Rationale and Objectives We retrospectively determined if signal enhancement ratio (SER), a quantitative measure of contrast kinetics using volumetric parameters, could reduce the number of biopsy recommendations without decreasing the number of cancers detected when applied to suspicious lesions seen on breast magnetic resonance imaging (MRI). Materials and Methods A retrospective review of Breast Imaging Reporting and Data System (BIRADS) 4 or 5 lesions seen on breast MRI in 2008 that were clinically and mammographically occult yielded a final sample size of 73 lesions in 65 patients. Images were processed with in-house software. Parameters used to predict benignity/malignancy included SER total tumor volume (lesion volume above a 70% initial enhancement level), SER partial tumor volume (volume with “washout” and “plateau” kinetics), SER washout tumor volume, peak SER, and peak percent enhancement. Thresholds were determined to retrospectively discriminate benign from malignant histopathology. Clinical impact was assessed through the reduction in the number of biopsies recommended (by eliminating benign lesions discriminated by SER). Results Based on the original radiologist interpretations, 73 occult lesions were called suspicious and biopsied with a predictive value of biopsies (PPV3) of 18/73 (25%). SER parameters were found to be significantly associated with histopathology (P < .05). Biopsy recommendations could be reduced using SER parameters of SER partial tumor volume (73 to 40), SER total tumor volume (73 to 45), and peak percent enhancement (73 to 55) without removing true positives. Conclusion The adjunctive use of SER parameters may reduce the number of recommended biopsies without reducing the number of cancers detected.

Purpose To determine if MRI BI-RADS criteria or radiologist perception correlate with presence of invasive cancer after initial core biopsy of ductal carcinoma in situ (DCIS). Materials and Methods Retrospective search spanning 2000-2007 identified all core-biopsy diagnoses of pure DCIS that coincided with preoperative MRI. Two radiologists fellowship-trained in breast imaging categorized lesions according to ACR MRI-BIRADS lexicon and estimated likelihood of occult invasion. Semi-quantitative signal enhancement ratio (SER) kinetic analysis was also performed. Results were compared to histopathology. Results 51 consecutive patients with primary core biopsy-proven DCIS and concurrent MRI were identified. Of these, 13 patients (25%) had invasion at excision. Invasion correlated significantly with presence of a mass for both readers (p=0.012, 0.001), rapid initial enhancement for Reader 1 (p=0.001), and washout kinetics for Reader 2 (p=0.012). Significant correlation between washout and invasion was confirmed by SER (p=0.006) when threshold percent enhancement was sufficiently high (130%), corresponding to rapidly enhancing portions of the lesion. Radiologist perception of occult invasion was strongly correlated to true presence of invasion. Conclusion These results provide evidence that certain BI-RADS MRI criteria, as well as radiologist perception, correlate with occult invasion after an initial core biopsy of DCIS.

One-view-only findings occur with both FFDM and FFDM-DBT and remain an important but uncommon sign of malignancy. They are more frequent, are more likely to represent summation artifacts, and have a lower PPV with FFDM than with FFDM-DBT.

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