Decision making for breast lesions initially detected at contrast-enhanced breast MRI

Ken Yamaguchi*, David V Schacht, Charlene A. Sennett, Gillian M. Newstead, Takeshi Imaizumi, Hiroyuki Irie, Hiroyuki Abe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

OBJECTIVE. The purpose of this study was to assess the clinical significance of breast lesions initially detected at contrast-enhanced breast MRI and to consider how to manage those lesions in accordance with the imaging findings and the indication for MRI. MATERIALS AND METHODS. A retrospective study of 4260 consecutive breast MRI examinations was performed to identify MRI-detected enhancing lesions. In 4260 studies, 554 MRI-detected lesions were found in 417 patients, and 134 (24%) of the lesions were malignant. Pathologic confirmation was obtained for 319 (58%) lesions. Results of the subsequent imaging workup, biopsy, surgery, and imaging follow-up were reviewed. RESULTS. The median size of the lesions was 8.39 mm (malignant, 15.45 mm; benign, 7.48 mm). Irregular shape, irregular or spiculated margins, and heterogeneous or rim enhancement were seen significantly more often in malignant mass lesions (p < 0.001). Malignant lesions were more likely to exhibit rapid enhancement (p < 0.001). Benign lesions were more likely to have persistent kinetics (p < 0.001). There was a statistically significant difference (p < 0.001) between malignant (58/87, 67%) and benign lesions (128/287, 45%) with respect to sonographic detection at second-look ultrasound examinations. Malignant lesions were most often detected in patients with metastatic axillary lymph nodes with an unknown primary tumor (8/8, 100%), followed by patients with positive or close margins in recent breast cancer surgery (45/76, 59%), and patients with newly diagnosed breast cancer (44/115, 38%). CONCLUSION. Management of MRI-detected lesions should be based on both MRI findings and the patient's indication for MRI.

Original languageEnglish (US)
Pages (from-to)1376-1385
Number of pages10
JournalAmerican Journal of Roentgenology
Volume201
Issue number6
DOIs
StatePublished - Dec 1 2013

Keywords

  • Breast MRI
  • Breast cancer
  • Enhancing lesion
  • Incidental lesion

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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