Rationale and Objectives
To evaluate the associations of patient age and clinical indication with the risk of malignancy for suspicious lesions initially detected on breast magnetic resonance imaging (MRI).
Methods and Materials
After institutional review board approval, a retrospective review of our breast MRI database was performed to identify all nonpalpable, mammographically occult, MRI-detected suspicious lesions between January 1, 2003, and November 30, 2006, that underwent needle or excisional biopsy. Clinical indication and patient age were recorded and their associations with risk of malignancy were assessed using univariate and multivariate generalized estimating equations.
Results
The likelihood of malignancy was significantly higher ( P = .0004) for suspicious lesions found on MRI examinations performed for a patient history of known cancer/evaluate extent of disease (130/309, 42%) compared to lesions identified on examinations conducted for high-risk screening (21/96, 22%). Suspicious lesions found in patients ≥50 years of age were also more likely to be malignant (92/209, 44%) compared to those found in patients <50 years of age (59/196, 30%) ( P = .004). In a multivariable model, both clinical indication of known cancer (OR 2.39, 95% CI 1.33–4.30) and age of 50 years or older (OR 1.66, 95% CI 1.03−2.68) were independently associated with greater risk of malignancy.
Conclusion
The clinical indication of known cancer/evaluate extent of disease and patient age of 50 years or older significantly increase the risk of malignancy in suspicious MRI-detected lesions.
Breast magnetic resonance imaging (MRI) is a highly sensitive imaging tool in the detection and characterization of breast cancer . Because of the evidence-based benefits of MRI, it is predicted that demand for this imaging tool will continue to increase for both screening of asymptomatic high risk women and for evaluation of extent of disease in newly diagnosed cancer patients.
It has been shown in the mammography literature that significantly different clinical outcomes exist for diagnostic mammography compared with screening mammography , and Sickles et al have thus recommended separating these two clinical indications in mammography audits to analyze diagnostic outcomes separately. To date, few studies have been performed to investigate the role that clinical indication plays in the setting of breast MRI-detected lesions.
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Materials and methods
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Patients and Lesions
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Data Collection
Breast MRI technique
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Image interpretation
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Statistical Analysis
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Results
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Table 1
Univariate and Multivariable Estimated Risk of Malignant Outcome
Total Malignant n = 151 Total Benign n = 254 Univariate Generalized Estimating Equations (GEE Models) Multivariate Generalized Estimating Equations (GEE Models) Total Lesions n = 405n (PPV ∗ )n (NPV † ) Chi-Square ( P Value) Odds Ratio 95% CI Chi-Square ( P Value) Odds Ratio 95% CI Patient age 6.37 (.012) 4.37 (0.37) <50 years old 196 (48.4%) 59 (30.1%) 137 (69.9%) ≥50 years old 209 (51.6%) 92 (44.0%) 117 (56.0%) 1.83 1.14 - 2.91 1.66 1.03-2.68 Clinical indication 10.04 (.002) 8.42 (0.004) Screening 96 (23.7%) 21 (21.9%) 75 (78.1%) Known cancer 309 (76.3%) 130 (42.1%) 179 (57.9%) 2.59 1.44-4.68 2.39 1.33-4.30
CI: confidence interval.
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Table 2
Fitted Values for Multivariable Model, with Frequency in Dataset
Patient Age Clinical Indication Predicted Probability of Malignancy (95% CI) Frequency (Proportion) <50 Screening 0.19 (0.12-0.28) 60 (0.14) <50 Known cancer 0.35 (0.27-0.44) 136 (0.34) ≥50 Screening 0.27 (0.17-0.41) 36 (0.09) ≥50 Known cancer 0.47 (0.39-0.56) 173 (0.43)
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Discussion
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Conclusion
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