MR lesion detection in a breast cancer population

Abstract

Implementation of MR imaging of the breast as an extension of the existing imaging modalities in the diagnosis of breast cancer was evaluated in a university cancer center, MR imaging of the breast was performed in 54 patients, in whom the MR results were compared with the triple test (the combination of clinical examination, mammographic evaluation, and cytology) and the final histological diagnosis. MR imaging of the breast depicted 30 of the 33 malignancies (sensitivity, 91%). In two of the malignancies, the carcinoma was clinically and mammographically occult. For the three patients with a false-negative MRI diagnosis, the conventional mammography showed suspicions clustered microcalcifications as a sign of in situ carcinoma. For seven patients, MR imaging of the breast incorrectly suggested the presence of a malignant lesion (specificity, 67%). To improve MR specificity, we perform MR-guided ultrasonographic fine-needle aspiration biopsy (FNAB). Although MR imaging of the breast is a highly sensitive examination, conventional x-ray mammography remains the most efficient imaging modality in the diagnosis of breast cancer. In our patient population, MR imaging of the breast had additional value for women with mammographically dense breast tissue and especially for patients with clinical evidence of breast carcinoma that could not be detected with conventional diagnostic methods.

Value of MR imaging in clinical evaluation of breast lesions

“…This was also discussed by O bdeijn et al. (15) in their evaluation of mammography, clinical examination and ultrasonography compared to MR in 54 patients, where their findings were in accordance with our present results. They found MR to be false‐negative in 3 patients with in situ cancers and false‐positive in 7 patients with scar tissue, mastitis and proliferative dysplasia.…”

“…In recent years MR imaging of the breast has proven to be valuable in certain applications (2, 5, 7, 10, 12, 14). Previous studies have shown MR to be useful as an adjunct to TD in patients with dense parenchyma (15) and for providing the highest possible sensitivity and negative predictive value (13). There have been comparisons of MR to TD for assessing local recurrence (11) and for preoperative detection of multifocal or multicentric breast tumours (3).…”

MRI in familial breast cancer

“…Without the use of contrast agent, MRI is of very little value to detect breast cancers. Currently, CE MRI of the breast is known to be the most sensitive modality to detect invasive breast cancer, yielding sensitivities approaching 100% [33][34][35][36]. Sensitivity is not impaired by dense parenchyma.…”

MRI: A role in clinical trials

“…In those studies the breast cancers that were missed were DCIS (43, 44). Obdeijn et al (46) reported a 91% detection rate for palpable lesions. Small breast cancers (less than 1 centimeter) can now be detected by MRI (47, 48).…”