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Suspicious Breast Lesions Detected at 3.0 T Magnetic Resonance Imaging

Posted May 31, 2012 Updated Apr 10, 2023
By Karen S. Johnson MD , Jay A. Baker MD , Sheila S. Lee MD , Mary S. Soo MD
11 min read

Rationale and Objectives

To evaluate the imaging features and histological and clinical outcomes of a series of suspicious, mammographically occult breast lesions detected at 3.0 T magnetic resonance imaging (MRI).

Materials and Methods

Approval was obtained from the institutional review board. A Health Insurance Portability and Accountability Act–compliant retrospective review was performed of 121 suspicious, mammographically occult lesions detected on 3.0 T contrast-enhanced breast MRI. All 121 lesions underwent histological sampling. Radiology and clinic reports were reviewed for patient demographics, MRI indication and findings, biopsy and localization details, histological results, and follow-up information. Positive predictive value (PPV) of biopsy recommendations were calculated and compared for screening versus diagnostic cases. Likelihood of malignancy was also compared with lesion size. Statistical analyses were performed using chi-square, Fisher’s exact, and two-tail z-tests.

Results

Overall 43 malignancies were diagnosed from 121 suspicious, mammographically occult 3.0 T MRI-detected lesions. Seventy-eight (64%) of the 121 were benign. The overall PPV of 3.0 T MRI-detected lesions was 36% (43/121). The PPV for biopsy in the screening setting (22% [10/45]) was statistically significantly less ( P = .018) compared to the PPV of a biopsy recommendation in the diagnostic setting (43% [33/76]). There was no correlation between lesion size and the likelihood of detecting malignancy.

Conclusion

Our PPV of suspicious, mammographically occult, breast lesions detected at 3.0 T breast MRI is similar to the PPV reported previously for suspicious breast lesions detected at 1.5 T. This study supports the use of 3.0 T breast MRI for both screening and diagnostic breast imaging.

Contrast-enhanced breast magnetic resonance imaging (MRI) is the most sensitive imaging tool for the detection of breast cancer based on improved contrast resolution over other imaging modalities . The American College of Radiology (ACR) practice guidelines for contrast-enhanced breast MRI include screening patients at high risk of developing breast cancer, evaluating extent of disease in patients with recently diagnosed breast cancer, monitoring response of biopsy-proven breast cancer to neoadjuvant chemotherapy, and evaluating patients with metastatic axillary adenocarcinoma of unknown primary . Prior studies report clinical outcomes of suspicious, mammographically occult, MRI-detected breast lesions ; however, most of these studies evaluated lesions detected at 1.0 and 1.5 T imaging . Today, higher field strength, namely 3.0 T, MRI systems are becoming increasingly common in clinical settings . These higher field strength 3.0 T systems offer the potential for improved resolution compared to lower field strength systems . However, there are limited data describing the use of high-field strength 3.0 T MRI for breast imaging , and 1.5 T remains the clinical standard.

At our institution, contrast-enhanced breast MRI has been routinely performed on 3.0 T scanners for 5 years. This retrospective study was undertaken to evaluate the imaging features and histological and clinical outcomes in a series of suspicious, mammographically occult, 3.0 T MRI-detected breast lesions.

Materials and methods

Lesion Characteristics

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Patients

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MRI Technique and Interpretation

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Siemens Trio

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GE Signa

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MRI-guided Intervention

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Targeted Ultrasound and Ultrasound-Guided Core Needle Biopsy

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Data Collection and Analysis

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Results

Initial Core Biopsy Results and Clinical Outcomes

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Table 1

Benign Concordant Core Biopsy Histology Results

Histology MRI-guided VAB MRI-guided NL US-guided Core Biopsy Total Fibrocystic change 52 1 1 54 Fibroadenoma 2 0 0 2 Papilloma 3 0 2 5 Benign lymph node 0 1 0 1 Sclerosing adenosis 4 0 3 7 Fibrosis 0 0 2 2 Radiation change 1 0 0 1 Total 62 2 8 72

MRI, magnetic resonance imaging; NL, needle localization; US, ultrasound; VAB, vacuum-assisted biopsy.

