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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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Logullo A, Prigenzi K, Nimir C, Franco A, Campos M. Breast microcalcifications: Past, present and future (Review). Mol Clin Oncol 2022; 16:81. [PMID: 35251632 PMCID: PMC8892454 DOI: 10.3892/mco.2022.2514] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
Mammary microcalcifications (MCs) are calcium deposits that are considered as robust markers of breast cancer when identified on mammography. MCs are frequently associated with premalignant and malignant lesions. The aim of the present review was to describe the MC types and associated radiological and pathological aspects in detail, provide insights and approaches to the topic, and describe specific clinical scenarios. The primary MC types are composed of calcium oxalate, hydroxyapatite and hydroxyapatite associated with magnesium. The first type is usually associated with benign conditions, while the others remain primarily associated with malignancy. Radiologically, MCs are classified as benign or suspicious. MCs may represent an active pathological mineralization process rather than a passive process, such as degeneration or necrosis. Practical management of breast specimens requires finely calibrated radiological pathological procedures. Understanding the molecular and structural development of MCs may contribute to breast lesion detection and treatment.
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Affiliation(s)
- Angela Logullo
- Department of Pathology, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo 04023‑062, Brazil
| | - Karla Prigenzi
- Department of Pathology, Femme Laboratories, São Paulo 04004‑030, Brazil
| | - Cristiane Nimir
- Department of Pathology, Femme Laboratories, São Paulo 04004‑030, Brazil
| | - Andreia Franco
- Department of Pathology, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo 04023‑062, Brazil
| | - Mario Campos
- Breast Imaging Service, Femme Laboratories, São Paulo 04004‑030, Brazil
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Knisely AT, Stewart ME, Garcia C, Thomas MH, Modesitt SC, Ring KL. Evaluation of breast screening strategies in a high risk breast and ovarian cancer clinic. Gynecol Oncol Rep 2020; 33:100587. [PMID: 32490124 PMCID: PMC7256456 DOI: 10.1016/j.gore.2020.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 11/16/2022] Open
Abstract
BRCA mutation carriers are more likely to be diagnosed with breast cancer compared to high-risk non-BRCA carriers. MRI was able to effectively identify DCIS in the BRCA population. In BRCA mutation carriers younger than 40, there were no MRI occult cancers found.
Recent data suggest that BRCA mutation carriers younger than 40 may not benefit from mammography in addition to MRI. Our objective was to evaluate screening modalities utilized in a high-risk population. Clinicopathologic data were abstracted for patients followed in a high risk clinic from 2007 to 2017. Descriptive statistics were calculated and associations between categorical variables were evaluated using chi-square tests. 631 women comprised the study population; 496 patients had no known mutation (79%), 128 (20%) had a BRCA mutation, and 7 patients had other deleterious mutations. BRCA mutation carriers were more likely to have cancers diagnosed after mammogram callbacks (p = 0.0046) and biopsies (p = 0.0026) compared to non-BRCA mutation carriers. BRCA mutation carriers were also more likely to have cancers diagnosed after biopsies following screening MRI (p = 0.045). 13 BRCA patients were diagnosed with cancer (average age 51). Of the cancers diagnosed after abnormal MRI, 3 were DCIS; all 3 patients had a normal mammogram 4–6 months prior. In those found after abnormal mammogram (n = 6), follow up MRI was performed in 4 cases; all demonstrated the lesion. Three patients were diagnosed younger than 40, 1 on mammogram and 2 on MRI. The patient diagnosed on mammogram had no prior MRI and the lesion was seen on follow-up MRI. Interval screening MRI identified DCIS in BRCA patients with a previous normal mammogram and cancers diagnosed on mammogram were all identified on follow-up MRI. These findings support further evaluation of MRI alone until age 40 in BRCA mutation carriers.
