To explore and evaluate new malignant predictors of breast non-mass enhancement lesions using the new BI-RADS MRI lexicon.
METHODS:
A dataset involving 422 consecutive women underwent breast 3.0 T MRI between January 2014 and July 2016 was assembled for this study. Each case was retrospectively reviewed by 3 radiologists. Eighty-four lesions that present non-mass enhancement in 79 patients were identified in the study. Dynamic contrast-enhanced MRI features were analyzed using univariate and multivariate analyses to identify significant indicators of malignancy.
RESULTS:
Of 84 non-mass enhancement lesions, 52 (61.9%) were malignant and 32 (38.1%) were benign. Segmental distribution (P = 0.015 from univariate analysis; OR = 4.739, P = 0.008 from multivariate analysis), cluster ring enhancement (P = 0.017 from univariate analysis; OR = 3.601, P = 0.032 from multivariate analysis), time-intensity curve of plateau (P = 0.002 from univariate analysis; OR = 3.525, P = 0.027 from multivariate analysis) and phase to peak (P = 0.06 from univariate analysis; OR = 6.327, P = 0.015 from multivariate analysis) were significantly different between malignant and benign lesions.
CONCLUSIONS:
This study demonstrated that segmental distribution, clustered ring enhancement, and short time to peak could act as new malignant predictors for breast non-mass enhancement detected on 3.0 T MRI.
American College of Radiology (ACR), Breast imaging reporting and data system (BI-RADS). 4th edition. American College of Radiology, Reston (VA); 2003.
2.
AgrawalG., SuM.Y., NalciogluO., FeigS.A. and ChenJ.H., Significance of breast lesion descriptors in the ACR BI-RADS MRI lexicon, Cancer115 (2009), 1363–1380.
3.
SohnsC., ScherrerM., StaabW. and ObenauerS., Value of the BI-RADS classification in MR-mammography for diagnosis of benign and malignant breast tumors, Eur Radiol21 (2011), 2475–2483.
4.
RaoA.A., FeneisJ., LalondeC. and Ojeda-FournierH., A pictorial review of changes in the BI-RADS fifth edition, Radiographics36 (2016), 623–639.
5.
SchnallM.D., BlumeJ., BluemkeD.A., DeAngelisG.A., DeBruhlN., HarmsS., et al., Diagnostic architectural and dynamic features at breast MRI imaging: Multicenter study, Radiology238 (2006), 42–53.
6.
BartellaL., LibermanL., MorrisE.A. and DershawD.D., Nonpalpable mammographically occult invasive breast cancers detected by MRI, AJR Am J Roentgenol186 (2006), 865–870.
7.
GutierrezR.L., DeMartiniW.B., EbyP.R., KurlandB.F., PeacockS. and LehmanC.D., BI-RADS lesion characteristics predict likelihood of malignancy in breast MRI for masses but not for nonmasslike enhancement, AJR Am J Roentgenol193 (2009), 994–1000.
8.
NewellD., NieK., ChenJ.H., HsuC.C., YuH.J., NalciogluO. and SuM.Y., Selection of diagnostic features on breast MRI to differentiate between malignant and benign lesions using computer-aided diagnosis: Differences in lesions presenting as mass and non-mass-like enhancement, Eur Radiol20 (2010), 771–781.
9.
WilhelmA., McDonoughM.D. and DePeriE.R., Malignancy rates of non-mass like enhancement on breast magnetic resonance imaging using American College of Radiology Breast Imaging Reporting and Data System descriptors, Breast J18 (2012), 523–526.
10.
YabuuchiH., MatsuoY., KamitaniT., SetoquchiT., OkafujiT., SoedaH., et al., Non-mass-like enhancement on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images, Eur J Radiol75 (2010), e126–e132.
11.
UematsuT. and KasamiM., High-spatial-resolution 3-T breast MRI of nonmasslike enhancement lesions: An analysis of their features as significant predictors of malignancy, AJR Am J Roentgenol198 (2012), 1223–1230.
12.
KuhlC.K., Breast MR imaging at 3T, Magn. Reson. Imaging Clin N Am15 (2007), 315–320.
13.
ChatterjiM., MercadoC.L. and MoyL., Optimizing 1.5-Tesla and 3-Tesla dynamic contrast-enhanced magnetic resonance imaging of the breasts, Magn Reson Imaging Clin N Am18 (2010), 207–224.
14.
American College of Radiology (ACR), Breast imaging reporting and data system. 5th edition, American College of Radiology. Reston (VA); 2013.
15.
ShinK., PhalakK., HamameA. and WhitmanG.J., Interpretation of breast MRI utilizing the BI-RADS fifth edition lexicon: How are we doing and where are we headed?Curr Probl Diagn Radiol46 (2017), 26–34.
16.
TozakiM. and FukudaK., High-spatial-resolution MRI of non-mass like breast lesions: Interpretation model based on BI-RADS MRI descriptors, AJR Am J Roentgenol187 (2006), 330–337.
17.
KuhlC.K., MielcarekP., KlaschikS., LeutnerC., WardelmannE., GiesekeJ., et al., Are signal time course data useful for differential diagnosis of enhancing lesion in dynamic breast MR imaging?, Radiology211 (1999), 101–110.
18.
GiessC.S., YehE.D., RazaS. and BirdwellR.L., Background parenchymal enhancement at breast MR Imaging: Normal patterns, diagnostic challenges, and potential for false-positive and false-negative interpretation, RadioGraphics34 (2014), 234–247.
19.
KuhlC.K., The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice, Radiology244 (2007), 356–378.
20.
Thomassin-NaggaraI., TropI., ChopierJ., DavidJ., LalondeL., DaraiE., et al., Non-masslike enhancement at breast MR imaging: The added value of mammography and US for lesion categorization, Radiology261 (2011), 69–79.
21.
ChenJ.H., LiuH., BaekH.M., NalciogluO. and SuM.Y., Magnetic resonance imaging features of fibrocystic change of the breast, Magn Reson Imaging26 (2008), 1207–1214.
22.
YuenS., UematsuT., MasakoK., UchidaY. and NishimuraT., Segmental enhancement on breast MR images: Differential diagnosis and diagnostic strategy, Eur Radiol18 (2008), 2067–2075.
23.
Morakkabati-SpitzN., LeutnerC., SchildH., TraeberF. and KuhlC.K., Diagnostic usefulness of segmental and linear enhancement in dynamic breast MRI, Eur Radiol15 (2005), 2010–2017.
24.
LibermanL., MorrisE.A., KimC.M., KaplanJ.B., AbramsonA.F., MenellJ.H., et al., MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer, AJR Am J Roentgenol180 (2003), 333–341.
25.
ChoY.H., ChoK.R., ParkE.K., SeoB.K., WooO.H., SungB.C., et al., Significance of additional non-mass enhancement in patients with breast cancer on preoperative 3T dynamic contrast enhanced MRI of the breast, Iran J Radiol13 (2016), e30909.
26.
BluemkeD.A., GatsonisC.A., ChenM.H., ChenM.H., DeAngelisG.A., DeBruhlN., et al., Magnetic resonance imaging of the breast prior to biopsy, JAMA292 (2004), 2735–2742.
27.
SzaboB.K., AspelinP., WibergM.K. and BoneB., Dynamic MR imaging of the breast. Analysis of kinetic and morphologic diagnostic criteria, Acta Radiol44 (2003), 379–386.