Figure 1, A 52-year-old female with biopsy proven ductal carcinoma in situ (DCIS) of the left breast. Initial first-pass postcontrast 3.0 T magnetic resonance imaging (MRI) performed for staging demonstrates linear non-mass-like enhancement in the inferior right breast on axial images (a) . MRI-guided biopsy was performed and histology yielded fibrocystic changes without evidence of malignancy. Follow-up breast MRI was recommended in 6 months. The patient did not return until 18 months later and axial postcontrast 3.0 T MRI scan (b) of the same breast performed shows progression to segmental non-mass-like enhancement and increase in size, especially at the anterior margin ( arrow ). A repeat MRI-guided biopsy was performed and yielded DCIS.

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Cancelled Cases of MRI-guided Intervention

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Final Histology

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Figure 2, Final histology of malignant results.

Table 2

Core Biopsy and Final Histological Results

Histological Category Core Biopsy Histology Final Surgical Histology Malignant 40 (33) 43 (36) Benign 73 (60) 71 (59) High risk 8 (7) 7 (6) Total 121 121

Data are number (%) of lesions.

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Table 3

Malignancy as a Function of Indication for Exam

Magnetic Resonance Imaging Indication Number of Malignant Lesions/Number of Lesions Biopsied per Category (%) Screening 10/45 (22) Staging 26/60 (43) Ipsilateral breast 21/46 (46) Contralateral breast 5/14 (36) Work-up of unknown primary adenocarcinoma 3/9 (33) Evaluation of tumor response to neoadjuvant chemotherapy 3/5 (60) Problem solving 1/2 (50) Total 43/121 (36)

Data are number (%) of lesions.

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Imaging Features

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Table 4

Frequency of Morphologic Descriptors as a Function of Histology

Descriptor Malignant Histology High-Risk Histology Benign Histology Total DCIS Invasive Mass (all) 0 12 2 16 30 Mass shape Round 0 5/13 (38) 0 8/13 (62) 13 Oval 0 1/5 (20) 1/5 (20) 3/5 (60) 5 Irregular 0 5/7 (71) 1/7 (14) 1/7 (14) 7 Lobular 0 1/7 (14) 0 4/7 (57) 5 Mass margin Smooth 0 2/11 (18) 2/11 (18) 7/11 (64) 11 Irregular 0 6/13 (46) 0 7/13 (54) 13 Spiculated 0 4/6 (67) 0 2 (33) 6 NMLE (all) 15 9 5 50 79 NMLE distribution Focal 6/30 (20) 4/30 (13) 2/30 (7) 18/30 (60) 30 Linear/ductal 6/30 (20) 2/30 (7) 3/30 (10) 19/30 (63) 30 Segmental 1/6 (17) 0 0 5/6 (83) 6 Regional 1/11 (9) 3/11 (27) 0 7/11 (64) 11 Diffuse 1/2 (50) 0 0 1/2 (50) 2 Focus 2 4 0 5 11 Suspicious node 1 1 Total 17 26 7 71 121

DCIS, ductal carcinoma in situ; NMLE, non-mass-like enhancement.

Data are number (%) of cases.

Figure 3, A 78-year-old female with invasive ductal carcinoma (IDC). First postcontrast 3.0 T magnetic resonance imaging (MRI) scan performed for staging shows minimal background parenchymal enhancement and a focus of enhancement in the right breast on axial (a) and sagittal (b) images. MRI-guided vacuum-assisted biopsy of enhancing focus demonstrated IDC.

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Table 5

Cancer Frequency versus Lesion Size and Magnetic Resonance Imaging Indication

Lesion Size (mm) Staging Screening Neoadjuvant Follow-up Unknown Primary Problem Solving All <5 2/3 (67) 0/2 (0) 1/1 (100) 0/0 0/0 3/6 (50) 5–9 6/16 (38) 1/5 (20) 0/0 0/5 (0) 1/1 (100) 8/27 (30) 10–14 8/16 (50) 2/5 (40) 0/0 1/1 (100) 0 11/22 (50) 15–19 4/7 (57) 0/4 (0) 0/0 0/0 0 4/11 (36) ≥20 6/18 (33) 7/29 (24) 2/4 (50) 2/3 (67) 0/1 (0) 17/55 (31) Total 26/60 (43) 10/45 (22) 3/5 (60) 3/9 (33) 1/2 (50) 43/121 (36)

Data are number (%) of cases.

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Discussion

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Academic Radiology, Volume 19, Issue 6
Journals General Radiology
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