Development, standardization, and testing of a lexicon for reporting contrast‐enhanced breast magnetic resonance imaging studies

Abstract

The purpose of this study was to develop, standardize, and test reproducibility of a lexicon for reporting contrastenhanced breast magnetic resonance imaging (MRI) examinations. To standardize breast MRI lesion description and reporting, seven radiologists with extensive breast MRI experience developed consensus on technical detail, clinical history, and terminology reporting to describe kinetic and architectural features of lesions detected on contrastenhanced breast MR images. This lexicon adapted American College of Radiology Breast Imaging and Data Reporting System terminology for breast MRI reporting, including recommendations for reporting clinical history, technical parameters for breast MRI, descriptions for general breast composition, morphologic and kinetic characteristics of mass lesions or regions of abnormal enhancement, and overall impression and management recommendations. To test morphology reproducibility, seven radiologists assessed morphology characteristics of 85 contrast-enhanced breast MRI studies. Data from each independent reader were used to compute weighted and unweighted kappa () statistics for interobserver agreement among readers. The MR lexicon differentiates two lesion types, mass and non-mass-like enhancement based on morphology and geographical distribution, with descriptors of shape, margin, and internal enhancement. Index terms: breast; magnetic resonance; breast neoplasms; breast neoplasm diagnosis; observer performance; kappa THERE IS A WIDE VARIETY of breast magnetic resonance imaging (MRI) techniques, resulting in varying interpretation criteria for benign or malignant lesions. This results in a major problem in consolidating data from breast MRI studies. A second problem is lack of a standard language to report breast lesion architecture and/or kinetic data. Varying terms have been used to describe findings to distinguish between benign and malignant breast disease on high spatial resolution scans emphasizing lesion morphology (1-5), contrast enhancement studies that describe signal intensity variations over time (6 -8), and technologies that collect both high spatial and temporal resolution data (9).This lack of consensus in terminology impairs comparison of MR research data among studies, decreases the assessment of the applicability of any one MR technique, and impedes the scientific evaluation of the efficacy of MRI for breast cancer. Clearly, there is a need to reach consensus among experts in how to describe lesions found on breast MRI, to standardize MRI reporting, and to reconcile terms describing breast lesion morphology and enhancement. A standard language for breast MRI would unify the breast MR research field by

Quantitative diffusion weighted imaging for differentiation of benign and malignant breast lesions: The influence of the choice of b‐values

“…Perfusion effects already cause a substantial signal attenuation at low b-values, which explains the contribution of mainly perfusion effects to the ADC when only low b-values are used. Prior studies reported that the contribution of perfusion effects to the ADC are larger than diffusion effects (15,16). Because perfusion effects are already present at low bvalues, the ADC at low b-values is higher than the ADC obtained with higher b-values.…”

“…A promising adjunct MRI technique is diffusion-weighted imaging (DWI) (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In DCE Breast MRI, lesions are characterized based on morphology, internal enhancement, and kinetic enhancement pattern (16,17). With DWI, the cellularity of a lesion can be indirectly assessed.…”

Breast lesion analysis of shape technique: Semiautomated vs. manual morphological description

“…In an attempt to correlate the shape parameters described in this work with a familiar and commonly used lexicon system, we scored each lesion according to their BI-RADS (MRI) classification (11). Lesions were divided into mass or non-mass-like enhancement.…”

“…Various lexicons have been introduced to categorize the morphological appearance of focal enhancement, such as that recently proposed by a breast lesion diagnosis working group (10,11). This group subclassified both shape and margin into several distinct types in an attempt to standardize reporting and help identify common architectural features.…”

Magnetic resonance imaging features of fibrocystic change of the breast

“…The initial enhancement phase is further categorized into fast, medium, and slow. The late enhancement phase is described as persistent, plateau, and washout [12][13][14][15][16].…”