Added value of abbreviated breast magnetic resonance imaging for assessing suspicious microcalcification on screening mammography-a prospective study

Unveiling the potential of breast MRI: a game changer for BI-RADS 4A microcalcifications

PURPOSE

To assess the diagnostic performance of breast MRI for BI-RADS 4A microcalcifications on mammography and propose a potential clinical pathway to avoid unnecessary biopsies.

METHODS

Bibliometrics analysis of breast MRI and BI-RADS 4 was provided. A retrospective analysis was conducted on 139 women and 142 cases of BI-RADS 4A microcalcifications on mammography from Fudan University Shanghai Cancer Center. The mammographic BI-RADS level and the MRI reports were compared with the final pathological diagnosis.

RESULTS

Much attention has been given to breast MRI and BI-RADS 4 in the literature. However, studies on BI-RADS 4A are limited. Pathological results showed 117 cases (82.4%) were benign lesions, malignant cases of 25 (17.6%) in our study. The positive predictive values (PPV), specificity, sensitivity and negative predictive values (NPV) of MRI were 44.2% (23/52), 75.2% (88/117), 92.0% (23/25), and 97.8% (88/90), respectively. Therefore, 75.2% (88/117) of biopsies for benign lesions could potentially be avoided. There were 2.2% (2/90) malignant lesions missed. Logistic regression indicated that patients who are postmenopausal (HR = 2.655, p = 0.012), have a history of breast cancer (family history) (HR = 2.833, p = 0.029), and exhibit clustered microcalcifications (HR = 2.179, p = 0.046) are more likely to have a higher MRI BI-RADS level.

CONCLUSIONS

Breast MRI has the potential to improve the diagnosis of BI-RADS 4A microcalcifications on mammography. We propose a potential clinical pathway that patients with BI-RADS 4A on mammography who are premenopausal, have no personal history of breast cancer (family history) or have non-clustered distribution of calcifications can undergo MRI to avoid unnecessary biopsies.

A single-institution retrospective evaluation of noninvasive localization for non-palpable breast microcalcification

TECHNIQUE

From January 1, 2018, to December 31, 2021, we localized the breast microcalcification of 40 patients before the surgical excision. We measured the distance between the nipple and the center of the calcification on the CC view and the ML view, respectively. The operation proceeded around the intersection between two lines, slightly larger than the diameter of the microcalcification. We also analyze the pathological findings.

RESULTS

All 40 patients successfully detected calcification by mammograms preoperatively using the method mentioned above. 38 patients have the microcalcification removal within the one-time operation, while the other two underwent an extended lumpectomy. 20 of 40 calcifications (50 %) were malignant and 12(30 %) were precancerous lesions. In the group of women older than 45 years old, the percentages of malignant and atypical hyperplasias are 56.25 % (18/32) and 31.25 % (10/32) respectively.

CONCLUSION

Our non-invasive method of preoperative localization is safe and cost-effective. Furthermore, initial observations suggest that there may be a link between age and malignant microcalcification.

Abbreviated Breast MRI: State of the Art

Abbreviated MRI is an umbrella term, defined as a focused MRI examination tailored to answer a single specific clinical question. For abbreviated breast MRI, this question is: "Is there evidence of breast cancer?" Abbreviated MRI of the breast makes maximum use of the fact that the kinetics of breast cancers and of benign tissue differ most in the very early postcontrast phase; therefore, abbreviated breast MRI focuses on this period. The different published approaches to abbreviated MRI include the following three subtypes: (a) short protocols, consisting of a precontrast and either a single postcontrast acquisition (first postcontrast subtracted [FAST]) or a time-resolved series of postcontrast acquisitions with lower spatial resolution (ultrafast [UF]), obtained during the early postcontrast phase immediately after contrast agent injection; (b) abridged protocols, consisting of FAST or UF acquisitions plus selected additional pulse sequences; and (c) noncontrast protocols, where diffusion-weighted imaging replaces the contrast information. Abbreviated MRI was proposed to increase tolerability of and access to breast MRI as a screening tool. But its widening application now includes follow-up after breast cancer and even diagnostic assessment. This review defines the three subtypes of abbreviated MRI, highlighting the differences between the protocols and their clinical implications and summarizing the respective evidence on diagnostic accuracy and clinical utility.

The value of DCE- MRI of the breast as a diagnostic tool in assessing amorphous calcifications in screening mammography

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.

Radiomics in breast MRI: current progress toward clinical application in the era of artificial intelligence

Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality for breast cancer diagnosis and is widely used clinically. Dynamic contrast-enhanced MRI is the basis for breast MRI, but ultrafast images, T2-weighted images, and diffusion-weighted images are also taken to improve the characteristics of the lesion. Such multiparametric MRI with numerous morphological and functional data poses new challenges to radiologists, and thus, new tools for reliable, reproducible, and high-volume quantitative assessments are warranted. In this context, radiomics, which is an emerging field of research involving the conversion of digital medical images into mineable data for clinical decision-making and outcome prediction, has been gaining ground in oncology. Recent development in artificial intelligence has promoted radiomics studies in various fields including breast cancer treatment and numerous studies have been conducted. However, radiomics has shown a translational gap in clinical practice, and many issues remain to be solved. In this review, we will outline the steps of radiomics workflow and investigate clinical application of radiomics focusing on breast MRI based on published literature, as well as current discussion about limitations and challenges in radiomics.