRI has the potential to improve the diagnosis of category 3 or 4 microcalcifications and could alter indications for biopsy. Breast MRI could help predict the presence or absence of higher-grade carcinoma for category 3 or 4 microcalcifications.
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Affiliation(s)
- Akiko Shimauchi
- Department of Radiology, Kameda Kyobashi Clinic, 3-1-1, Kyobashi, Chuo-ku, Tokyo, Japan.
| | - Youichi Machida
- Department of Radiology, Kameda Kyobashi Clinic, 3-1-1, Kyobashi, Chuo-ku, Tokyo, Japan
| | - Ichiro Maeda
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eisuke Fukuma
- Division of Breast Surgery, Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kazuei Hoshi
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Mitsuhiro Tozaki
- Department of Radiology, Sagara Hospital Affiliated Breast Center, Tenokuchi-cho, Kagoshima, Japan
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Bennani-Baiti B, Dietzel M, Baltzer PA. MRI for the assessment of malignancy in BI-RADS 4 mammographic microcalcifications. PLoS One 2017; 12:e0188679. [PMID: 29190656 PMCID: PMC5708819 DOI: 10.1371/journal.pone.0188679] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose Assess the performance of breast MRI to diagnose breast cancer in BI-RADS 4 microcalcifications detected by mammography. Materials and methods This retrospective, IRB-approved study included 248 consecutive contrast-enhanced breast MRI (1.5T, protocol in accordance with EUSOBI recommendations) performed to further diagnose BI-RADS 4 microcalcifications detected at mammography during a 3-year period. Standard of reference had to be established by histopathology. Routine consensus reading results by two radiologists were dichotomized as positive or negative and compared with the reference standard (benign vs malignant) to calculate diagnostic parameters. Results There were 107 malignant and 141 benign microcalcifications. Malignancy rates were 18.3% (23/126 BI-RADS 4a), 41.7% (25/60 BI-RADS 4b) and 95% (59/62 BI-RADS 4c). There were 103 true-positive, 116 true-negative, 25 false-positive, and 4 false-negative (one invasive cancer, three DCIS; 2 BI-RADS 4c, 1 BI-RADS 4b on mammography) breast MRI findings, effecting a sensitivity, specificity, PPV, and NPV of 96.3% (95%-CI 90.7–99.0%), 82.3% (95%-CI 75.0–88.2%), 80.5% (95%-CI 72.5–87.0%) and 96.7% (95%-CI 91.7–99.1%), respectively. Conclusion MRI is an accurate tool to further diagnose BI-RADS 4a and 4b microcalcifications and may be helpful to avoid unnecessary biopsies in BI-RADS 4a and 4b lesions. BI-RADS 4c microcalcifications should be biopsied irrespective of MRI findings.
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Affiliation(s)
- Barbara Bennani-Baiti
- Department of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria
| | - Matthias Dietzel
- Department of Radiology, University of Erlangen-Nürnberg, Nürnberg, Germany
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital (AKH), Medical University of Vienna, Vienna, Austria
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van Zelst JCM, Mus RDM, Woldringh G, Rutten MJCM, Bult P, Vreemann S, de Jong M, Karssemeijer N, Hoogerbrugge N, Mann RM. Surveillance of Women with the BRCA1 or BRCA2 Mutation by Using Biannual Automated Breast US, MR Imaging, and Mammography. Radiology 2017; 285:376-388. [PMID: 28609204 DOI: 10.1148/radiol.2017161218] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate a multimodal surveillance regimen including yearly full-field digital (FFD) mammography, dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) imaging, and biannual automated breast (AB) ultrasonography (US) in women with BRCA1 and BRCA2 mutations. Materials and Methods This prospective multicenter trial enrolled 296 carriers of the BRCA mutation (153 BRCA1 and 128 BRCA2 carriers, and 15 women with first-degree untested