Reading Protocol for Dynamic Contrast-enhanced MR Images of the Breast: Sensitivity and Specificity Analysis

Warren, Ruth; Pointon, Linda; Thompson, Deborah J.; Hoff, Rebecca; Gilbert, Fiona J.; Padhani, Anwar R.; Easton, Doug; Lakhani, Sunil R.; Leach, Martin O.

doi:10.1148/radiol.2363040735

Cited by 104 publications

(67 citation statements)

References 16 publications

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“…The effect of double reading of the MR examinations was evaluated in a population of screening examinations mixed with symptomatic cases [35]. The double reading policy achieved a higher sensitivity: 84% with single reading and 91% with double reading, but at costs of higher recall and biopsy rate.…”

Section: Discussionmentioning

confidence: 99%

Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition

Obdeijn

Loo

Rijnsburger

et al. 2009

Breast Cancer Res Treat

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In order to assess the characteristics of malignant breast lesions those were not detected during screening by MR imaging. In the Dutch MRI screening study (MRISC), a non-randomized prospective multicenter study, women with high familial risk or a genetic predisposition for breast cancer were screened once a year by mammography and MRI and every 6 months with a clinical breast examination (CBE). The false-negative MR examinations were subject of this study and were retrospectively reviewed by two experienced radiologists. From November 1999 until March 2006, 2,157 women were eligible for study analyses. Ninety-seven malignant breast tumors were detected, including 19 DCIS (20%). In 22 patients with a malignant lesion, the MRI was assessed as BI-RADS 1 or 2. One patient was excluded because the examinations were not available for review. Forty-three percent (9/21) of the false-negative MR cases concerned pure ductal carcinoma in situ (DCIS) or DCIS with invasive foci, in eight of them no enhancement was seen at the review. In six patients the features of malignancy were missed or misinterpreted. Small lesion size (n = 3), extensive diffuse contrast enhancement of the breast parenchyma (n = 2), and a technically inadequate examination (n = 1) were other causes of the missed diagnosis. A major part of the false-negative MR diagnoses concerned non-enhancing DCIS, underlining the necessity of screening not only with MRI but also with mammography. Improvement of MRI scanning protocols may increase the detection rate of DCIS. The missed and misinterpreted cases are reflecting the learning curve of a multicenter study.

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Section: Discussionmentioning

confidence: 99%

Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition

Obdeijn

Loo

Rijnsburger

et al. 2009

Breast Cancer Res Treat

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“…Dynamic contrast-enhanced breast MR imaging (DCE-MRI) has been reported to have high sensitivity for cancer detection, reportedly as high as 88%-100%, but specificity may be relatively low as 68%-96% (4 -6,8,9). The high diagnostic value of the time-intensity curve (TIC) derived from DCE-MRI has been well documented in past studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Moreover, MR imaging has recently been used to analyze combined morphologic characteristics and kinetic enhancement patterns of breast lesions, and a combination of these parameters shows high positive predictive value (8,9).…”

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confidence: 98%

“…MAGNETIC RESONANCE IMAGING (MRI) of the breast is increasingly used as an important tool for detecting breast cancer or preoperative diagnosis of breast cancer to determine the area of tumor spreading or to find additional lesions (1)(2)(3)(4)(5)(6)(7). Dynamic contrast-enhanced breast MR imaging (DCE-MRI) has been reported to have high sensitivity for cancer detection, reportedly as high as 88%-100%, but specificity may be relatively low as 68%-96% (4 -6,8,9).…”

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confidence: 99%

Enhanced mass on contrast‐enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast‐enhanced and diffusion‐weighted MR images

