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Magnetic Resonance Imaging–Directed Ultrasound Imaging of Non‐Mass Enhancement in the Breast: Outcomes and Frequency of Malignancy
Author(s) -
Newburg Adrienne R.,
Chhor Chloe M.,
Young Lin Leng Leng,
Heller Samantha L.,
Gillman Jennifer,
Toth Hildegard K.,
Moy Linda
Publication year - 2017
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.16.03001
Subject(s) - medicine , magnetic resonance imaging , biopsy , malignancy , radiology , retrospective cohort study , breast cancer , ultrasound , cancer , concordance , pathology
Objectives This study was performed to determine the frequency, predictors, and outcomes of ultrasound (US) correlates for non‐mass enhancement. Methods From January 2005 to December 2011, a retrospective review of 5837 consecutive breast magnetic resonance imaging examinations at our institution identified 918 non‐mass enhancing lesions for which follow‐up or biopsy was recommended. Retrospective review of the images identified 879 of 918 lesions (96%) meeting criteria for non‐mass enhancement. Patient demographics, pathologic results, and the presence of an adjacent landmark were recorded. Targeted US examinations were recommended for 331 of 879 cases (38%), and 284 of 331 women (86%) underwent US evaluations. Results The US correlate rate for non‐mass enhancement was 23% (64 of 284). An adjacent landmark was significantly associated with a US correlate ( P < .001). Biopsy was recommended for 43 of 64 correlates (67%). Ultrasound‐guided biopsy was performed on 39 of 43 (91%); 7 of 39 (18%) were malignant. No correlate was seen for 220 of 284 lesions (77%). At magnetic resonance imaging–guided biopsy, 14 of 117 (12%) were malignancies. For all biopsied non‐mass enhancements, the malignancy rate was 18% (55 of 308) and was significantly more prevalent in the setting of a known index cancer ( P < .001), older age ( P < .001), the presence of a landmark ( P = .002), and larger lesion size ( P = .019). Conclusions Non‐mass enhancement with an adjacent landmark is more likely to have a US correlate compared to non‐mass enhancement without an adjacent landmark. Non‐mass enhancement in the setting of a known index cancer, older age, a landmark, and larger lesion size is more likely to be malignant. However, no statistical difference was detected in the rate of malignancy between non‐mass enhancement with (18%) or without (12%) a correlate. Absence of a correlate does not obviate the need to biopsy suspicious non‐mass enhancement.