Nonmass enhancement lesions of the breast on core needle biopsy: outcomes, frequency of malignancy, and pathologic findings

Bartels, Anne K.; Fadare, Oluwole; Hasteh, Farnaz; Zare, Somaye

doi:10.1016/j.humpath.2021.03.003

Cited by 7 publications

(11 citation statements)

References 19 publications

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“…[7][8][9][10]17 Bartels et al reported that 69.2% of all malignant biopsies from NME were DCIS. 11 Chou et al evaluated qualitative MRI features of DCIS and found that most DCIS were identified as NME (58%) on MRI, with the NME having a larger median size than the size quantified on mammogram. 18 In our study, the correlation coefficient between NME and DCIS was .63, which was much stronger than the correlation between NME and invasive cancer.…”

Section: Discussionmentioning

confidence: 99%

“…24 Similarly, 68% of NME lesions were benign in Bartels’ study, most commonly diagnosed as fibrocystic changes. 11 Some groups recommend MRI-guided vacuum-assisted biopsy for incidentally detected NME lesions as to not miss up to 15% of malignant non-mass enhancing lesions. 17 However, no definitive consensus exists as to what feature of NME best predicts malignancy or whether NME should be routinely biopsied.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] NME remains a diagnostic challenge for radiologists, and prior research has attempted to correlate different patterns of NME with pathologic findings. 6,[11][12][13] Bartels et al reported that MRI-guided biopsies performed in the evaluation of NME comprised 5.5% of all core needle biopsies obtained from 2010 to 2019. 11 They found that NME carried a significant (32%) risk of atypia or malignancy.…”

Section: Introductionmentioning

confidence: 99%

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How Well Does Non-mass Enhancement Correlate With DCIS/Invasive Cancer?

Huang

Dufresne

Baksh

et al. 2023

The American Surgeon™

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Introduction Contiguous non-mass enhancement (NME) often coexists with a solid tumor component on MRI, but it can be challenging to predict whether NME represents invasive breast cancer, ductal carcinoma in situ (DCIS), benign disease, or biopsy site reaction. The purpose of this study was to determine the association between the size/extent of NME and the presence of invasive cancer and/or DCIS on final pathology. Methods This was a single institution retrospective analysis of a prospectively maintained breast cancer registry (2010-2020). Female patients who underwent surgical resection were included if they had a diagnosis of invasive breast cancer (with or without DCIS) and had an MRI showing both a solid mass and contiguous NME. The size of NME on MRI was compared with the size of invasive cancer and/or DCIS on the final pathology. Results From a total of 3443 patients, 225 patients were included. 86.2% had invasive ductal carcinoma (IDC), and 12.0% had invasive lobular carcinoma 76.9% were ER+, 16.4% were HER2+, and 13.3% were triple negative breast cancer (TNBC). 18.7% received neoadjuvant chemotherapy (NCT) of whom 31% achieved a complete radiographic/pathologic response. Pearson correlation coefficients (r) between the size of NME and invasive cancer/DCIS showed a strong and positive correlation of MRI NME with DCIS on pathology in patients without NCT. Subgroup analysis showed the strongest correlations for NME and DCIS among non-white (r = .70) and HER2 + patients (r = .74) who did not receive NCT. Conclusions Strong correlations between NME and DCIS were found for HER2 + disease and non-white patients, but only modest correlations were found for other patient/disease characteristics. These correlations may impact decisions in surgical approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

How Well Does Non-mass Enhancement Correlate With DCIS/Invasive Cancer?

Huang

Dufresne

Baksh

et al. 2023

The American Surgeon™

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“…While breast MRI is highly sensitive for the detection of breast cancer, the specificity of breast MRI remains suboptimal; the majority (60%-80%) of all MRI-guided breast biopsies continue to yield benign findings. [2][3][4][5][6][7][8][9] Due to the inherent complexity of reporting breast MRI, combined with heterogeneous breast pathology diagnoses, breast MRI radiology-pathology correlation remains challenging. While prior studies have described the pathologic findings of MRI breast biopsies, often with radiologic correlation, [2][3][4][5][6][7][8][9] there has been variable progress in reducing the number of unnecessary breast MRI-guided biopsies.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Due to the inherent complexity of reporting breast MRI, combined with heterogeneous breast pathology diagnoses, breast MRI radiology-pathology correlation remains challenging. While prior studies have described the pathologic findings of MRI breast biopsies, often with radiologic correlation, [2][3][4][5][6][7][8][9] there has been variable progress in reducing the number of unnecessary breast MRI-guided biopsies. Furthermore, no studies have focused on potential variation in the distribution of histologic diagnoses over an extended time period.…”

