The Added Diagnostic Value of Dynamic Contrast-Enhanced MRI at 3.0 T in Nonpalpable Breast Lesions

Laura G Merckel,Teun Weits,Willem P Th M Mali,Helena M Verkooijen,Maurice A A J Van Den Bosch,Nicky H G M Peters,Thijs Van Dalen,Petra H M Peeters,Katya M Duvivier,Remmert K Storm,Ritse M Mann,Wouter B Veldhuis

doi:10.1371/journal.pone.0094233

Abstract

ObjectiveTo investigate the added diagnostic value of 3.0 Tesla breast MRI over conventional breast imaging in the diagnosis of in situ and invasive breast cancer and to explore the role of routine versus expert reading.Materials and MethodsWe evaluated MRI scans of patients with nonpalpable BI-RADS 3–5 lesions who underwent dynamic contrast-enhanced 3.0 Tesla breast MRI. Initially, MRI scans were read by radiologists in a routine clinical setting. All histologically confirmed index lesions were re-evaluated by two dedicated breast radiologists. Sensitivity and specificity for the three MRI readings were determined, and the diagnostic value of breast MRI in addition to conventional imaging was assessed. Interobserver reliability between the three readings was evaluated.ResultsMRI examinations of 207 patients were analyzed. Seventy-eight of 207 (37.7%) patients had a malignant lesion, of which 33 (42.3%) patients had pure DCIS and 45 (57.7%) invasive breast cancer. Sensitivity of breast MRI was 66.7% during routine, and 89.3% and 94.7% during expert reading. Specificity was 77.5% in the routine setting, and 61.0% and 33.3% during expert reading. In the routine setting, MRI provided additional diagnostic information over clinical information and conventional imaging, as the Area Under the ROC Curve increased from 0.76 to 0.81. Expert MRI reading was associated with a stronger improvement of the AUC to 0.87. Interobserver reliability between the three MRI readings was fair and moderate.Conclusions3.0 T breast MRI of nonpalpable breast lesions is of added diagnostic value for the diagnosis of in situ and invasive breast cancer.

Highlights

Dynamic contrast-enhanced magnetic resonance imaging (MRI) of the breast has become mainstream for the detection and characterization of breast lesions in clinical practice [1,2,3]
3.0 T breast MRI of nonpalpable breast lesions is of added diagnostic value for the diagnosis of in situ and invasive breast cancer
Preoperative breast MRI is currently only indicated in a selection of patients, e.g. in patients with invasive lobular carcinoma, patients with a discrepancy in lesion size of more than 1 cm between mammography and ultrasound, and patients eligible for partial breast irradiation, in whom the clinical benefit of preoperative breast MRI is more clear [8]

Summary

Introduction

Dynamic contrast-enhanced magnetic resonance imaging (MRI) of the breast has become mainstream for the detection and characterization of breast lesions in clinical practice [1,2,3]. Two randomised controlled trials have studied the impact of preoperative breast MRI on the reoperation rate after breast-conserving surgical treatment [6,7]. In these studies, the addition of breast MRI to conventional imaging did not reduce the number of additional surgical interventions, e.g. repeat lumpectomy or mastectomy. Several studies assessed the overall diagnostic accuracy of breast MRI in patients with suspicious breast lesions, reporting a high sensitivity of around 90%, and a considerably lower specificity of 70–75% [2,9,10]. Large studies assessing the overall diagnostic performance of breast MRI at 3.0 T are lacking

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Results

Conclusion