Foci on breast magnetic resonance imaging in high-risk women: cancer or not?

Abstract

PurposeTo assess how frequently foci are identified on MRI in high-risk patients, and their association with malignancy, breast density, and background parenchymal enhancement (BPE).Materials and methodsIn this multicentric study, two readers, in consensus, retrospectively reviewed screening breast MRI of 245 high-risk women, performed between 2009 and 2014. Eligible patients had at least two consecutive screening MRI, and a follow-up of at least 1 year after a lesion was first detected; histology was available for all suspicious findings. Breast density, BPE (both using BI-RADS lexicon), presence, and changes at follow-up for foci were evaluated. Clinical history of the patients was reviewed. Chi-square test was used to define significant correlations.Results166 women (mean age 43 years), who underwent a median of 4 MRI (range 2–6) during the study period, were included. 68 foci were found in 58 women [34.9 %, 95 % confidence interval (CI) 28.1–42.5 %]. Foci were more frequent in dense breasts (P = 0.079) and with moderate or marked BPE (P < 0.001). During follow-up, two foci increased in size (2.9 %, 95 % CI 0.8–10.1 %) and at biopsy, a cancer was found (1 high-grade ductal carcinoma in situ, 1 tubular carcinoma). Breast cancer was diagnosed in the other three cases, not initially appearing as foci, and it was more frequent in women with dense breasts (P = 0.04); no correlation between cancer and BPE was found (P = 0.145).ConclusionsFoci are relatively frequent in screening MRI, and they are usually benign. An increase in size is the most reliable criteria to suspect malignancy.

Enhanced Masses on Contrast‐Enhanced Breast: Differentiation Using a Combination of Dynamic Contrast‐Enhanced MRI and Quantitative Evaluation with Synthetic MRI

“…Thus, the characterization of nonmass enhancement and foci is important. However, a standardized classification scheme for the interpretation of lesions showing nonmass‐like enhancement does not exist, and the best management of foci remains under discussion 5,38 . In the future, we would like to continue investigating the utility of synthetic MRI to differentiate benign from malignant lesions in patients with nonmass enhancement and foci.…”

Motion artifacts, lesion type, and parenchymal enhancement in breast MRI: what does really influence diagnostic accuracy?

“…Although none of the lesions was defined as a focus, and the mean lesion size was relatively large, we did analyze lesions in the range of 3-10 mm separately and we found that size can reduce the sensitivity of MRI. Foci were either classified as BPE, or as BI-RADS 3, and sent to control due to the low rate of malignancy for foci (28). As only histologically verified lesions were included in our analysis, no focus was included in the study.…”

A machine learning approach for differentiating malignant from benign enhancing foci on breast MRI

“…might be difficult to further characterise. These small findings were defined by the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) as enhancing foci [7]. Depending on the spatial resolution, it is difficult to evaluate their morphology and dynamic behaviour, while the small size makes difficult to perform MRI-guided needle biopsy, so that their changes are commonly longitudinally monitored with serial examinations to reach a conclusive diagnosis [8].…”