False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features

Alikhassi, Afsaneh; Li, Xuan; Au, Frederick; Kulkarni, Supriya; Ghai, Sandeep; Allison, Grant; Freitas, Vivianne

doi:10.1007/s10549-023-06861-y

Cited by 8 publications

(6 citation statements)

References 38 publications

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“…Our rate of high-risk lesions is slightly lower than a recently published multi-center study conducted in three other hospitals within the same city, which reported a rate of 19.6% (43/219) [21]. However, it is important to note that their study included MRI indications other than high-risk screening, such as staging, surveillance, and problem-solving [21]. In our clinical practice, non-classical LCIS, papillary lesions with atypia or palpable papillary lesions, and ADH are typically surgically excised.…”

Section: Discussioncontrasting

confidence: 83%

“…Nonetheless, it is noteworthy that 9.5% of the BI-RADS 4/5 observations in our cohort yielded high-risk pathologies, and some of these findings would have impacted clinical management based on standard recommendations [19,20]. Our rate of high-risk lesions is slightly lower than a recently published multi-center study conducted in three other hospitals within the same city, which reported a rate of 19.6% (43/219) [21]. However, it is important to note that their study included MRI indications other than high-risk screening, such as staging, surveillance, and problem-solving [21].…”

Section: Discussioncontrasting

confidence: 68%

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How Does Diagnostic Accuracy Evolve with Increased Breast MRI Experience?

Wu,

Alikhassi,

Curpen

2023

Tomography

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Introduction: Our institution is part of a provincial program providing annual breast MRI screenings to high-risk women. We assessed how MRI experience, background parenchymal enhancement (BPE), and the amount of fibroglandular tissue (FGT) affect the biopsy-proven predictive value (PPV3) and accuracy for detecting suspicious MRI findings. Methods: From all high-risk screening breast MRIs conducted between 1 July 2011 and 30 June 2020, we reviewed all BI-RADS 4/5 observations with pathological tissue diagnoses. Overall and annual PPV3s were computed. Radiologists with fewer than ten observations were excluded from performance analyses. PPV3s were computed for each radiologist. We assessed how MRI experience, BPE, and FGT impacted diagnostic accuracy using logistic regression analyses, defining positive cases as malignancies alone (definition A) or malignant or high-risk lesions (definition B). Findings: There were 536 BI-RADS 4/5 observations with tissue diagnoses, including 77 malignant and 51 high-risk lesions. A total of 516 observations were included in the radiologist performance analyses. The average radiologist’s PPV3 was 16 ± 6% (definition A) and 25 ± 8% (definition B). MRI experience in years correlated significantly with positive cases (definition B, OR = 1.05, p = 0.03), independent of BPE or FGT. Diagnostic accuracy improved exponentially with increased MRI experience (definition B, OR of 1.27 and 1.61 for 5 and 10 years, respectively, p = 0.03 for both). Lower levels of BPE significantly correlated with increased odds of findings being malignant, independent of FGT and MRI experience. Summary: More extensive MRI reading experience improves radiologists’ diagnostic accuracy for high-risk or malignant lesions, even in MRI studies with increased BPE.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussioncontrasting

confidence: 68%

How Does Diagnostic Accuracy Evolve with Increased Breast MRI Experience?

Wu,

Alikhassi,

Curpen

2023

Tomography

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“…We saw this trend, with a higher incidence of cancers in the diagnostic versus the screening cohort. Additionally, in line with other published studies, we identi ed in the univariate analysis other relevant imaging ndings associated with malignancy, including clumped and clustered ring non-mass enhancement pattern 27 and washout kinetics 28 , which also should play important roles as individual features in the biopsy decision-making process.…”

Section: Discussionsupporting

confidence: 68%

“…To our knowledge, there are scanty studies explicitly focused on determining malignant rates of T2 hyperintense lesions solely identi ed by MRI [25][26][27] . Our results contrast with these studies that showed that T2 hyperintensity is a benign imaging characteristic at breast MRI.…”

Section: Discussionmentioning

confidence: 99%

MRI-Visualized T2 Hyperintense Breast Lesions: Identifying Clinical and Imaging Factors Linked to Malignant Biopsy Outcomes