Yabuuchi

Matsuo

Okafuji

et al. 2008

Magnetic Resonance Imaging

176

166

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Purpose:To evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in characterization of enhanced mass on breast MR imaging and to find the strongest discriminators between carcinoma and benignancy. Materials and Methods:We analyzed consecutive breast MR images in 270 patients; however, 13 lesions in 93 patients were excluded based on our criteria. We analyzed tumor size, shape, margin, internal mass enhancement, kinetic curve pattern, and apparent diffusion coefficient (ADC) values. We applied univariate and multivariate analyses to find the strongest indicators of malignancy and calculate a predictive probability for malignancy. We added the corresponding categories to these prediction probabilities for malignancy and calculated diagnostic accuracy when we consider category 4b, 4c, and 5 lesions as malignant and category 4a, 3, and 2 lesions as benign. In a validation study, 75 enhancing lesions in 71 patients were examined consecutively.Results: Irregular margin, heterogeneous internal enhancement, rim enhancement, plateau time-intensity curve (TIC) pattern, and washout TIC pattern were the strongest indicators of malignancy as well as past studies, and ADC values less than 1.1 ϫ 10 Ϫ3 mm 2 /s were also the strongest indicators of malignancy. In a validation study, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92% (56/61), 86% (12/14), 97% (56/58), 71% (12/17), and 91% (68/75), respectively. Conclusion:The combination of DWI and DCE-MRI could produce high diagnostic accuracy in the characterization of enhanced mass on breast MR imaging.

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“…Dynamic contrast-enhanced (DCE) imaging has high sensitivity, and it is the most proposed breast MRI method. However, this method is time consuming, needs contrast injection, has moderate specificity, and is relatively difficult to evaluate (10)(11)(12). DCE MRI evaluation of all low-risk lesions recommended for biopsy would not be cost effective.…”

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confidence: 99%

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

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T he Breast Imaging Reporting and Data Systems (BI-RADS) lexicon (1) of AmericanCollege of Radiology (ACR) provides an efficient and standardized assessment and management of breast lesions. It also stratifies breast cancer risk for a given lesion by classifying them into categories 1 through 5 according to the degree of suspicion.According to this system, solid masses with a circumscribed margin, oval shape (including those with two or three gentle lobulations) and parallel orientation on ultrasonography (US) exam are classified as BI-RADS 3. These types of masses are commonly seen at diagnostic and screening examinations. In this category malignancy is highly unlikely (less than 2%) and a short interval follow-up is recommended (1). However, up to one-third of such masses undergo biopsy mainly because of radiologist, referring clinician, or patient concern about the substantial risk of malignancy (2-4). Many BI-RADS 3 masses are traditionally referred for biopsy if they are palpable, large in size, patient is of advanced age or has a positive family history for breast cancer.The BI-RADS 4 assessment is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy. This category is largely indeterminate and highly variable in outcome. Breast lesions in this category carry 2% to 95% risk for malignancy (1). Thus, almost all recommendations for breast biopsies come from assessments made using this category. According to BI-RADS classification; category 4 is subgrouped as 4A, 4B, and 4C to better inform the clinicians, pathologists, and patients of the degree of concern. However, the criteria for distinguishing among these subcategories have not been well delineated. BI-RADS 4A designates lesions with a low suspicion for malignancy. In this group, a benign pathologic diagnosis is expected and considered concordant (1). Studies of several institutions by the use of their internal criteria revealed positive predictive value (PPV) of 7%-9% for 4A lesions, and more than 50% of the suspicious lesions fall into this category. On the other hand, BI-RADS 4B and 4C 287From the Department of Radiology (S.K.  sibel_ozy@ yahoo.com) Karadeniz Technical University, School of Medicine, Trabzon, Turkey. BREAST IMAGING ORIGINAL ARTICLE PURPOSE We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates. METHODSAfter institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging charact...

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Reading Protocol for Dynamic Contrast-enhanced MR Images of the Breast: Sensitivity and Specificity Analysis

Cited by 104 publications

References 16 publications

Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition

Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition

Enhanced mass on contrast‐enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast‐enhanced and diffusion‐weighted MR images

Can unenhanced breast MRI be used to decrease negative biopsy rates?

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