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Affiliation(s)
- Anne T. Knisely
- Columbia University College of Physicians and Surgeons, United States
- New York Presbyterian Hospital, United States
| | - Martha E. Stewart
- University of Virginia Health System, Division of Gynecologic Oncology, United States
| | - Christine Garcia
- University of Virginia Health System, Division of Gynecologic Oncology, United States
- Kaiser Permanente San Francisco Medical Center, United States
| | - Martha H. Thomas
- University of Virginia Health System, Division of Gynecologic Oncology, United States
| | - Susan C. Modesitt
- University of Virginia Health System, Division of Gynecologic Oncology, United States
| | - Kari L. Ring
- University of Virginia Health System, Division of Gynecologic Oncology, United States
- Corresponding author at: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia Health System, Charlottesville, VA 22903, United States.
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Agreement between dynamic contrast-enhanced magnetic resonance imaging and pathologic tumour size of breast cancer and analysis of the correlation with BI-RADS descriptors. Pol J Radiol 2019; 84:e616-e624. [PMID: 32082460 PMCID: PMC7016361 DOI: 10.5114/pjr.2019.92285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to evaluate magnetic resonance imaging (MRI)-pathology concordance of tumour size in patients with invasive breast carcinoma, with an emphasis on Breast Imaging Reporting and Data System (BI-RADS) descriptors of dynamic contrast-enhanced MRI (DCE-MRI). Material and methods Of patients who had preoperative DCE-MRI, 94 were enrolled. Concordance between MRI and the pathological findings was defined as a difference in tumour size of 5 mm or less. The greatest dimension was measured by two radiologists, and BI-RADS descriptives were described in accordance. The gold standard was chosen as the pathologic assessment. Results Tumour measurements determined by MRI and the pathological reports were not statistically different (2.64 ± 1.16 cm, Wilcaxon Z = –1.853, p = 0.064). Tumour sizes were concordant in 72/94 patients (76.6%). The mean difference between the pathological and MRI tumour sizes was –0.1 cm. MRI overestimated the size of 17/94 tumours (18.1%) and underestimated the size of 5/94 tumours (5.3%). Discordance was associated with larger tumour size. Histologic and molecular type of tumours, patient age, histologic grade, lymphovascular invasion or perineural invasion positivity, fibroglandular volume, background parenchymal enhancement, and being mass or non-mass were not associated with concordance. Irregular margin and heterogenous enhancement in DCE-MRI were associated with discordance in logistic regression analysis (p = 0.035, OR: 4.24; p = 0.021, OR: 4.96). Conclusions Two BI-RADS descriptors of irregular contour and heterogeneous contrast uptake were found to be associated with tumour size discrepancy. This might be attributed to the dynamic and morphologic specialities of tumours primarily rather than tumour biology.
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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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Cohen E, Leung JWT. Problem-Solving MR Imaging for Equivocal Imaging Findings and Indeterminate Clinical Symptoms of the Breast. Magn Reson Imaging Clin N Am 2018; 26:221-233. [PMID: 29622127 DOI: 10.1016/j.mric.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Breast MR imaging is commonly used for high-risk screening and for assessing the extent of disease in patients with newly diagnosed breast cancer, but its utility for assessing suspicious symptoms and equivocal imaging findings is less widely accepted. The authors review current literature and guidelines regarding the use of breast MR imaging for these indications. Overall, problem-solving breast MR imaging is best reserved for pathologic nipple discharge and sonographically occult architectural distortion with limited biopsy options. Further study is necessary to define the role of problem-solving MR imaging for calcifications, mammographic asymmetries, and surgical scarring.
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Affiliation(s)
- Ethan Cohen
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030-4009, USA.
