Efficacy of Magnetic Resonance Imaging in BIRADS 3, 4 and 5 Patients Detected on Full Filed Digital Mammography: Our Experience

Abstract

Aim of the study: To perform Dynamic contrast enhanced MRI of breast in patients with positive findings (BIRADS 3, 4 and 5) detected on screening mammography; to correlate the findings of digital mammography and contrast enhanced MRI of breast with histopathological examinations. Settings and Design: A prospective observation study was conducted at a single centre, i.e. HCG Manavata Cancer Centre. Materials and Methods: Screening mammography was performed on patients with age > 40 years and on patients with age 35-40 years having positive family history. The positive mammography was reported and the lesions classified according to BIRADS criteria for mammography. Results: Mammographic examination of the breast lesions yielded an overall sensitivity of 97.67% and a specificity of 85.71%. In our study we combined both morphologic and dynamic parameters and its modification into BIRADS category for lesion classification. The sensitivity of MRI examinations was 97.67% while the specificity was 71.43%. Spiculated margins were encountered only in malignant lesions (p = 0.0006). Statistical correlation was obtained between the pathologically proven benign and malignant lesions regarding their enhancement pattern with p value of <0.001. Conclusion: As per the results, dynamic contrast MRI had high sensitivity but limited specificity. We did not find any significant difference between FFDM and MRI in terms of diagnostic accuracy. The use of DWI showed high specificity at cut off point of ADC value-0.85 mm 2 /s. Thus, DWI can be used in addition of morphological and dynamic kinetic characteristics to increase specificity of MRI.