Section: Introductionmentioning

confidence: 99%

Sixteen-Year Institutional Review of Magnetic Resonance Imaging–Guided Breast Biopsies: Trends in Histologic Diagnoses With Radiologic Correlation

Motanagh,

Dwan,

Azizgolshani

et al. 2023

Breast Cancer�(Auckl)

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Background: Breast magnetic resonance imaging (MRI) is an important imaging tool for the management of breast cancer patients and for screening women at high risk for breast cancer. Objectives: To examine long-term trends in the distribution of histologic diagnoses obtained from MRI-guided breast biopsies. Design: Retrospective analysis. Methods: We retrospectively reviewed the distribution of histologic diagnoses of MRI-guided breast biopsies from 2004 to 2019. All cases underwent central pathology review and lesions were classified based on the most prominent histologic finding present. Magnetic resonance imaging features were extracted from radiology reports when available and correlated with pathology diagnoses. Results: Four hundred ninety-four MRI-guided biopsies were performed on 440 patients; overall, 73% of biopsies were benign and 27% were malignant. The annual percentages of benign and malignant diagnoses remained similar throughout the 16-year period. Of the benign entities commonly identified, the percentage of benign papillary and sclerosing lesions detected in the benign biopsies increased significantly (13% in 2004-2011 vs 31% in 2012-2019, P = .03). The mean size of malignant lesions was larger than benign lesions (30.1 mm compared with 14.2 mm, P = .045); otherwise, there were no distinguishing radiologic features between benign and malignant lesions. Conclusion: The specificity of breast MRI remained constant over a 16-year period; however, there was a shift in the distribution of benign diagnoses with increased detection and biopsy of benign papillary and sclerosing lesions. Monitoring the distribution of breast MRI biopsy diagnoses over time with radiology-pathology correlation might improve the suboptimal specificity of breast MRI.

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Fibrocystic Changes of the Breast: Radiologic–Pathologic Correlation of MRI

Choe

Kasales

Mack

et al. 2021

Journal of Breast Imaging

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Breast MRI provides high sensitivity but modest positive predictive value for identifying breast cancers, with approximately 75% of MRI-guided biopsies returning benign pathologies. Fibrocystic change (FCC) is a descriptive term used colloquially by many radiologists (and falling out of favor with many pathologists) to refer to several benign entities encountered in the breast. Many of the benign entities believed to comprise FCC can show enhancement on MRI. Recognizing the pathologic correlates of these enhancing lesions should help guide management after such a result on MRI-guided biopsy. Premenopausal women may present with clinical symptoms attributed to FCC, including pain, nipple discharge, breast lumps, or discrete masses. Benign entities associated with FCC include proliferative lesions such as usual ductal hyperplasia and sclerosing adenosis, and nonproliferative lesions including cysts, apocrine metaplasia, and stromal fibrosis. Fibrocystic change can be diffuse or focal. Diffuse FCC usually presents as non-mass enhancement (NME), often with persistent kinetics. Focal FCC can present as an irregular mass or focus with variable enhancement patterns including washout kinetics. Following a benign concordant MRI-guided biopsy result of one or more of the above entities, follow-up with MRI in 12 months is reasonable. Accurate radiologic–pathologic correlation can be achieved when careful review of histologic findings is carried out in the context of MRI features.

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Nonmass enhancement lesions of the breast on core needle biopsy: outcomes, frequency of malignancy, and pathologic findings

Cited by 7 publications

References 19 publications

How Well Does Non-mass Enhancement Correlate With DCIS/Invasive Cancer?

How Well Does Non-mass Enhancement Correlate With DCIS/Invasive Cancer?

Sixteen-Year Institutional Review of Magnetic Resonance Imaging–Guided Breast Biopsies: Trends in Histologic Diagnoses With Radiologic Correlation

Fibrocystic Changes of the Breast: Radiologic–Pathologic Correlation of MRI

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