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01.09.2020 | Breast

Can Follow-up be Avoided for Probably Benign US Masses with No Enhancement on MRI?

verfasst von: Daly Avendano, Maria Adele Marino, Natsuko Onishi, Doris Leithner, Danny F. Martinez, Peter Gibbs, Maxine Jochelson, Katja Pinker, Elizabeth A. Morris, Elizabeth Jane Sutton

Erschienen in: European Radiology | Ausgabe 2/2021

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Abstract

Objectives

To assess whether no enhancement on pre-treatment MRI can rule out malignancy of additional US mass(es) initially assessed as BI-RADS 3 or 4 in women with newly diagnosed breast cancer.

Methods

This retrospective study included consecutive women from 2010–2018 with newly diagnosed breast cancer; at least one additional breast mass (distinct from index cancer) assigned a BI-RADS 3 or 4 on US; and a bilateral contrast-enhanced breast MRI performed within 90 days of US. All malignant masses were pathologically proven; benign masses were pathologically proven or defined as showing at least 2 years of imaging stability. Incidence of malignant masses and NPV were calculated on a per-patient level using proportions and exact 95% CIs.

Results

In 230 patients with 309 additional masses, 140/309 (45%) masses did not enhance while 169/309 (55%) enhanced on MRI. Of the 140 masses seen in 105 women (mean age, 54 years; range 28–82) with no enhancement on MRI, all had adequate follow-up and 140/140 (100%) were benign, of which 89/140 (63.6%) were pathologically proven and 51/140 (36.4%) demonstrated at least 2 years of imaging stability. Pre-treatment MRI demonstrating no enhancement of US mass correlate(s) had an NPV of 100% (95% CI 96.7–100.0).

Conclusions

All BI-RADS 3 and 4 US masses with a non-enhancing correlate on pre-treatment MRI were benign. The incorporation of MRI, when ordered by the referring physician, may decrease unnecessary follow-up imaging and/or biopsy if the initial US BI-RADS assessment and management recommendation were to be retrospectively updated.

Key Points

• Of 309 BI-RADS 3 or 4 US masses with a corresponding mass on MRI, 140/309 (45%) demonstrated no enhancement whereas 169/309 (55%) demonstrated enhancement

• All masses classified as BI-RADS 3 or 4 on US without enhancement on MRI were benign

• MRI can rule out malignancy in non-enhancing US masses with an NPV of 100%

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Bennani-Baiti B, Bennani-Baiti N, Baltzer PA (2016) Diagnostic performance of breast magnetic resonance imaging in non-calcified equivocal breast findings: results from a systematic review and meta-analysis. PLoS One 11:e0160346CrossRef

Giess CS, Chikarmane SA, Sippo DA, Birdwell RL (2017) Clinical utility of breast MRI in the diagnosis of malignancy after inconclusive or equivocal mammographic diagnostic evaluation. AJR Am J Roentgenol 208:1378–1385CrossRef

Dorrius MD, Pijnappel RM, Sijens PE, van der Weide MC, Oudkerk M (2012) The negative predictive value of breast magnetic resonance imaging in noncalcified BIRADS 3 lesions. Eur J Radiol 81:209–213CrossRef

Riedl CC, Luft N, Bernhart C et al (2015) Triple-modality screening trial for familial breast cancer underlines the importance of magnetic resonance imaging and questions the role of mammography and ultrasound regardless of patient mutation status, age, and breast density. J Clin Oncol 33:1128–1135

Eggertson L (2004) MRIs more accurate than mammograms but expensive. CMAJ 171:840–840CrossRef

Lee KA, Talati N, Oudsema R, Steinberger S, Margolies LR (2018) BI-RADS 3: Current and future use of probably benign. Curr Radiol Rep 6:5CrossRef

Mahoney MC, Gatsonis C, Hanna L, DeMartini WB, Lehman C (2012) Positive predictive value of BI-RADS MR imaging. Radiology 264:51–58CrossRef

Agrawal G, Su MY, Nalcioglu O, Feig SA, Chen JH (2009) Significance of breast lesion descriptors in the ACR BI-RADS MRI lexicon. Cancer 115:1363–1380CrossRef

Lee AY, Ichikawa L, Lee JM et al (2016) Concordance of BI-RADS assessments and management recommendations for breast MRI in community practice. AJR Am J Roentgenol 206:211–216CrossRef

10.