| | - Jessica W T Leung
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030-4009, USA
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Mosier A, Gupta E, Ataya D, Bhatt K, Rim A. Low Compliance in a Health-Conscience Spending Era Likely Helps Obviates the Need for 6 month BI-RADS 3 Breast MRI Follow-up After 1 year. Breast J 2017; 23:504-508. [DOI: 10.1111/tbj.12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Mosier
- Department of Radiology; Cleveland Clinic Foundation Imaging Institute; Cleveland Ohio
| | - Esha Gupta
- Department of Radiology; Cleveland Clinic Foundation Imaging Institute; Cleveland Ohio
| | - Dana Ataya
- Department of Radiology; Cleveland Clinic Foundation Imaging Institute; Cleveland Ohio
| | - Kavita Bhatt
- Department of Radiology; Cleveland Clinic Foundation Imaging Institute; Cleveland Ohio
| | - Alice Rim
- Department of Radiology; Cleveland Clinic Foundation Imaging Institute; Cleveland Ohio
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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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Clinical Utility of Breast MRI in the Diagnosis of Malignancy After Inconclusive or Equivocal Mammographic Diagnostic Evaluation. AJR Am J Roentgenol 2017; 208:1378-1385. [DOI: 10.2214/ajr.16.16751] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Si L, Zhai R, Liu X, Yang K, Wang L, Jiang T. MRI in the differential diagnosis of primary architectural distortion detected by mammography. Diagn Interv Radiol 2017; 22:141-50. [PMID: 26899149 DOI: 10.5152/dir.2016.15017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) values in lesions that manifest with architectural distortion (AD) on mammography. METHODS All full-field digital mammography (FFDM) images obtained between August 2010 and January 2013 were reviewed retrospectively, and 57 lesions showing AD were included in the study. Two independent radiologists reviewed all mammograms and MRI data and recorded lesion characteristics according to the BI-RADS lexicon. The gold standard was histopathologic results from biopsies or surgical excisions and results of the two-year follow-up. Receiver operating characteristic curve analysis was carried out to define the most effective threshold ADC value to differentiate malignant from benign breast lesions. We investigated the sensitivity and specificity of FFDM, DCE-MRI, FFDM+DCE-MRI, and DCE-MRI+ADC. RESULTS Of the 57 lesions analyzed, 28 were malignant and 29 were benign. The most effective threshold for the normalized ADC (nADC) was 0.61 with 93.1% sensitivity and 75.0% specificity. The sensitivity and specificity of DCE-MRI combined with nADC was 92.9% and 79.3%, respectively. DCE-MRI combined with nADC showed the highest specificity and equal sensitivity compared with other modalities, independent of the presentation of calcification. CONCLUSION DCE-MRI combined with nADC values was more reliable than mammography in differentiating the nature of disease manifesting as primary AD on mammography.
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Affiliation(s)
- Lifang Si
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Abstract
Breast MR imaging has increased in popularity over the past 2 decades due to evidence of its high sensitivity for cancer detection. Current clinical MR imaging approaches rely on the use of a dynamic contrast-enhanced acquisition that facilitates morphologic and semiquantitative kinetic assessments of breast lesions. The use of more functional and quantitative parameters holds promise to broaden the utility of MR imaging and improve its specificity. Because of wide variations in approaches for measuring these parameters and the considerable technical challenges, robust multicenter data supporting their routine use are not yet available, limiting current applications of many of these tools to research purposes.
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Affiliation(s)
- Habib Rahbar
- Breast Imaging Section, Department of Radiology, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Avenue East, PO Box 19023, Seattle, WA 98109-1023, USA
| | - Savannah C Partridge
- Breast Imaging Section, Department of Radiology, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Avenue East, PO Box 19023, Seattle, WA 98109-1023, USA.
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Diagnostic Performance of Breast Magnetic Resonance Imaging in Non-Calcified Equivocal Breast Findings: Results from a Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0160346. [PMID: 27482715 PMCID: PMC4970763 DOI: 10.1371/journal.pone.0160346] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/18/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the performance of MRI for diagnosis of breast cancer in non-calcified equivocal breast findings. MATERIALS AND METHODS We performed a systematic review and meta-analysis of peer-reviewed studies in PubMed from 01/01/1986 until 06/15/2015. Eligible were studies applying dynamic contrast-enhanced breast MRI as an adjunct to conventional imaging (mammography, ultrasound) to clarify equivocal findings without microcalcifications. Reference standard for MRI findings had to be established by histopathological sampling or imaging follow-up of at least 12 months. Number of true or false positives and negatives and other characteristics were extracted, and possible bias was determined using the QUADAS-2 applet. Statistical analyses included data pooling and heterogeneity testing. RESULTS Fourteen out of 514 studies comprising 2,316 lesions met our inclusion criteria. Pooled diagnostic parameters were: sensitivity (99%, 95%-CI: 93-100%), specificity (89%, 95%-CI: 85-92%), PPV (56%, 95%-CI: 42-70%) and NPV (100%, 95%-CI: 99-100%). These estimates displayed significant heterogeneity (P<0.001). CONCLUSIONS Breast MRI demonstrates an excellent diagnostic performance in case of non-calcified equivocal breast findings detected in conventional imaging. However, considering the substantial heterogeneity with regard to prevalence of malignancy, problem solving criteria need to be better defined.
