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30.01.2020 | Breast

Can breast MRI accurately exclude malignancy in mammographic architectural distortion?

verfasst von: Yoav Amitai, Anabel Scaranelo, Tehillah S. Menes, Rachel Fleming, Supriya Kulkarni, Sandeep Ghai, Vivianne Freitas

Erschienen in: European Radiology | Ausgabe 5/2020

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Abstract

Objectives

To investigate the diagnostic accuracy of problem-solving breast magnetic resonance imaging (MRI) in excluding malignancy in a cohort of patients diagnosed with mammographic architectural distortion (MAD).

Methods

The Institutional Review Board approved the study. Imaging database with 40,245 breast MRIs done between January 2008 and September 2018 was retrospectively reviewed. The study included all exams considered problem-solving MRI for MAD. Two radiologists reviewed the imaging data. Outcome was determined by the pathology results of biopsy/surgical excision or at least 1 year of clinical and radiological follow-up. Predictors for malignancy were examined, and appropriate statistical tests were applied.

Results

One hundred seventy-five patients (median age 53 years) fulfilled the inclusion criteria and formed the study cohort. No cancers were diagnosed in 106 patients with a negative MRI. Out of 69 women with positive MRI findings, 48 (70%) had benign outcome defined either by pathology result or by negative follow-up, and 21 (30%) yielded malignancy. Malignancy was significantly associated with positive MRI (p < 0.001) and older age (p = 0.014). Falsely positive MRIs were frequently found in women with radial scars. The sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy of breast MRI were 100% (95% CI 84 to 100%), 68% (CI 61 to 76%), 100% (CI 95 to 100%), 30% (CI 26 to 36%), and 73% (95% CI 66–79), respectively.

Conclusion

A negative breast MRI in patients with MAD was reliable in excluding malignancy in this cohort and may have a role as a precision medicine tool for avoiding unnecessary interventions.

Key Points

• MRI shows a high negative predictive value in MAD cases.

• MRI displays low accuracy in differentiating malignancy from RS.

• MRI is a reliable non-invasive method to exclude malignancy in women with mammographic architectural distortion, potentially avoiding unnecessary biopsies and surgeries.

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Titel: Can breast MRI accurately exclude malignancy in mammographic architectural distortion?
verfasst von: Yoav Amitai
Anabel Scaranelo
Tehillah S. Menes
Rachel Fleming
Supriya Kulkarni
Sandeep Ghai
Vivianne Freitas
Publikationsdatum: 30.01.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 5/2020
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06586-x

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Can breast MRI accurately exclude malignancy in mammographic architectural distortion?