relatives) between September 2010 and November 2012, with follow-up until November 2015. Participants underwent 2 years of intensified surveillance including biannual AB US, and routine yearly DCE MR imaging and FFD mammography. The surveillance performance for each modality and possible combinations were determined. Results Breast cancer was screening-detected in 16 women (age range, 33-58 years). Three interval cancers were detected by self-examination, all in carriers of the BRCA1 mutation under age 43 years. One cancer was detected in a carrier of the BRCA1 mutation with a palpable abnormality in the contralateral breast. One incidental breast cancer was detected in a prophylactic mastectomy specimen. Respectively, sensitivity of DCE MR imaging, FFD mammography, and AB US was 68.1% (14 of 21; 95% confidence interval [CI]: 42.9%, 85.8%), 37.2% (eight of 21; 95% CI: 19.8%, 58.7%), and 32.1% (seven of 21; 95% CI: 16.1%, 53.8%); specificity was 95.0% (643 of 682; 95% CI: 92.7%, 96.5%), 98.1% (638 of 652; 95% CI: 96.7%, 98.9%), and 95.1% (1030 of 1088; 95% CI: 93.5%, 96.3%); cancer detection rate was 2.0% (14 of 702), 1.2% (eight of 671), and 1.0% (seven of 711) per 100 women-years; and positive predictive value was 25.2% (14 of 54), 33.7% (nine of 23), and 9.5% (seven of 68). DCE MR imaging and FFD mammography combined yielded the highest sensitivity of 76.3% (16 of 21; 95% CI: 53.8%, 89.9%) and specificity of 93.6% (643 of 691; 95% CI: 91.3%, 95.3%). AB US did not depict additional cancers. FFD mammography yielded no additional cancers in women younger than 43 years, the mean age at diagnosis. In carriers of the BRCA2 mutation, sensitivity of FFD mammography with DCE MR imaging surveillance was 90.9% (10 of 11; 95% CI: 72.7%, 100%) and 60.0% (six of 10; 95% CI: 30.0%, 90.0%) in carriers of the BRCA1 mutation because of the high interval cancer rate in carriers of the BRCA1 mutation. Conclusion AB US may not be of added value to yearly FFD mammography and DCE MR imaging surveillance of carriers of the BRCA mutation. Study results suggest that carriers of the BRCA mutation younger than 40 years may not benefit from FFD mammography surveillance in addition to DCE MR imaging. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Jan C M van Zelst
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Roel D M Mus
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Gwendolyn Woldringh
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Matthieu J C M Rutten
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Peter Bult
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Suzan Vreemann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Mathijn de Jong
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nico Karssemeijer
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Nicoline Hoogerbrugge
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
| | - Ritse M Mann
- From the Departments of Radiology and Nuclear Medicine (J.C.M.v.Z., R.D.M.M., S.V., N.K., R.M.M.), Human Genetics (G.W., N.H.), and Pathology (P.B.), Radboud University Medical Centre, Route 766, Geert Grooteplein 10, 6525GA Nijmegen, the Netherlands; and Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands (M.J.C.M.R., M.d.J.)
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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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Wilkinson L, Thomas V, Sharma N. Microcalcification on mammography: approaches to interpretation and biopsy. Br J Radiol 2016; 90:20160594. [PMID: 27648482 DOI: 10.1259/bjr.20160594] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This article discusses the significance of microcalcifications on mammography and the changes in technology that have influenced management; it also describes a pragmatic approach to investigation of microcalcification in a UK screening programme.