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Giess CS, Chikarmane SA, Sippo DA, Birdwell RL. Breast MR Imaging for Equivocal Mammographic Findings: Help or Hindrance? Radiographics 2016; 36:943-56. [PMID: 27284757 DOI: 10.1148/rg.2016150205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Breast magnetic resonance (MR) imaging, because of its extremely high sensitivity in detecting invasive breast cancers, is sometimes used as a diagnostic tool to evaluate equivocal mammographic findings. However, breast MR imaging should never substitute for a complete diagnostic evaluation or for biopsy of suspected, localizable suspicious mammographic lesions, whenever possible. The modality's high cost, in addition to only moderate specificity, mandate that radiologists use it sparingly and with discrimination for problematic mammographic findings. It is rare that the reality or significance of a noncalcified mammographic finding remains equivocal or problematic at diagnostic mammography evaluation, which usually includes targeted ultrasonography (US). There are several reasons for this infrequent occurrence: (a) an asymmetry may persist on diagnostic views but be visible only on craniocaudal or mediolateral oblique projections, precluding three-dimensional localization for US or biopsy, or a lesion may persist on some diagnostic spot views but dissipate or efface on others; (b) uncertainty may exist as to whether apparent change is clinically important or owing to technical factors such as compression or positioning differences; or (c) a lesion may be suspected but biopsy options are limited owing to lack of a US correlate and lesion inaccessibility for stereotactic biopsy, or biopsy of a vague or questionably real lesion has been attempted unsuccessfully. This article will discuss the indications for problem-solving MR imaging for equivocal mammographic findings, present cases illustrating appropriate and inappropriate uses of problem-solving MR imaging, and present false-positive and false-negative cases affecting the specificity of breast MR imaging. (©)RSNA, 2016.
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Affiliation(s)
- Catherine S Giess
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Sona A Chikarmane
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Dorothy A Sippo
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Robyn L Birdwell
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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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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Yamashita Y, Murayama S, Okada M, Watanabe Y, Kataoka M, Kaji Y, Imamura K, Takehara Y, Hayashi H, Ohno K, Awai K, Hirai T, Kojima K, Sakai S, Matsunaga N, Murakami T, Yoshimitsu K, Gabata T, Matsuzaki K, Tohno E, Kawahara Y, Nakayama T, Monzawa S, Takahashi S. The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline. Jpn J Radiol 2015; 34:43-79. [DOI: 10.1007/s11604-015-0499-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Iacconi C, Galman L, Zheng J, Sacchini V, Sutton EJ, Dershaw D, Morris EA. Multicentric Cancer Detected at Breast MR Imaging and Not at Mammography: Important or Not? Radiology 2015; 279:378-84. [PMID: 26605912 DOI: 10.1148/radiol.2015150796] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To review the magnetic resonance (MR) imaging and pathologic features of multicentric cancer detected only at MR imaging and to evaluate its potential biologic value. MATERIALS AND METHODS This retrospective study was institutional review board approved and HIPAA compliant; informed consent was waived. A review of records from 2001 to 2011 yielded 2021 patients with newly diagnosed breast cancer who underwent biopsy after preoperative MR imaging, 285 (14%) of whom had additional cancer detected at MR imaging that was occult at mammography. In 73 patients (3.6%), MR imaging identified 87 cancers in different quadrants than the known index cancer, constituting the basis of this report. In 62 of 73 patients (85%; 95% confidence interval [CI]: 75, 