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The Mantra about Low Specificity of Breast MRI

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Breast MRI for High-risk Screening

Abstract

Since the introduction of contrast-enhanced breast magnetic resonance imaging (MRI) of the breast, the medical community acknowledged its high sensitivity. On the other hand, breast MRI has been criticized for its supposedly inherently low or at least inferior specificity as compared to mammography and ultrasound. This book chapter analyzes whether this assumption is really true and the reasons which initially led to it. After demonstrating that contrast enhancement is the basis of the high sensitivity of breast MRI, we explain why a number of benign lesions do enhance and can be misinterpreted as false positives, potentially impacting on patient management. An in-depth comparison between a paper published in 1993 showing a specificity of 37% and a paper published in 1994 showing a specificity of 97% is presented as a way to discuss the mantra of a low specificity associated with breast MRI. Factors influencing specificity such as the reference standard used, the indication to the MRI examination (and, therefore, the study population investigated), the technical characteristics of the MRI equipment, and the technical quality of the MRI examination, the reader’s experience, and the diagnostic criteria are discussed. The potential role of diffusion-weighed imaging (DWI) for improving breast MRI specificity is presented.

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Abbreviations

BI-RADS:

Breast Imaging Reporting and Data System

DWI :

Diffusion-weighted imaging

MRI:

Magnetic resonance imaging

US:

Ultrasonography, ultrasound

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Author information

Authors and Affiliations

  1. Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria

    Pascal A. T. Baltzer

  2. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Francesco Sardanelli

  3. Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy

    Francesco Sardanelli

Authors
  1. Pascal A. T. Baltzer
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  2. Francesco Sardanelli
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Corresponding author

Correspondence to Pascal A. T. Baltzer .

Editor information

Editors and Affiliations

  1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Francesco Sardanelli

  2. Department of Cell Biology and Neurosciences Molecular and Cellular Imaging Unit, Istituto Superiore di Sanità (ISS), Rome, Italy

    Franca Podo

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Baltzer, P.A.T., Sardanelli, F. (2020). The Mantra about Low Specificity of Breast MRI. In: Sardanelli, F., Podo, F. (eds) Breast MRI for High-risk Screening. Springer, Cham. https://doi.org/10.1007/978-3-030-41207-4_2

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  • DOI: https://doi.org/10.1007/978-3-030-41207-4_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-41206-7

  • Online ISBN: 978-3-030-41207-4

  • eBook Packages: MedicineMedicine (R0)

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