Can follow-up be avoided for probably benign US masses with no enhancement on MRI? Journal Article
| Authors: | Avendano, D.; Marino, M. A.; Onishi, N.; Leithner, D.; Martinez, D. F.; Gibbs, P.; Jochelson, M.; Pinker, K.; Morris, E. A.; Sutton, E. J. |
| Article Title: | Can follow-up be avoided for probably benign US masses with no enhancement on MRI? |
| Abstract: | Objectives: To assess whether no enhancement on pre-treatment MRI can rule out malignancy of additional US mass(es) initially assessed as BI-RADS 3 or 4 in women with newly diagnosed breast cancer. Methods: This retrospective study included consecutive women from 2010–2018 with newly diagnosed breast cancer; at least one additional breast mass (distinct from index cancer) assigned a BI-RADS 3 or 4 on US; and a bilateral contrast-enhanced breast MRI performed within 90 days of US. All malignant masses were pathologically proven; benign masses were pathologically proven or defined as showing at least 2 years of imaging stability. Incidence of malignant masses and NPV were calculated on a per-patient level using proportions and exact 95% CIs. Results: In 230 patients with 309 additional masses, 140/309 (45%) masses did not enhance while 169/309 (55%) enhanced on MRI. Of the 140 masses seen in 105 women (mean age, 54 years; range 28–82) with no enhancement on MRI, all had adequate follow-up and 140/140 (100%) were benign, of which 89/140 (63.6%) were pathologically proven and 51/140 (36.4%) demonstrated at least 2 years of imaging stability. Pre-treatment MRI demonstrating no enhancement of US mass correlate(s) had an NPV of 100% (95% CI 96.7–100.0). Conclusions: All BI-RADS 3 and 4 US masses with a non-enhancing correlate on pre-treatment MRI were benign. The incorporation of MRI, when ordered by the referring physician, may decrease unnecessary follow-up imaging and/or biopsy if the initial US BI-RADS assessment and management recommendation were to be retrospectively updated. Key Points: • Of 309 BI-RADS 3 or 4 US masses with a corresponding mass on MRI, 140/309 (45%) demonstrated no enhancement whereas 169/309 (55%) demonstrated enhancement • All masses classified as BI-RADS 3 or 4 on US without enhancement on MRI were benign • MRI can rule out malignancy in non-enhancing US masses with an NPV of 100%. © 2020, European Society of Radiology. |
| Keywords: | adult; controlled study; aged; retrospective studies; major clinical study; histopathology; cancer patient; nuclear magnetic resonance imaging; follow up; follow-up studies; magnetic resonance imaging; cancer diagnosis; diagnostic accuracy; breast cancer; breast; phyllodes tumor; echomammography; retrospective study; ultrasound; confidence interval; contrast enhancement; breast carcinoma; cancer size; physician; predictive value; lobular carcinoma in situ; breast fibroadenoma; breast hyperplasia; breast fibrosis; breast papilloma; atypical ductal hyperplasia; diagnostic test accuracy study; breast neoplasm; fibrocystic breast disease; breast imaging reporting and data system; human; female; priority journal; article; benign breast tumor; gadobutrol; breast carcinoma in situ; breast adenoma |
| Journal Title: | European Radiology |
| Volume: | 31 |
| Issue: | 2 |
| ISSN: | 0938-7994 |
| Publisher: | Springer |
| Date Published: | 2021-02-01 |
| Start Page: | 975 |
| End Page: | 982 |
| Language: | English |
| DOI: | 10.1007/s00330-020-07216-7 |
| PUBMED: | 32870394 |
| PROVIDER: | scopus |
| PMCID: | PMC7855658 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 March 2021 -- Source: Scopus |
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