92), one additional cancer was found, and in 11 of 73 (15%; 95% CI: 8, 25), multiple additional cancers were found. A χ(2) test with adjustment for multiple lesions was used to examine whether MR imaging and pathologic features differ between the index lesion and additional multicentric lesions seen only at MR imaging. RESULTS Known index cancers were more likely to be invasive than MR imaging-detected multicentric cancers (88% vs 76%, P = .023). Ductal carcinoma in situ (21 of 87 lesions [24%]; 95% CI: 15, 36) represented a minority of additional MR imaging-detected multicentric cancers. Overall, the size of MR imaging-detected multicentric invasive cancers (median, 0.6 cm; range, 0.1-6.3 cm) was smaller than that of the index cancer (median, 1.2 cm; range, 0.05-7.0 cm; P = .023), although 17 of 73 (23%) (95% CI: 14, 35) patients had larger MR imaging-detected multicentric cancers than the known index lesion, and 18 of 73 (25%) (95% CI: 15, 36) had MR imaging-detected multicentric cancers larger than 1 cm. MR imaging-detected multicentric cancers and index cancers differed in histologic characteristics, invasiveness, and grade in 27 of 73 (37%) patients (95% CI: 26, 49). In four of 73 (5%) patients (95% CI: 2, 13), MR imaging-detected multicentric cancers were potentially more biologically relevant because of the presence of unsuspected invasion or a higher grade. CONCLUSION Multicentric cancer detected only at MR imaging was invasive in 66 of 87 patients (76%), larger than 1 cm in 18 of 73 patients (25%), larger than the known index cancer in 17 of 73 patients (23%), and more biologically important in four of 73 women (5%). An unsuspected additional multicentric cancer seen only at MR imaging is likely clinically relevant disease.
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Affiliation(s)
- Chiara Iacconi
- From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lanie Galman
- From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Junting Zheng
- From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Virgilio Sacchini
- From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Elizabeth J Sutton
- From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY
| | - David Dershaw
- From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Elizabeth A Morris
- From the Breast Unit, USL1 Massa-Carrara, Piazza Monzoni 2, 54033 Carrara, Italy (C.I.); and Departments of Pathology (L.G.), Statistics (J.Z.), Surgery (V.S.), and Radiology (E.J.S., D.D., E.A.M.), Memorial Sloan-Kettering Cancer Center, New York, NY
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Chamming's F, Chopier J, Mathelin C, Chéreau E. [Explorations of breast microcalcifications: Guidelines]. ACTA ACUST UNITED AC 2015; 44:960-9. [PMID: 26527023 DOI: 10.1016/j.jgyn.2015.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess imaging performances for the detection, characterization and biopsy of breast microcalcifications and make recommendations. MATERIALS AND METHODS French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. RESULTS Digital mammography (DR [Direct Radiography] and CR [Computed Radiography]) and screen-film mammography demonstrate good performances for the detection and the characterization of breast microcalcifications. Systematic use of the 2013 edition of the BI-RADS lexicon is recommended for description and characterization of microcalcifications. Faced with BI-RADS 4 or 5 microcalcifications, breast ultrasound is recommended but a normal result does not eliminate the diagnosis of cancer and other examination should be performed. Literature review does not allow recommending digital breast tomosynthesis, elastography or MRI to analyze microcalcifications. In case of probably benign microcalcifications (BI-RADS 3), six months, one year and at least two years follow-up are recommended. In case a biopsy is indicated, it is recommended to use a vacuum-assisted macrobiopsy system with 11-gauges needles or bigger. If no calcification is visible on the radiography of the specimen, it is recommended to obtain additional samples.
