MRI and comparison mammography: a worthy diagnostic alliance for breast microcalcifications?

Abstract

Background

There is a lack of data concerning diagnostic performance of magnetic resonance imaging (MRI) in patients with new or increasing microcalcifications.

Purpose

To evaluate suspicious microcalcifications by using comparison mammography, MRI, and a combination of both methods.

Material and Methods

Our study group consisted of 55 patients with mammographically detected BI-RADS (Breast Imaging Reporting and Data System) 3–5 microcalcifications for whom comparison mammograms were available. All patients underwent breast MRI before SVAB (stereotactic vacuum-assisted biopsy). Diagnostic performances of comparison mammography and MRI were evaluated, as well as the combination of the respective imaging findings.

Results

Of the 55 microcalcification cases, 35 showed progression and 20 were stable between interval screenings. The negative predictive value (NPV) of comparison mammography was 100%, whereas the NPV of MRI was 92%. However, the specificity of combination of findings was 97%, significantly higher than the 42% specificity of comparison mammography (P < 0.001). Additionally, the positive predictive value of combination of findings was 93% versus 44% of comparison mammography (P = 0.001).

Conclusion

A biopsy is recommended when MRI positive lesion corresponding the area of new or increasing mammographic microcalcifications is detected. Patients with stable microcalcifications can continue follow-up mammography, regardless of MRI result.

Keywords

Magnetic resonance imaging (MRI)comparison mammography microcalcifications descriptors stability

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References

Gajdos

Tartter

Bleiweiss

. Mammographic appearance of nonpalpable breast cancer reflects pathologic characteristics. Ann Surg 2002; 235: 246–251.

Bluekens

Holland

Karssemeijer

. Comparison of digital screening mammography and screen-film mammography in the early detection of clinically relevant cancers: a multicenter study. Radiology 2012; 265: 707–714.

Stomper

Connolly

Meyer

. Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation. Radiology 1989; 172: 235–241.

Burnside

Ochsner

Fowler

. Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology 2007; 242: 388–395.

Bent

Bassett

D’Orsi

. The positive predictive value of BI-RADS microcalcification descriptors and final assessment categories. Am J Roentgenol 2010; 194: 1378–1383.

Shin

Kim

. BI-RADS descriptors for mammographically detected microcalcifications verified by histopathology after needle-localized open breast biopsy. Am J Roentgenol 2010; 195: 1466–1471.

Youk

Son

Kim

. Scoring system based on BI-RADS lexicon to predict probability of malignancy in suspicious microcalcifications. Ann Surg Oncol 2012; 19: 1491–1498.

Kettritz

Morack

Decker

. Stereotactic vacuum-assisted breast biopsies in 500 women with microcalcifications: radiological and pathological correlations. Eur J Radiol 2005; 55: 270–276.

American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS), Reston, VA: ACR, 2003.

10.

Lev-Toaff

Feig

Saitas

. Stability of malignant breast microcalcifications. Radiology 1994; 192: 153–156.

11.

American College of Radiology. Practice Guideline for the performance of screening and diagnostic mammography, Reston, VA: ACR, 2013.

12.

Bazzocchi

Zuiani

Panizza

. Contrast-enhanced breast MRI in patients with suspicious microcalcifications on mammography: results of a multicenter trial. Am J Roentgenol 2006; 186: 1723–1732.

13.

Akita

Tanimoto

Jinno

. The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography? Eur Radiol 2009; 19: 2089–2096.

14.

Cilotti

Iacconi

Marini

. Contrast-enhanced MR imaging in patients with BI-RADS microcalcifications. Radiol Med 2007; 112: 272–286.

15.

Fiaschetti

Pistolese

Perretta

. 3-5 BI-RADs microcalcifications: correlation between MRI and histological findings. ISRN Oncol 2011; 2011: 643890–643890.

16.

Stehouwer

Merckel

Verkooijen

. 3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography. Eur Radiol 2014; 24: 603–609.

17.

Kuhl

. Current status of breast MR imaging. Part 2. Clinical applications. Radiology 2007; 244: 672–691.

18.

Iglesias

Arias

Santiago

. Benign breast lesions that simulate malignancy: magnetic resonance imaging with radiologic-pathologic correlation. Curr Probl Diagn Radiol 2007; 36: 66–82.

19.

American College of Radiology ACR BI-RADS. Magnetic Resonance Imaging. In: ACR Breast Imaging and Data System, Breast Imaging Atlas, Reston, VA: ACR, 2003, pp. 1–109.

20.

Bombonati

Sqroi

. The molecular pathology of breast cancer progression. J Path 2011; 223: 307–317.

21.

Jansen

Paunesku

Fan

. Ductal carcinoma in situ: X-ray fluorescence microscopy and dynamic contrast-enhanced MR imaging reveals gadolinium uptake within neoplastic mammary ducts in a murine model. Radiology 2009; 253: 399–406.

22.

Kuhl

Schrading

Bieling

. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 2007; 370: 485–492.

23.

Chan S, Chen JH, Agrawal G, et al. Characterization of pure ductal carcinoma in situ on dynamic contrast-enhanced MR imaging: do nonhigh grade and high grade show different imaging features? J Oncol 2010;2010:431341.

24.

Martinchich

Faivre-Pierret

Zechmann

. Multicenter, double-blind, randomized, intraindividual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine for breast MR imaging (DETECT Trial). Radiology 2011; 258: 396–408.

25.

Millet

Pages

Hoa

. Pearls and pitfalls in breast MRI. Br J Radiol 2012; 85: 197–207.

26.

Demartini

Kalish

Peacock

. Screening MRI for high risk women: should patients with a treated personal history of breast cancer be screened? Paper presented at: Radiologic Society of North America; November 28, 2010, Chicago, IL: Radiological Society of North America, 2010.