Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis

Abstract

Dynamic contrast-enhanced breast magnetic resonance (MR) is a promising emerging technique for evaluating breast lesions. A quantitative systematic review was performed to estimate the accuracy of breast MR in the diagnosis of high-risk breast lesions and breast cancer. A comprehensive search of the Cochrane Library, MEDLINE, CANCERLIT, LILACS, and EMBASE databases was performed from January 1985 to August 2010. The medical subjects heading (MeSH) and text words for the terms "breast neoplasm", "breast lesions", "breast cancer" and "magnetic resonance" were combined with the MeSH term diagnosis ("sensitivity and specificity"). Studies that compared breast MR with paraffin-embedded sections parameters for the diagnosis of breast lesions (benign, high-risk borderline, and breast cancer) were included. Sixty-nine studies were analyzed, which included 9,298 women with 9,884 breast lesions. Interrater overall agreement between breast MR and paraffin section diagnosis was 79% (κ = 0.55), indicating moderate agreement. Pooled sensitivity and specificity were 90% [95% CI 88-92%] and 75% [95% CI 70-79%], respectively. The pooled likelihood positive ratio was 3.64 (95% CI 3.0-4.2) and the negative ratio was 0.12 (95% CI 0.09-0.15). For breast cancer or high-risk lesions versus benign lesions, the AUC was 0.91 for breast MR and the point Q* was 0.84. In summary, breast MR is a useful pre-operative test for predicting the diagnosis of breast lesions.

MRI of the breast in patients with DCIS to exclude the presence of invasive disease

“…The sensitivity of MRI has been reported to vary between 90% and 94% in larger studies and meta-analyses [18,19]. However, MRI of the breast in patients with DCIS is not routinely performed.…”

Characterization of breast masses as benign or malignant at 3.0T MRI with whole-lesion histogram analysis of the apparent diffusion coefficient

“…Particularly, dynamic contrast‐enhanced MRI (DCE‐MRI) is an important MRI sequence for the characterization and classification of benign and malignant lesions through assessment of morphologic characteristics and kinetic enhancement patterns . However, DCE‐MRI has a high false‐positive rate due to the background parenchymal enhancement and the overlap of kinetic enhancement patterns, often leading to unnecessary biopsies …”

Whole-lesion apparent diffusion coefficient (ADC) metrics as a marker of breast tumour characterization—comparison between ADC value and ADC entropy

“…However, its suboptimal specificity (reportedly around 75%) imposes a significant setback, particularly in patients referred for evaluation of inconclusive findings on clinical examination and conventional breast imaging. 14,15 DWI provides a non-contrast mechanism in MRI and has a high sensitivity in the detection of changes in the microscopic cellular local biologic environment. 1,[16][17][18][19][20] Its effectiveness stems from the inverse correlation between the tumour cellularity and the ADC metrics.…”