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Affiliation(s)
- Louise Wilkinson
- 1 Department of Breast Imaging, St Georges Hospital, Tooting, London.,2 Department of Pathology, St Georges Hospital, Tooting, London.,3 Breast Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Val Thomas
- 1 Department of Breast Imaging, St Georges Hospital, Tooting, London.,2 Department of Pathology, St Georges Hospital, Tooting, London.,3 Breast Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Nisha Sharma
- 1 Department of Breast Imaging, St Georges Hospital, Tooting, London.,2 Department of Pathology, St Georges Hospital, Tooting, London.,3 Breast Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Badan GM, Piato S, Roveda D, de Faria Castro Fleury E. Predictive values of BI-RADS(®) magnetic resonance imaging (MRI) in the detection of breast ductal carcinoma in situ (DCIS). Eur J Radiol 2016; 85:1701-1707. [PMID: 27666605 DOI: 10.1016/j.ejrad.2016.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/16/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate BI-RADS indicators in the detection of DCIS by MRI. MATERIALS AND METHODS Prospective observational study that started in 2014 and lasted 24 months. A total of 110 consecutive patients were evaluated, who presented with suspicious or highly suspicious microcalcifications on screening mammography (BI-RADS categories 4 and 5) and underwent stereotactic-guided breast biopsy, having had an MRI scan performed prior to biopsy. RESULTS Altogether, 38 cases were characterized as positive for malignancy, of which 25 were DCIS and 13 were invasive ductal carcinoma cases. MRI had a sensitivity of 96%; specificity of 75.67%; positive predictive value (PPV) for DCIS detection of 57.14%; negative predictive value (NPV) in the detection of DCIS of 98.24%; and an accuracy of 80.80%. CONCLUSION BI-RADS as a tool for the detection of DCIS by MRI is a powerful instrument whose sensitivity was higher when compared to that observed for mammography in the literature. Likewise, the PPV obtained by MRI was higher than that observed in the present study for mammography, and the high NPV obtained on MRI scans can provide early evidence to discourage breast biopsy in selected cases.
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Affiliation(s)
- Gustavo Machado Badan
- Breast Imaging Service of Radiology Depatment-Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
| | - Sebastião Piato
- Mastology Division-Gynecology and Obstetrics Department, Brazil
| | - Décio Roveda
- Breast Imaging Service of Radiology Depatment-Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Eduardo de Faria Castro Fleury
- Breast Imaging Service of Radiology Depatment-Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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Brnic D, Brnic D, Simundic I, Vanjaka Rogosic L, Tadic T. MRI and comparison mammography: a worthy diagnostic alliance for breast microcalcifications? Acta Radiol 2016; 57:413-21. [PMID: 25995311 DOI: 10.1177/0284185115585036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/07/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is a lack of data concerning diagnostic performance of magnetic resonance imaging (MRI) in patients with new or increasing microcalcifications. PURPOSE To evaluate suspicious microcalcifications by using comparison mammography, MRI, and a combination of both methods. MATERIAL AND METHODS Our study group consisted of 55 patients with mammographically detected BI-RADS (Breast Imaging Reporting and Data System) 3-5 microcalcifications for whom comparison mammograms were available. All patients underwent breast MRI before SVAB (stereotactic vacuum-assisted biopsy). Diagnostic performances of comparison mammography and MRI were evaluated, as well as the combination of the respective imaging findings. RESULTS Of the 55 microcalcification cases, 35 showed progression and 20 were stable between interval screenings. The negative predictive value (NPV) of comparison mammography was 100%, whereas the NPV of MRI was 92%. However, the specificity of combination of findings was 97%, significantly higher than the 42% specificity of comparison mammography (P < 0.001). Additionally, the positive predictive value of combination of findings was 93% versus 44% of comparison mammography (P = 0.001). CONCLUSION A biopsy is recommended when MRI positive lesion corresponding the area of new or increasing mammographic microcalcifications is detected. Patients with stable microcalcifications can continue follow-up mammography, regardless of MRI result.
