Open AccessMagnetic Resonance Imaging of the Breast as a Problem‐solving Method: To Be or Not to Be?
Author(s) -
Oztekin Pelin Seher,
Kosar Pinar Nercis
Publication year - 2014
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/tbj.12334
Subject(s) - medicine , malignancy , radiology , magnetic resonance imaging , mammography , breast cancer , biopsy , breast imaging , abnormality , breast mri , bi rads , ultrasound , retrospective cohort study , physical examination , population , medical record , cancer , surgery , pathology , environmental health , psychiatry
Abstract The use of dynamic magnetic resonance imaging ( MRI ) of the breast as a complementary problem‐solving tool was explored in a heterogeneous population sample. A total of 3,076 patients that underwent breast MRI examination between J anuary 2008 and J une 2012 in our center were screened retrospectively. Of these, 868 met the following inclusion criteria and were considered eligible for the study: available data on clinical signs, symptoms and on the results of mammography and ultrasound examinations in medical records; at least 1 year of follow‐up; and documented pathology findings. Lesions with a stable course over a follow‐up period of at least 12 months were considered benign. MRI was suggestive of a suspicious abnormality ( BI ‐ RADS 4) or highly suggestive of malignancy ( BI ‐ RADS 5) in 129 (15%) of 868 patients, leading to a biopsy examination in these cases. On the other hand, MRI findings were considered normal in 739 (85%) subjects based on normal ( BI ‐ RADS 1), benign ( BI ‐ RADS 2) or probably benign ( BI ‐ RADS 3) findings. Of the 129 patients undergoing a histopathologic examination based on MRI findings, 63 were diagnosed with cancer, and in 66, the biopsy proved to be benign. Forty of the 63 patients (40/63) with a diagnosis of malignancy and 34 of the 66 patients (34/66) with a benign diagnosis had been categorized as BI ‐ RADS 4 with conventional methods. A total of 23 patients with BI ‐ RADS category of 0 to 3 according to conventional methods were diagnosed as having cancer with MRI. In six of these, the family history was positive. The sensitivity, specificity, positive predictive value, and negative predictive value ( NPV ) of MRI for the detection of cancer were 100%, 92%, 52%, and 100%, respectively. In cases with inconclusive findings on conventional imaging studies or in patients with clinical/radiological suspicion of malignancy, MRI should be more effectively used as a problem‐solving approach owing to its high sensitivity and NPV in this condition. Use of MRI as a problem‐solving method in such cases may decrease rather than increase unnecessary biopsy procedures and patient anxiety.