Is breast MRI helpful in the evaluation of inconclusive mammographic findings?

OBJECTIVE The purpose of this study was to evaluate the usefulness of MRI of the breast in cases in which mammographic or sonographic findings are inconclusive. MATERIALS AND METHODS We retrospectively reviewed images from 115 MRI examinations of the breast performed from 1999 to 2005 for the indication of problem-solving for inconclusive findings on a mammogram. Forty-eight of the 115 women (41.8%) were at high risk. We discerned whether sonography or MRI was used as an adjunctive tool and correlated the findings with those in the pathology database. RESULTS The equivocal findings most frequently leading to MRI were asymmetry and architectural distortion. No suspicious MRI correlate was found in 100 of 115 cases (87%). These cases were found stable at follow-up mammography or MRI after a mean of 34 months. Fifteen enhancing masses (13%) that corresponded to the mammographic abnormality were seen on MR images. All masses identified at MRI were accurately localized for biopsy, and six malignant lesions were identified. Four of six malignant tumors were seen in one mammographic view only; two were seen on second-look ultrasound images. MRI had a sensitivity of 100% and compared with mammography had significantly higher specificity (91.7% vs 80.7%, p = 0.029), positive predictive value (40% vs 8.7%, p = 0.032), and overall accuracy (92.2% vs 78.3%, p = 0.0052). Eighteen incidental lesions (15.7%) were detected at MRI, and all were subsequently found benign. CONCLUSION We found breast MRI to be a useful adjunctive tool when findings at conventional imaging were equivocal. Strict patient selection criteria should be used because of the high frequency of incidental lesions seen on MR images.

[1]  Mark Rosen,et al.  Breast MR imaging: current indications and advanced imaging techniques. , 2010, Radiologic clinics of North America.

[2]  E. Sickles,et al.  Efficacy of step-oblique mammography for confirmation and localization of densities seen on only one standard mammographic view. , 2000, AJR. American journal of roentgenology.

[3]  Elizabeth A. Morris,et al.  Advances in breast imaging: Magnetic resonance imaging , 2006, Current oncology reports.

[4]  F. Sardanelli,et al.  Magnetic resonance imaging of the breast in characterizing positive or uncertain mammographic findings. , 1998, Cancer detection and prevention.

[5]  Findings at mammographic screening on only one standard projection: outcomes analysis. , 1998, Radiology.

[6]  L. Liberman,et al.  Breast imaging reporting and data system (BI-RADS). , 2002, Radiologic clinics of North America.

[7]  J. Leung MR imaging in the evaluation of equivocal clinical and imaging findings of the breast. , 2010, Magnetic resonance imaging clinics of North America.

[8]  M. Schnall,et al.  High-resolution MR imaging of the breast: clinical context. , 1996, Radiographics : a review publication of the Radiological Society of North America, Inc.

[9]  Dimitrios L. Arvanitis,et al.  Characterization of breast lesions with CE-MR multimodal morphological and kinetic analysis: comparison with conventional mammography and high-resolution ultrasound. , 2009, European journal of radiology.

[10]  M. Oudkerk,et al.  Breast Magnetic Resonance Imaging as a Problem‐Solving Modality? , 2009 .

[11]  C D Claussen,et al.  Do mammography, sonography, and MR mammography have a diagnostic benefit compared with mammography and sonography? , 1997, AJR. American journal of roentgenology.

[12]  Wendy B DeMartini,et al.  BI‐RADS MRI Enhancement Characteristics of Ductal Carcinoma In Situ , 2007, The breast journal.

[13]  S H Heywang,et al.  Gd-DTPA enhanced MR imaging of the breast in patients with postoperative scarring and silicon implants. , 1990, Journal of computer assisted tomography.

[14]  D. Vanel The American College of Radiology (ACR) Breast Imaging and Reporting Data System (BI-RADS): a step towards a universal radiological language? , 2007, European journal of radiology.

[15]  Chiara Zuiani,et al.  Contrast-enhanced breast MRI in patients with suspicious microcalcifications on mammography: results of a multicenter trial. , 2006, AJR. American journal of roentgenology.

[16]  Rebecca S Lewis,et al.  Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. , 2004, Radiology.

[17]  I. Tocino,et al.  Clinical usefulness of MR imaging of the breast in the evaluation of the problematic mammogram. , 1999, AJR. American journal of roentgenology.

[18]  Simone Schrading,et al.  MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study , 2007, The Lancet.

[19]  C. Kuhl Current status of breast MR imaging. Part 2. Clinical applications. , 2007, Radiology.

[20]  Robert C. Smith,et al.  Incidental enhancing lesions found on MR imaging of the breast. , 2001, AJR. American journal of roentgenology.

[21]  L. Liberman,et al.  Probably benign lesions at breast magnetic resonance imaging , 2003, Cancer.

[22]  H. Lehr,et al.  Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. , 2003, AJR. American journal of roentgenology.

[23]  R. Schmidt,et al.  Pure ductal carcinoma in situ: kinetic and morphologic MR characteristics compared with mammographic appearance and nuclear grade. , 2007, Radiology.

[24]  R. Gilles,et al.  Assessment of breast cancer recurrence with contrast-enhanced subtraction MR imaging: preliminary results in 26 patients. , 1993, Radiology.

[25]  S. Heywang-Köbrunner,et al.  Contrast-Enhanced MRI of the Breast , 1991 .

[26]  N. Hylton,et al.  Magnetic resonance imaging of the breast prior to biopsy. , 2004, JAMA.

[27]  W. Wells,et al.  What should be done first in the imaging workup of densities seen on only one standard mammographic view: diagnostic mammography or sonography? , 2001, AJR. American journal of roentgenology.

[28]  R. Fimmers,et al.  Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.