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Affiliation(s)
- F Chamming's
- Service de radiologie, hôpital européen George-Pompidou AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - J Chopier
- Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Mathelin
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg, France
| | - E Chéreau
- Service de chirurgie oncologique, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
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Rominger M, Berg D, Frauenfelder T, Ramaswamy A, Timmesfeld N. Which factors influence MRI-pathology concordance of tumour size measurements in breast cancer? Eur Radiol 2015; 26:1457-65. [DOI: 10.1007/s00330-015-3935-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
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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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Oztekin PS, Kosar PN. Magnetic resonance imaging of the breast as a problem-solving method: to be or not to be? Breast J 2014; 20:622-31. [PMID: 25200378 DOI: 10.1111/tbj.12334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The use of dynamic magnetic resonance imaging (MRI) of the breast as a complementary problem-solving tool was explored in a heterogeneous population sample. A total of 3,076 patients that underwent breast MRI examination between January 2008 and June 2012 in our center were screened retrospectively. Of these, 868 met the following inclusion criteria and were considered eligible for the study: available data on clinical signs, symptoms and on the results of mammography and ultrasound examinations in medical records; at least 1 year of follow-up; and documented pathology findings. Lesions with a stable course over a follow-up period of at least 12 months were considered benign. MRI was suggestive of a suspicious abnormality (BI-RADS 4) or highly suggestive of malignancy (BI-RADS 5) in 129 (15%) of 868 patients, leading to a biopsy examination in these cases. On the other hand, MRI findings were considered normal in 739 (85%) subjects based on normal (BI-RADS 1), benign (BI-RADS 2) or probably benign (BI-RADS 3) findings. Of the 129 patients undergoing a histopathologic examination based on MRI findings, 63 were diagnosed with cancer, and in 66, the biopsy proved to be benign. Forty of the 63 patients (40/63) with a diagnosis of malignancy and 34 of the 66 patients (34/66) with a benign diagnosis had been categorized as BI-RADS 4 with conventional methods. A total of 23 patients with BI-RADS category of 0 to 3 according to conventional methods were diagnosed as having cancer with MRI. In six of these, the family history was positive. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of MRI for the detection of cancer were 100%, 92%, 52%, and 100%, respectively. In cases with inconclusive findings on conventional imaging studies or in patients with clinical/radiological suspicion of malignancy, MRI should be more effectively used as a problem-solving approach owing to its high sensitivity and NPV in this condition. Use of MRI as a problem-solving method in such cases may decrease rather than increase unnecessary biopsy procedures and patient anxiety.
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Affiliation(s)
- Pelin Seher Oztekin
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
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21
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Stehouwer BL, Merckel LG, Verkooijen HM, Peters NHGM, Mann RM, Duvivier KM, Mali WPTM, Peeters PHM, Veldhuis WB, van den Bosch MAAJ. 3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography. Eur Radiol 2013; 24:603-9. [DOI: 10.1007/s00330-013-3029-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/30/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
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22
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Quinn EM, Coveney AP, Redmond HP. Use of Magnetic Resonance Imaging in Detection of Breast Cancer Recurrence: A Systematic Review. Ann Surg Oncol 2012; 19:3035-41. [DOI: 10.1245/s10434-012-2341-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Indexed: 11/18/2022]
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Dorrius M, Pijnappel R, Sijens P, van der Weide MJ, Oudkerk M. The negative predictive value of breast Magnetic Resonance Imaging in noncalcified BIRADS 3 lesions. Eur J Radiol 2012; 81:209-13. [DOI: 10.1016/j.ejrad.2010.12.046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/17/2010] [Indexed: 11/28/2022]
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Fiaschetti V, Pistolese CA, Perretta T, Cossu E, Arganini C, Salimbeni C, Scarano AL, Arduini S, Simonetti G. 3-5 BI-RADs Microcalcifications: Correlation between MRI and Histological Findings. ISRN ONCOLOGY 2011; 2011:643890. [PMID: 22084735 PMCID: PMC3200091 DOI: 10.5402/2011/643890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 05/12/2011] [Indexed: 12/03/2022]
Abstract
Purpose. To evaluate the correlation between MRI and histopathological findings in patients with mammographically detected 3–5 BI-RAD (Breast Imaging Reporting And Data Systems) microcalcifications and to allow a better surgical planning.
Materials and Method. 62 female Patients (age 50 ± 12) with screening detected 3–5 BI-RAD microcalcifications underwent dynamic 3 T contrast-enhanced breast MRI. After 30-day (range 24–36 days) period, 55 Patients underwent biopsy using stereotactic vacuum-assisted biopsy (VAB), 5 Patients underwent stereotactic mammographically guided biopsy, and 2 Patients underwent MRI-guided VAB. Results. Microhistology examination demonstrated 36 malignant lesions and 26 benign lesions. The analysis of MRI findings identified 8 cases of MRI BI-RADS 5, 23 cases of MRI BI-RADS 4, 11 cases of MRI BI-RADS 3, 4 cases type A and 7 cases type B, and 20 cases of MRI BI-RADS 1-2. MRI sensitivity, specificity, positive predictive value, and negative predictive value were 88.8%, 76.9%, 84.2%, and 83.3%, respectively.
