Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size Journal Article
| Authors: | Liberman, L.; Mason, G.; Morris, E. A.; Dershaw, D. D. |
| Article Title: | Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size |
| Abstract: | OBJECTIVE. The purpose of this study was to determine the impact of lesion size on the positive predictive value (PPV) of biopsy in MRI-detected breast lesions. MATERIALS AND METHODS. A retrospective review was performed of 666 consecutive nonpalpable, mammographically occult lesions that had MRI-guided localization. MRI examinations were performed using a 1.5-T magnet. Lesions were measured by the interpreting radiologist before biopsy. Malignancy rate versus lesion size was determined. RESULTS. The median MRI lesion size was 1 cm (range, 0.3-7.0 cm). Malignancy was present in 149/666 (22%) lesions, of which 80 (54%) were ductal carcinoma in situ (DCIS), 66 (44%) were invasive cancer, and three (2%) were lymphoma. The frequency of malignancy increased significantly (p = 0.0005) with lesion size, with malignancy found in one (3%) of 37 lesions less than 5 mm, 44 (17%) of 254 lesions 5-9 mm, 37 (25%) of 151 lesions 10-14 mm, 21 (28%) of 74 lesions 15-19 mm, and 46 (31%) of 150 lesions 20 mm or larger. Lesions less than 5 mm accounted for 37 (6%) of 666 lesions that had a biopsy and one (< 1%) of 149 cancers (one DCIS). Among lesions less than 10 mm, the likelihood of malignancy was highest in postmenopausal women (22% malignant) and in the extent of disease setting (22% malignant), and lowest in premenopausal women (10% malignant) and in the high-risk screening setting (10% malignant). CONCLUSION. The PPV of biopsy for lesions identified at breast MRI using a 1.5-T magnet significantly increased with increasing lesion size. Biopsy is rarely necessary for lesions smaller than 5 mm because of their low (3%) likelihood of cancer. Further work is needed to develop an algorithm that uses size in addition to other patient and lesion factors to guide biopsy recommendations for MRI-detected breast lesions. © American Roentgen Ray Society. |
| Keywords: | adult; aged; middle aged; retrospective studies; major clinical study; nuclear magnetic resonance imaging; methodology; magnetic resonance imaging; breast cancer; breast; tumor volume; cancer screening; tumor biopsy; pathology; breast neoplasms; retrospective study; high risk patient; cancer invasion; radiologist; breast imaging; mammography; biopsy, needle; breast tumor; breast carcinoma; carcinoma in situ; needle biopsy; prediction and forecasting; predictive value of tests; neoplasm invasiveness; age distribution; premenopause; postmenopause; paget nipple disease; mri; breast biopsy; breast lesion; carcinoma, ductal, breast; oncologic imaging |
| Journal Title: | American Journal of Roentgenology |
| Volume: | 186 |
| Issue: | 2 |
| ISSN: | 0361-803X |
| Publisher: | American Roentgen Ray Society |
| Date Published: | 2006-02-01 |
| Start Page: | 426 |
| End Page: | 430 |
| Language: | English |
| DOI: | 10.2214/ajr.04.1707 |
| PUBMED: | 16423948 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 59" - "Export Date: 4 June 2012" - "CODEN: AJROA" - "Source: Scopus" |
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