Bissell,

Keshavarzi,

Fleming

et al. 2023

Preprint

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Purpose To determine the malignancy rate for MRI-guided breast biopsies performed for T2 hyperintense breast lesions and to assess additional clinical and MRI characteristics that can predict benign and malignant outcomes. Methods A retrospective chart review of consecutive MRI-guided breast biopsies performed in two tertiary hospitals was conducted over two years. Biopsies performed for T2 hyperintense lesions were selected, and further lesion imaging characteristics and patient risk factors were collected. Univariate and multivariate modeling regression was used to determine additional imaging and patient factors associated with malignant outcomes for biopsies of T2 hyperintense lesions. Results Out of 369 MRI-guided breast biopsies, 100 (27%) were performed for T2 hyperintense lesions. Two biopsy-proven benign lesions were excluded as the patient was lost on follow-up. With a study cohort of 98 lesions, the final pathology results were benign for 80 (80%) of these lesions, while 18 (18%) were malignant. Using multivariate logistic modeling, patient age > 50 (OR 5.99 (1.49,24.08 95%CI), p < 0.05) and lesion size > 3cm (OR 5.54 (1.54–18.7), p < 0.01) were found to be important predictors of malignant outcomes for MRI biopsies performed for T2 hyperintense lesions. Conclusion Our study observed a high malignancy rate, challenging the assumption that T2 hyperintensity can be considered a benign imaging characteristic for otherwise suspicious MRI-detected lesions. Decision-making regarding tissue sampling should be made based on a thorough evaluation of more reliable additional demographic and imaging factors, including patient age and lesion size.

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“…In our sample, the risk of FP results was signi cantly higher in case of NME vs. mass-like enhancement (p: 0.028782), but this result is not surprising since previous literature has highlighted how NME have a lower PPV for malignancy vs. mass both in CEM and MRI [36,37].…”

Section: Discussionsupporting

confidence: 55%

Contrast-enhanced mammography in the management of breast architectural distortions and avoidance of unnecessary biopsies

Bellini,

Pugliese,

Bicchierai

et al. 2024

Breast Cancer

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Objectives: to assess the diagnostic performance of contrast-enhanced mammography (CEM) in the management of breast architectural distortions (AD) classi ed as BI-RADS3 in digital breast tomosynthesis (DBT).Materials & methods: we retrospectively reviewed 328 women with 332 ADs detected on DBT from January 2017 to October 2021 and selected those classi ed as BI-RADS3 receiving CEM as problem solving. In CEM recombined images we evaluated the contrast enhancement (CE) of AD according to its presence/absence, type according to CEM BI-RADS lexicon, and size (<10 mm or ≥10 mm). AD with enhancement underwent breast biopsy by core needle biopsy or vacuum-assisted biopsy while AD without enhancement underwent imaging follow-up or biopsy if detected in high-or intermediate-risk women.Results: AD with enhancement were 174 (52.4%): 72 (41.4%) were malignant lesions, 102 (59.6%) false positive results: 28 (16%) B3 lesions and 74 (42.5%) benign lesions. AD without enhancement were 158 (47.6%): 26 (16.5%) were subjected to biopsy (1 malignant lesion and 25 benign lesions) while the other 132 cases were sent to imaging follow-up, still negative after two years. The sensitivity, speci city, positive (PPV) and negative predictive values (NPV) and accuracy of CEM were 98.63%, 60.62%, 41.38%, 99.37% and 68.98%. The area under the curve determined by ROC for CEM was 0.796 (95% CI, 0.749-0.844).Conclusion: CEM has shown a high sensitivity and NPV in the evaluation of BI-RADS3 AD. We showed promising results in favor of CEM as a complementary tool in assessing AD lesions to avoid unnecessary biopsies without compromising cancer detection.Clinical relevance statement: our ndings are encouraging towards the utility of CEM as a valuable complementary tool for the evaluation of BI-RADS 3 AD, to reduce unnecessary biopsies for its high NPV, without compromising the effectiveness of cancer detection. Key Points1. Many architectural distortions are caused by benign lesions, so we need to identify some diagnostic features to reduce the number of unnecessary biopsies.2. Contrast-enhanced mammography in the assessment of BI-RADS 3 distortions has shown an optimal sensitivity and negative predictive value.3. Since its high negative predictive value, contrast-enhanced mammography is a useful tool in the management of architectural distortions to avoid unnecessary invasive assessment without compromising cancer detection.

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False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features

Cited by 8 publications

References 38 publications

How Does Diagnostic Accuracy Evolve with Increased Breast MRI Experience?

How Does Diagnostic Accuracy Evolve with Increased Breast MRI Experience?

MRI-Visualized T2 Hyperintense Breast Lesions: Identifying Clinical and Imaging Factors Linked to Malignant Biopsy Outcomes

Contrast-enhanced mammography in the management of breast architectural distortions and avoidance of unnecessary biopsies

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