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Affiliation(s)
- Valeria Fiaschetti
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Yau EJ, Gutierrez RL, DeMartini WB, Eby PR, Peacock S, Lehman CD. The Utility of Breast MRI as a Problem-Solving Tool. Breast J 2011; 17:273-80. [DOI: 10.1111/j.1524-4741.2011.01075.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Indications for breast MRI: self-assessment module. AJR Am J Roentgenol 2011; 196:S29-33. [PMID: 21343533 DOI: 10.2214/ajr.10.7291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of breast MRI.
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27
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28
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Medeiros LR, Duarte CS, Rosa DD, Edelweiss MI, Edelweiss M, Silva FR, Winnnikow EP, Simões Pires PD, Rosa MI. Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis. Breast Cancer Res Treat 2011; 126:273-85. [PMID: 21221772 DOI: 10.1007/s10549-010-1326-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/20/2010] [Indexed: 12/21/2022]
Abstract
Dynamic contrast-enhanced breast magnetic resonance (MR) is a promising emerging technique for evaluating breast lesions. A quantitative systematic review was performed to estimate the accuracy of breast MR in the diagnosis of high-risk breast lesions and breast cancer. A comprehensive search of the Cochrane Library, MEDLINE, CANCERLIT, LILACS, and EMBASE databases was performed from January 1985 to August 2010. The medical subjects heading (MeSH) and text words for the terms "breast neoplasm", "breast lesions", "breast cancer" and "magnetic resonance" were combined with the MeSH term diagnosis ("sensitivity and specificity"). Studies that compared breast MR with paraffin-embedded sections parameters for the diagnosis of breast lesions (benign, high-risk borderline, and breast cancer) were included. Sixty-nine studies were analyzed, which included 9,298 women with 9,884 breast lesions. Interrater overall agreement between breast MR and paraffin section diagnosis was 79% (κ = 0.55), indicating moderate agreement. Pooled sensitivity and specificity were 90% [95% CI 88-92%] and 75% [95% CI 70-79%], respectively. The pooled likelihood positive ratio was 3.64 (95% CI 3.0-4.2) and the negative ratio was 0.12 (95% CI 0.09-0.15). For breast cancer or high-risk lesions versus benign lesions, the AUC was 0.91 for breast MR and the point Q* was 0.84. In summary, breast MR is a useful pre-operative test for predicting the diagnosis of breast lesions.
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Affiliation(s)
- Lidia Rosi Medeiros
- Postgraduate Program in Medicine, Medical Sciences at Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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29
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Dorrius MD, Pijnappel RM, Jansen-van der Weide MC, Oudkerk M. Breast magnetic resonance imaging as a problem-solving modality in mammographic BI-RADS 3 lesions. Cancer Imaging 2010; 10 Spec no A:S54-8. [PMID: 20880790 PMCID: PMC2967149 DOI: 10.1102/1470-7330.2010.9020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The probability of a mammographic Breast Imaging Reporting and Data System (BI-RADS) 3 lesion being cancer is considered to be less than 2%. Therefore, the work-up of a mammographic BI-RADS 3 lesion should be biopsy or follow-up mammography after 6 months. However, most patients referred for biopsy have benign disease. Although the negative predictive value (NPV) of magnetic resonance imaging (MRI) is highest of all imaging techniques, it is not yet common practice to use breast MRI as a problem-solving modality to exclude patients for further diagnostic work-up. Therefore, in this meta-analysis the usefulness of breast MRI as a problem-solving modality in mammographic BI-RADS 3 lesions is investigated. After a systematic search only 5 out of 61 studies met the inclusion criteria. The NPV in 2 of those studies was reported to be 100%. It was concluded that MRI can be used as an adjunctive tool to mammographic BI-RADS 3 findings to exclude patients for further diagnostic work-up. The other 3 studies assessed the accuracy of MRI in mammographic BI-RADS 3 microcalcifications. These studies reported an NPV of MRI between 76% and 97%. Therefore, MRI cannot be implemented as a diagnostic tool to evaluate mammographic microcalcifications at this time. The first solid data indicate that breast MRI might be useful as a problem-solving modality to exclude patients with non-calcified mammographic BI-RADS 3 lesions for further diagnostic work-up. However, further research is needed to verify these results.
