Abstract
ObjectivesTo evaluate the performance of MRI for diagnosis of breast cancer in non-calcified equivocal breast findings.Materials and MethodsWe performed a systematic review and meta-analysis of peer-reviewed studies in PubMed from 01/01/1986 until 06/15/2015. Eligible were studies applying dynamic contrast-enhanced breast MRI as an adjunct to conventional imaging (mammography, ultrasound) to clarify equivocal findings without microcalcifications. Reference standard for MRI findings had to be established by histopathological sampling or imaging follow-up of at least 12 months. Number of true or false positives and negatives and other characteristics were extracted, and possible bias was determined using the QUADAS-2 applet. Statistical analyses included data pooling and heterogeneity testing.ResultsFourteen out of 514 studies comprising 2,316 lesions met our inclusion criteria. Pooled diagnostic parameters were: sensitivity (99%, 95%-CI: 93–100%), specificity (89%, 95%-CI: 85–92%), PPV (56%, 95%-CI: 42–70%) and NPV (100%, 95%-CI: 99–100%). These estimates displayed significant heterogeneity (P<0.001).ConclusionsBreast MRI demonstrates an excellent diagnostic performance in case of non-calcified equivocal breast findings detected in conventional imaging. However, considering the substantial heterogeneity with regard to prevalence of malignancy, problem solving criteria need to be better defined.
Highlights
Breast is the most frequently affected organ by cancer in women [1]
Breast MRI demonstrates an excellent diagnostic performance in case of non-calcified equivocal breast findings detected in conventional imaging
Depending on whether healthy women are screened for breast cancer or whether assessment of symptomatic patients or screening findings is performed, mammography, breast ultrasound and percutaneous imageguided biopsies play a major role in diagnosis and to rule-out cancer [2,3,4]
Summary
Breast is the most frequently affected organ by cancer in women [1]. Imaging plays a major role in secondary and tertiary prevention of breast cancer. A variety of results are usually classified as such: asymmetry without associated microcalcifications, architectural distortions and other ambiguous abnormalities such as multiple lesions, discrepancy between clinical symptoms and imaging findings, benign biopsy results with insufficient radiological-pathological concordance, lesions that could not be sufficiently localized during biopsy attempts, as well as scars. In these instances, an additional imaging-based diagnostic test would be most welcome. Microcalcifications are considered less problematic, since these lesions can be visualized by mammography and the workup of these lesions either by biopsy or follow-up imaging does usually not require additional imaging modalities
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