The Frequency and Causes of Not-Detected Breast Malignancy in Dynamic Contrast-Enhanced MRI

Abstract

Breast MR is the most sensitive imaging modality, but there are cases of malignant tumors that are not detected in MR. This study evaluated the frequency and main causes of malignant breast lesions not detected in dynamic contrast-enhanced (DCE) MR. A total of 1707 cases of preoperative breast MR performed between 2020 and 2021 were included. Three radiologists individually reviewed the DCE MRs and found not-detected malignancy cases in the MRs. The final cases were decided through consensus. For the selected cases, images other than DCE MRIs, such as mammography, ultrasounds, diffusion-weighted MRs, and, if possible, contrast-enhanced chest CTs, were analyzed. In the final sample, 12 cases were not detected in DCE MR, and the frequency was 0.7% (12/1707). Six cases were not detected due to known non-enhancing histologic features. In four cases, tumors were located in the breast periphery and showed no enhancement in MR. In the remaining two cases, malignant lesions were not identified due to underlying marked levels of BPE. The frequency of not-detected malignancy in DCE MR is rare. Knowing the causes of each case and correlating it with other imaging modalities could be helpful in the diagnosis of breast malignancy in DCE MR.

Quantitative evaluation of Kaiser score in diagnosing breast dynamic contrast-enhanced magnetic resonance imaging for patients with high-grade background parenchymal enhancement

“…Among our 4 false-negative cases, there were 2 invasive ductal carcinomas with ductal carcinoma in situ and 1 ductal carcinoma in situ. In a previous study of 1,707 cases, 12 cases were false negatives ( 27 ), with invasive ductal carcinoma accounting for 0.3% of the lesions and ductal carcinoma in situ accounting for 0.4%; moreover, the proportion of false negatives was significantly lower than that in our study. However, other studies ( 32 , 33 ) have reported false-negative rates that are consistent with our results.…”

“…Use of the Kaiser score in this study yielded 5 false-positive cases and 4 false-negative cases. We speculate that these misdiagnoses occurred for the following reasons: (I) with high-grade BPE, the biopsy recommendation rate of breast MRI reading is higher compared with lower grades of BPE ( 27 ). Owing to the particularity of the data in this study, the inclusion criteria were moderate and marked BPE, and among the 9 false-positive and false-negative cases, 6 (85.7%) of the lesions were smaller than 10 mm in diameter, making it almost impossible to separate the lesions from the breast parenchyma ( 28 ).…”

Understanding Breast Cancer Aggressiveness and Its Implications in Diagnosis and Treatment

“…These changes often cause the formation of metabolites in cancer cells that can be distinguished from the metabolites of normal cells [ 14 ]. Imaging techniques such as magnetic resonance imaging (MRI) can be used to study increased metabolite uptake by tumor cells, which could translate into earlier diagnosis and improved patient outcomes [ 15 ]. Integrated bioinformatics and systems biology can play a role in understanding and testing key expressed genes related to BC recurrence.…”

Non-enhancing malignant lesions of the breast: A case report and review of literature

“…In the case report by Vlastarakos, the tumor measured 23 mm on breast MRI but was not detected on mammography [ 19 ]. There are few studies addressing non-enhancing ILC on MRI, which are summarized in Table 1 [ 8 , 9 , [20] , [21] , [22] ].…”