Abstract
ObjectiveCurrently, mammography and ultrasonography are the most used imaging techniques for breast cancer screening. However, these examinations report many indeterminate studies with a low probability of being malignant, i.e., BIRADS 3 and 4A. This prospective study aims to evaluate the value of breast magnetic resonance imaging (MRI) to clarify the BIRADS categorization of indeterminate mammography or ultrasonography studies.MethodsMRI studies acquired prospectively from 105 patients previously classified as BIRADS 3 or 4A were analyzed independently by four radiologists with different experience levels. Interobserver agreement was determined by the first-order agreement coefficient (AC1), and divergent results were re-analyzed for consensus. The possible correlation between the MRI and the mammography/ultrasound findings was evaluated, and each study was independently classified in one of the five BIRADS categories (BIRADS 1 to 5). In lesions categorized as BIRADS 4 or 5 at MRI, histopathological diagnosis was established by image-guided biopsy; while short-term follow-up was performed in lesions rated as BIRADS 3.ResultsBreast MRI was useful in diagnosing three invasive ductal carcinomas, upgraded from BIRADS 4A to BIRADS 5. It also allowed excluding malignancy in 86 patients (81.9%), avoiding 22 unnecessary biopsies and 64 short-term follow-ups. The MRI showed good diagnostic performance with the area under roc curve, sensitivity, specificity, PPV, and NPV of 0.995, 100%, 83.5%, 10.5%, and 100%, respectively.ConclusionsMRI showed to be useful as a problem-solving tool to clarify indeterminate findings in breast cancer screening and avoiding unnecessary short-follow-ups and percutaneous biopsies.
Highlights
Breast cancer is the most frequently diagnosed cancer in women and the leading cause of death by cancer among women worldwide [1]
Patients were considered eligible when they were over 18 years old and had examinations categorized as Breast Imaging-Reporting and Database System (BIRADS) 3 or 4A (ACR BIRADS® Atlas Fifth Edition) at mammography, ultrasonography or both during the last year
Between June 2019 and January 2020, 130 women with a previous breast image examination ranked as BIRADS 3 or 4A were invited to participate in this study
Summary
Breast cancer is the most frequently diagnosed cancer in women and the leading cause of death by cancer among women worldwide [1]. Ultrasonography is used as a screening tool, specially indicated for young and lactating or pregnant women, and as a supplement to mammography screening in women with heterogeneously or extremely dense breasts This technique presents limitations to detect small lesions and differentiate the cysts with dense contents from solid lesions and be a user-dependent technique [4]. The most frequent mammographic and ultrasonography findings reported in BIRADS 3 were circumscribed solid nodules, multiple nodules, complicated cysts, and asymmetries; they were correlated at MRI with solid non-enhanced nodules, solid nodules with persistent enhancement, and cysts (Tables 5 and 6). The most frequent findings from previous BIRADS 4A were circumscribed nodules and multiple nodules, correlated with solid nodules with persistent enhancement (Tables 7, 8) at MRI. These were: 26 nodules, 27 simple cysts, 4 clusters of microcysts, two Appearance of ultrasound findings DCE characterization
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
