Highlights
- •Enhancing foci on breast MRIs sometimes pose diagnostic dilemmas.
- •Foci on screening MRIs may be less suspicious than foci on diagnostic MRIs.
- •Foci in the same quadrant of a known malignancy may be more suspicious.
Abstract
Objective
Prior studies evaluating features of foci associated with malignancy have not been
conclusive. This study evaluates foci that were deemed suspicious and assesses multiple
imaging and clinical findings with the goal of identifying criteria that can increase
diagnostic confidence when evaluating foci on breast MRI.
Methods
After Institutional Review Board approval, a retrospective chart review was performed
to identify patients who underwent an image-guided biopsy of an enhancing focus. To
be included in the study, a breast MRI performed between 2012 and 2019 must have been
classified as suspicious for an enhancing focus or foci, and a biopsy using imaging
guidance must have been subsequently performed. Patient and imaging characteristics
as well as the corresponding biopsy results were recorded and statistically analyzed.
Results
There were 74 patients with 85 foci of enhancement who underwent biopsy within the
study period. Thirteen of the 85 foci yielded malignant results for an overall positive
predictive value of 15.3% (95% confidence interval: 7.7–22.9%). Additionally, twenty-six
of the 85 cases (30.6%) yielded high risk lesions. There was a statistically significant
negative correlation between screening breast MRIs and biopsies that yielded cancer
or atypia (p = 0.04). There was also a significant association between foci and malignant results
if the focus was in the same quadrant of a known malignancy (p = 0.001).
Conclusion
Clinical information, such as the indication for a breast MRI or the location of a
focus relative to a known cancer, can play an important role in evaluating foci of
enhancement. Diagnostic confidence in identifying suspicious foci can be aided by
incorporating clinical context with imaging findings deemed suspicious by prior research
studies.
Keywords
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Article info
Publication history
Published online: February 07, 2022
Accepted:
February 4,
2022
Received in revised form:
January 15,
2022
Received:
October 25,
2021
Identification
Copyright
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