Frequency, Upgrade Rates, and Characteristics of High-Risk Lesions Initially Identified With Breast MRI

Abstract

There are no specific imaging features that predict upgrade for high-risk lesions when detected with MRI. Therefore, surgical excision is recommended because upgrade to invasive carcinoma or ductal carcinoma in situ can occur in up to 31% of cases, regardless of biopsy technique.

Magnetic Resonance Imaging-Guided Core Needle Breast Biopsies Resulting in High-Risk Histopathologic Findings: Upstage Frequency and Lesion Characteristics

“…6 This finding supports the hypothesis proposed by Liberman et al 15 that the greater rate of underestimation of malignancy in lesions containing ADH biopsied with MRI guidance compared with stereotactic guidance might be related to the greater probability of breast cancer in high-risk women undergoing breast MRI.…”

“…A part of the smaller sample size resulted from a lack of surgical follow-up in 10 cases and inability to correlate the excision site with the biopsy site in 11 cases. A similar limitation was noted in the study by Strigel et al, 6 in which a correlation between the biopsy and surgical excisions sites was unavailable in 22 of 61 (36%) of high-risk lesions detected by MRI biopsy. In cases in which no surgery was performed, the analysis by Menes et al 5 of the Breast Cancer Surveillance Consortium suggested that surgeons are successful at selecting which patients will be suitable for observation with low rates of subsequent breast cancer and suggested, therefore, that management of these high-risk lesions could be determined on a case-by-case basis.…”

“…This finding was in agreement with the existing data, lending additional support to the idea that MRI characteristics are not predictive of upstaging to malignancy. [6][7][8][9][13][14][15] Finally, all upstaged lesions in our study were in patients with a history of breast cancer. Although not statistically significant, this characteristic is likely related to the small sample size and our specific population at a tertiary cancer center.…”

“…However, data on high-risk lesions from MRI-guided biopsies, including ADH, ALH, flat epithelial atypia (FEA), and LCIS are limited. [6][7][8][9][10] The purpose of our study was to determine the frequency of high-risk histopathologic features resulting from MRI-guided core needle biopsy, the subsequent upstage rates to malignancy, and whether the imaging characteristics could help predict upstage rates.…”

Breast Magnetic Resonance Imaging-Guided Biopsy

“…The atypical ductal hyperplasia (ADH) upgrade rate at surgery is reportedly 25-38% (19,30,38,40,42,43). In ductal carcinoma in situ (DCIS), the upgrade rate ranges from 5-24% (19,30,38,44).…”