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Affiliation(s)
- Dijana Brnic
- Department of Diagnostic and Interventional Radiology, University Hospital Center Split, Croatia
| | - Darko Brnic
- Department of Internal Medicine, University Hospital Center Split, Croatia
| | - Ivan Simundic
- Department of Diagnostic and Interventional Radiology, University Hospital Center Split, Croatia
| | | | - Tade Tadic
- Department of Diagnostic and Interventional Radiology, University Hospital Center Split, Croatia
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Kaiser CG, Reich C, Dietzel M, Baltzer PAT, Krammer J, Wasser K, Schoenberg SO, Kaiser WA. DCE-MRI of the breast in a stand-alone setting outside a complementary strategy - results of the TK-study. Eur Radiol 2015; 25:1793-800. [PMID: 25577524 DOI: 10.1007/s00330-014-3580-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the accuracy of MRI of the breast (DCE-MRI) in a stand-alone setting with extended indications. MATERIALS AND METHODS According to the inclusion criteria, breast specialists were invited to refer patients to our institution for DCE-MRI. Depending on the MR findings, patients received either a follow-up or biopsy. Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospectively examined. RESULTS Of 1,488 included patients, 393 patients were lost to follow-up, 1,095 patients were evaluated. 124 patients were diagnosed with malignancy by DCE-MRI (76 TP, 48 FP, 971 TN, 0 FN cases). Positive cases were confirmed by histology, negative cases by MR follow-ups or patient questionnaires over the next 5 years in 1,737 cases (sensitivity 100 %; specificity 95.2 %; PPV 61.3 %; NPV 100 %; accuracy 95.5 %). For invasive cancers only (DCIS excluded), the results were 63 TP; 27 FP; 971 TP and 0 FN (sensitivity 100 %; specificity 97.2 %; PPV 70 %; NPV 100 %; accuracy 97.5 %). CONCLUSION The DCE-MRI indications tested imply that negative results in DCE-MRI reliably exclude cancer. The results were achieved in a stand-alone setting (single modality diagnosis). However, these results are strongly dependent on reader experience and adequate technical standards as prerequisites for optimal diagnoses. KEY POINTS • DCE-MRI of the breast has a high accuracy in finding breast cancer. • The set of indications for DCE-MRI of the breast is still very limited. • DCE-MRI can achieve a high accuracy in a 'screening-like' setting. • Accuracy of breast DCE-MRI is strongly dependent on technique and reader experience. • A negative DCE-MRI effectively excludes cancer.
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Affiliation(s)
- Clemens G Kaiser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
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Li E, Li J, Song Y, Xue M, Zhou C. A comparative study of the diagnostic value of contrast-enhanced breast MR imaging and mammography on patients with BI-RADS 3-5 microcalcifications. PLoS One 2014; 9:e111217. [PMID: 25365327 PMCID: PMC4218847 DOI: 10.1371/journal.pone.0111217] [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: 04/13/2014] [Accepted: 09/29/2014] [Indexed: 02/03/2023] Open
Abstract
Objective To retrospectively investigate the diagnostic value of breast MRI in patients with BI-RADS 3–5 microcalcifications in mammography. Methods Eighty-four patients with BI-RADS 3–5 microcalcifications on mammography underwent breast MR exams before surgical biopsy with a hookwire position under mammographic guidance. Two radiologists reviewed each lesion with BI-RADS by consensus. The diagnostic value of mammography and MRI was compared. Results Histopathological examination revealed 49 benign lesions and 42 malignant lesions. In the assessments of mammography, 21 lesions (23.1%) were assigned to category 3, 51 lesions (56.0%) to category 4, and 19 lesions (20.9%) to category 5. The area under the receiver operating characteristic(ROC) curve for mammography and MR assessment was 0.844, and 0.945, respectively (p<0.05). In cases of category 3 microcalcifications, the specificity of mammography and MR was 100%, and 95.2% (p = 1.000), respectively. In cases of category 4 microcalcifications, the specificity, PPV and accuracy of mammography was 0%, 45.1% and 45.1%; whereas those for MR was 82.1% (p<0.05), 80.8% (P = 0.003) and 86.3% (p<0.05). All microcalcifications of category 5 were correctly diagnosed by mammography and MR. Conclusions Breast MRI has the potential to significantly improve the diagnosis of category 4 microcalcifications on mammography. Among mammographic category 4 microcalcifications, about 82% of benign lesions can be degraded to BI-RADS 1∼3 by MRI. However for microcalcifications of category 3 and 5, MR exams do not show significant improvement over mammography.
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Affiliation(s)
- Erni Li
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Li
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Song
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Xue
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunwu Zhou
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
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