Clumped vs non-clumped internal enhancement patterns in linear non-mass enhancement on breast MRI

Chen, Shu-Tian; Covelli, James; Okamoto, Satoko; Daniel, Bruce L.; DeMartini, Wendy B.; Ikeda, Debra M.

doi:10.1259/bjr.20201166

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…We also excluded patients when the NME features were described as associated findings, which explains the PPV difference from other studies that included NME as primary and associated findings. [25][26][27] Our results show the features of the breast NME lesions in asymptomatic patients referred for screening MRI. We observed the high potential risk for malignancy in the clustered-ring enhancement, followed by the clumped pattern.…”

Section: Discussionmentioning

confidence: 53%

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Management of Non-Mass Enhancement at Breast Magnetic Resonance in Screening Settings Referred for Magnetic Resonance-Guided Biopsy

Fleury

Castro²,

Amaral³

et al. 2022

Breast Cancer�(Auckl)

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Rationale and Objectives: According to the Breast Imaging and Reporting Data System (BI-RADS), one of the main limitations of MRI is diagnosing the non-mass enhancement (NME). The NME lesion is challenging since it is unique to the MRI lexicon. This study aims to report our experience with NME lesions diagnosed by MRI referred for MRI-guided biopsies and discuss the management and follow-up of these lesions. Materials and Methods: We retrospectively evaluated all MRI-guide breast biopsies. We included all patients referred for NME breast MRI-guided biopsy in screening settings. All patients had a negative second-look mammography or ultrasonography. We correlated the distribution and internal enhancement pattern (IEP) of the NME lesions with histology. Invasive ductal carcinomas (IDC) of no special type and ductal carcinoma in situ (DCIS) were considered malignant lesions. Results: From January-2018 to July-2021, we included 96 women with a total of 96 lesions in the study. There were 90 benign and 6 malignant lesions with DCIS prevalence (5/6 cancers). The most frequent benign lesion type was fibrocystic changes. There were no NME lesions with diffuse or multiple area distribution features referred to MRI-guided biopsy. The positive-predictive values (PPV) were respectively 0.0%, 2.5%, 9.0%, and 11.0% for linear, focal, regional, and segmental distribution describers, and 0.0, 3.0%, 7.9%, and 50% for homogenous, heterogeneous, clumped, and clustered-ring enhancement patterns. Conclusion: We observe the high potential risk for malignancy in the clustered-ring enhancement followed by the clumped pattern. Segmental distribution presented the highest predictive-positive values.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Management of Non-Mass Enhancement at Breast Magnetic Resonance in Screening Settings Referred for Magnetic Resonance-Guided Biopsy

Fleury

Castro²,

Amaral³

et al. 2022

Breast Cancer�(Auckl)

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“…Chen et al examined 120 cases of linear enhancement and reported a PPV of 20.8%, with no significant difference due to internal enhancement or size difference [ 14 ]. The 2003 edition of BI-RADS-MRI used the term “ductal” to refer to intraductal lesions, but the 2013 edition no longer uses this term.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging diagnosis of non-mass enhancement of the breast

et al. 2023

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Breast Imaging Reporting and Data System magnetic resonance imaging (BI-RADS-MRI) classifies lesions as mass, non-mass enhancement (NME), or focus. BI-RADS ultrasound does not currently have the concept of non-mass. Additionally, knowing the concept of NME in MRI is significant. Thus, this study aimed to provide a narrative review of NME diagnosis in breast MRI. Lexicons are defined with distribution (focal, linear, segmental, regional, multiple regions, and diffuse) and internal enhancement patterns (homogenous, heterogeneous, clumped, and clustered ring) in the case of NME. Among these, linear, segmental, clumped, clustered ring, and heterogeneous are the terms that suggest malignancy. Hence, a hand search was conducted for reports of malignancy frequencies. The malignancy frequency in NME is widely distributed, ranging from 25 to 83.6%, and the frequency of each finding varies. Latest techniques, such as diffusion-weighted imaging and ultrafast dynamic MRI, are attempted to differentiate NME. Additionally, attempts are made in the preoperative setting to determine the concordance of lesion spread based on findings and the presence of invasion.

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“…The histological type of NMEs is listed as focal adenosis, fibro-cystic, radial scar, complex sclerosing lesion, inflammatory changes, intraductal papilloma, flat epithelial atypia, lobular carcinoma, diffuse invasive breast cancer, invasive ductal carcinoma, and DCIS [ 38 – 41 ].…”

Section: Introductionmentioning

confidence: 99%

“…NME is noted as the primary lesion in about 20% of cases, of which 20.8% are malignant and 84% are noninvasive ductal carcinoma of the breast [ 41 , 42 ]. On the other hand, DCIS is often noted as a lesion with calcification on MG, and DCIS with a high histological grade, such as those with necrosis, are characterized by characteristic non-mass images on MRI findings, which are highly suspicious of malignancy [ 43 – 49 ].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound diagnosis of non-mass MRI-detected lesions

Izumori

Kokubu

2023

J Med Ultrasonics

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Magnetic resonance imaging (MRI)-detected lesions are often category 2 or 3 lesions on initial ultrasound examination. In addition, in the case of new non-mass lesions detected on MRI, one would expect to find lesions with ductal dilatation with minimal secretory accumulation, single short lesions with ductal dilatation, cyst-like lesions less than 5 mm in size, mammary gland-like lesions less than 8 mm in size, and very indistinct lesions. Detection is expected to be even more difficult. Currently, there are no clear uniform criteria for the indication of second-look ultrasonography (US) for MRI-detected lesions, so it is not possible to make a general comparison, but recent studies have indicated that the ratio of mass to non-mass MRI-detected lesions is 7:3. And it has been pointed out that the percentage of malignancy is about 30% for each. Before about 2012, the US detection rate was about 70%, and MRI-guided biopsies of undetected lesions showed a small percentage of malignant lesions. Therefore, some observers believe that lesions not detected on US should be followed up, while others believe that MRI-guided biopsy should be performed. Recently, however, the use of surrounding anatomical structures as landmarks for second-look US has increased the detection rate to as high as 87–99%, and the percentage of malignancy remains the same. In addition, recent surveillance of high-risk breast cancer requires careful management of MRI-detected lesions. In this review, we will discuss the literature on MRI-detected lesions and describe ultrasound techniques to accurately detect small lesions and reliably reveal pale lesions based on their structural differences from their surroundings.

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Clumped vs non-clumped internal enhancement patterns in linear non-mass enhancement on breast MRI

Cited by 4 publications

References 31 publications

Management of Non-Mass Enhancement at Breast Magnetic Resonance in Screening Settings Referred for Magnetic Resonance-Guided Biopsy

Management of Non-Mass Enhancement at Breast Magnetic Resonance in Screening Settings Referred for Magnetic Resonance-Guided Biopsy

Magnetic resonance imaging diagnosis of non-mass enhancement of the breast

Ultrasound diagnosis of non-mass MRI-detected lesions

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