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Affiliation(s)
- M D Dorrius
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
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30
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Leung JWT. MR imaging in the evaluation of equivocal clinical and imaging findings of the breast. Magn Reson Imaging Clin N Am 2010; 18:295-308, ix-x. [PMID: 20494313 DOI: 10.1016/j.mric.2010.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of its high negative predictive value in excluding breast cancer, magnetic resonance (MR) imaging plays a role in the evaluation of selected clinical and imaging findings of the breast, especially when biopsy is not technically feasible. Case selection is very important in ensuring the efficacy of this use of MR imaging because of potential false-positive and (albeit less likely) false-negative results. This article examines the clinical scenarios and imaging findings in which MR imaging is contributory to patient management after conventional workup with equivocal results.
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Affiliation(s)
- Jessica W T Leung
- Breast Health Center, California Pacific Medical Center, 3698 California Street, 2nd Floor, San Francisco, CA 94118, USA.
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31
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Schouten van der Velden AP, Schlooz-Vries MS, Boetes C, Wobbes T. Magnetic resonance imaging of ductal carcinoma in situ: what is its clinical application? A review. Am J Surg 2009; 198:262-9. [PMID: 19375068 DOI: 10.1016/j.amjsurg.2009.01.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 01/20/2009] [Accepted: 01/20/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND After breast-conserving surgery of ductal carcinoma in situ (DCIS) of the breast or invasive breast carcinoma with an extensive intraductal component, tumor-positive surgical margins are frequently found. Therefore, the extent of the intraductal disease needs to be accurately determined preoperatively. METHODS Data for this review were identified by search of PubMed. Reference lists of selected articles were cross-searched for additional literature. RESULTS DCIS is accurately detected with magnetic resonance imaging (MRI), but the typical malignant features are inconsistently seen and most often in high-grade DCIS or in DCIS with a small invasive component. The histopathologic extent of DCIS is more accurately demonstrated with MRI. However, overestimation due to benign proliferative lesions does frequently occur. An improved depiction of DCIS could lead to improved preoperative staging. Conversely, the identification of more extensive disease on MRI could give rise to unnecessary interventions. Therefore, MRI should be used carefully and preferable in specialized and experienced centers. CONCLUSION [corrected] To date, there is no evidence that the use of MRI improves outcomes (ie, decreases recurrence rates) in patients with DCIS.
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Contrast-enhanced breast MR imaging of claustrophobic or oversized patients using an open low-field magnet. Radiol Med 2009; 114:267-85. [DOI: 10.1007/s11547-008-0358-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Accepted: 08/07/2008] [Indexed: 11/27/2022]
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DeMartini W, Lehman C. A review of current evidence-based clinical applications for breast magnetic resonance imaging. Top Magn Reson Imaging 2008; 19:143-150. [PMID: 18941394 DOI: 10.1097/rmr.0b013e31818a40a5] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Magnetic resonance imaging (MRI) is an important new tool for imaging of the breast. MRI has now been demonstrated to be the most sensitive imaging method for detecting breast carcinoma, allowing depiction of cancers that are occult on mammography, ultrasound, and clinical breast examination. This is tempered by imperfect specificity due to overlap in the features of benign and malignant lesions, and by higher examination cost and more limited availability compared to other breast imaging tests. This article describes the current evidence-based clinical indications for use of breast MRI. Specifically, MRI has been shown to be advantageous for cancer assessment for screening patients at high risk, evaluating patients with a new breast cancer diagnosis, monitoring patients undergoing neoadjuvant chemotherapy, and evaluating patients with metastatic axillary adenocarcinoma and unknown primary site. This tool has also been shown to be useful for the evaluation of silicone breast implant integrity. Employment of breast MRI as a problem solving technique for equivocal mammographic or clinical findings is controversial. For each of these clinical applications, the evidence regarding the diagnostic accuracy of breast MRI will be reviewed. An understanding of the current evidence will facilitate the most appropriate utilization of this important medical resource.
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Affiliation(s)
- Wendy DeMartini
- University of Washington Medical Center, Seattle Cancer Care Alliance, Seattle, WA 98109-1023, USA.
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