Magnetic resonance imaging in diagnosis of indeterminate breast (BIRADS 3 & 4A) in a general population

Abstract

Objective Currently, mammography and ultrasonography are the most used imaging techniques for breast cancer screening. However, these examinations report many indeterminate studies with a low probability of being malignant, i.e., BIRADS 3 and 4A. This prospective study aims to evaluate the value of breast magnetic resonance imaging (MRI) to clarify the BIRADS categorization of indeterminate mammography or ultrasonography studies. Methods MRI studies acquired prospectively from 105 patients previously classified as BIRADS 3 or 4A were analyzed independently by four radiologists with different experience levels. Interobserver agreement was determined by the first-order agreement coefficient (AC1), and divergent results were re-analyzed for consensus. The possible correlation between the MRI and the mammography/ultrasound findings was evaluated, and each study was independently classified in one of the five BIRADS categories (BIRADS 1 to 5). In lesions categorized as BIRADS 4 or 5 at MRI, histopathological diagnosis was established by image-guided biopsy; while short-term follow-up was performed in lesions rated as BIRADS 3. Results Breast MRI was useful in diagnosing three invasive ductal carcinomas, upgraded from BIRADS 4A to BIRADS 5. It also allowed excluding malignancy in 86 patients (81.9%), avoiding 22 unnecessary biopsies and 64 short-term follow-ups. The MRI showed good diagnostic performance with the area under roc curve, sensitivity, specificity, PPV, and NPV of 0.995, 100%, 83.5%, 10.5%, and 100%, respectively. Conclusions MRI showed to be useful as a problem-solving tool to clarify indeterminate findings in breast cancer screening and avoiding unnecessary short-follow-ups and percutaneous biopsies.

Systematic analysis of changes in radiomics features during dynamic breast-MRI: Evaluation of specific biomarkers

“…In their cohort malignancy was excluded in 82% as only three additional carcinomas (3%) were diagnosed. 6 There were 149 BI-RADS 3 findings in our patient cohort. Although they showed characteristic contrast enhancement for fibroadenomas, all patients were recalled for a short-term follow-up examination, according to the BI-RADS guidelines.…”

Grade 3 invasive breast cancer masquerading as a hematoma—the importance of concordance in the clinical and imaging pathway

“…Other authors have also suggested MRI as a sensitive problem solving modality in indeterminate breast lesions. 13 …”