Can magnetic resonance imaging obviate the need for biopsy for microcalcifications?

Abstract

Background: Although microcalcifications detected with mammography (MG) are usually biopsied, biopsies cannot be performed in all cases. We sought to determine if magnetic resonance imaging (MRI) findings could indicate whether stereotactic vacuum-assisted biopsy (SVAB) is necessary. Methods:Patients with mammographically detected Breast Imaging-Reporting and Data System (BI-RADS) 3, 4, and 5 microcalcifications were analyzed from April 2012 to September 2014. All patients underwent MRI. All patients with enhancing lesions in the region of the microcalcifications underwent SVAB. Non-enhancing lesions were followed or biopsied, depending on the patient's preferences. MRI findings were classified as either malignant-suspicious or benign-suspicious ("none" or "nonspecific"), and we evaluated the positive predictive value (PPV) and negative predictive value (NPV) of these classifications for predicting malignancy.Results: A total of 87 patients underwent both MRI and SVAB. The NPV of MRI was 100% in the group with no enhancement. In BI-RADS category 3, there were 57 benign-suspicious lesions on MRI, of which eight were malignant (NPV of MRI: 85.0%). Conclusions:It may be possible to omit SVAB for microcalcifications if there is no enhancement on MRI; however, any kind of enhancement indicates the need for biopsy in cases of BI-RADS 3 calcifications on MG.

The value of DCE- MRI of the breast as a diagnostic tool in assessing amorphous calcifications in screening mammography

“…Overall, the addition of DCE-MRI after mammography could decrease 65.5% (129/197) of the biopsy, and the PPV increased from 25.4% to 69.1%, with 3 false negatives of non-high-grade DCIS. Although the diagnostic value of DCE-MRI in mammographic microcalcifications has been investigated in several reports, to the best of our knowledge, no study has specifically analyzed that in the case of suspicious amorphous calcifications ( 1 – 3 , 5 – 7 , 17 – 26 ). We included the largest dataset (n = 197) of suspicious amorphous calcifications to date.…”

“…Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a highly sensitive imaging modality for breast cancer detection, with reported sensitivity up to 100% in patients with suspicious lesions ( 1 – 3 ).However, the diagnostic value of DCE-MRI for suspicious microcalcifications detected by mammography is a topic of debate ( 4 – 9 ),and the current guideline does not recommend downgrading suspicious calcifications based on benign MRI appearance. Recent meta-analyses suggest that the absence of enhancement on DCE-MRI can be used to rule out malignancy for some BI-RADS 4 microcalcifications and avoid unnecessary biopsy ( 10 , 11 ).…”