Heywang SH, Hahn D, Schmidt H et al (1986) MR imaging of the breast using gadolinium-DTPA. J Comput Assist Tomogr 10:199–204CrossRef

11.

Kuhl C (2007) The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 244:356–378CrossRef

12.

Marino MA, Helbich T, Baltzer P, Pinker-Domenig K (2018) Multiparametric MRI of the breast: a review. J Magn Reson Imaging 47:301–315CrossRef

13.

Lee JY, Jang M, Kim SM, Yun B, Jang JY, Ahn HS (2018) Preoperative magnetic resonance imaging characteristics of oval circumscribed fast enhancing lesions in patients with newly diagnosed breast cancer. Medicine (Baltimore) 97:e0704CrossRef

14.

Kuhl CK, Klaschik S, Mielcarek P, Gieseke J, Wardelmann E, Schild HH (1999) Do T2-weighted pulse sequences help with the differential diagnosis of enhancing lesions in dynamic breast MRI? J Magn Reson Imaging 9:187–196CrossRef

15.

American College of Radiology (2017) Breast magnetic resonance imaging (MRI) accreditation program requirements

16.

Morris EA, Comstock CE, Lee CH et al (2013) ACR BI-RADS® magnetic resonance imaging. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology

17.

Spick C, Szolar DHM, Preidler KW et al (2018) 3 Tesla breast MR imaging as a problem-solving tool: Diagnostic performance and incidental lesions. PLoS One 13:e0190287CrossRef

18.

Baum F, Fischer U, Vosshenrich R, Grabbe E (2002) Classification of hypervascularized lesions in CE MR imaging of the breast. Eur Radiol 12:1087–1092CrossRef

19.

Taskin F, Polat Y, Erdogdu IH, Turkdogan FT, Ozturk VS, Ozbas S (2018) Problem-solving breast MRI: useful or a source of new problems? Diagn Interv Radiol 24:255–261CrossRef

20.

Folkman J, Merler E, Abernathy C, Williams G (1971) Isolation of a tumor factor responsible for angiogenesis. J Exp Med 133:275–288CrossRef

21.

Heywang SH, Wolf A, Pruss E, Hilbertz T, Eiermann W, Permanetter W (1989) MR imaging of the breast with Gd-DTPA: use and limitations. Radiology 171:95–103CrossRef

22.

Kaiser WA (1994) False-positive results in dynamic MR mammography. Causes, frequency, and methods to avoid. Magn Reson Imaging Clin N Am 2:539–555PubMed

23.

Shimauchi A, Jansen SA, Abe H, Jaskowiak N, Schmidt RA, Newstead GM (2010) Breast cancers not detected at MRI: review of false-negative lesions. AJR Am J Roentgenol 194:1674–1679CrossRef

24.

Schnall MD, Blume J, Bluemke DA et al (2006) Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology 238:42–53CrossRef

25.

Spick C, Szolar DHM, Preidler KW, Tillich M, Reittner P, Baltzer PA (2015) Breast MRI used as a problem-solving tool reliably excludes malignancy. Eur J Radiol 84:61–64CrossRef

26.

Zuley ML, Bandos AI, Abrams GS et al (2019) Contrast enhanced digital mammography (CEDM) helps to safely reduce benign breast biopsies for low to moderately suspicious soft tissue lesions. Acad Radiol. https://doi.org/10.1016/j.acra.2019.07.020

Titel: Can Follow-up be Avoided for Probably Benign US Masses with No Enhancement on MRI?
verfasst von: Daly Avendano
Maria Adele Marino
Natsuko Onishi
Doris Leithner
Danny F. Martinez
Peter Gibbs
Maxine Jochelson
Katja Pinker
Elizabeth A. Morris
Elizabeth Jane Sutton
Publikationsdatum: 01.09.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2021
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07216-7

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Can Follow-up be Avoided for Probably Benign US Masses with No Enhancement on MRI?