Benign Breast Disease Research Articles

356 Upregulated Genes in Age-Related Lobular Involution Stagnation Represent Potential Biomarkers That Link To Increased Breast Cancer Risk

OBJECTIVES/GOALS: Age-related lobular involution (LI) is a physiological process of breast epithelial regression that occurs primarily during perimenopause (ages 45-55); women in this age range for which the process of LI is delayed, defined as LI stagnation, show significantly increased risk of breast cancer as compared to LI progression patients. METHODS/STUDY POPULATION: The Mayo Clinic Benign Breast Disease (BBD) cohort includes ~1000 women who had multiple sequential benign biopsies. 103 patients were found to have sequential biopsies during the perimenopausal period, of which 10 eventually progressed to breast cancer. These patients were assessed for LI stagnation vs LI progression by quantifying 10 lobules per slide and comparing median acini number and median lobule size between initial and subsequent biopsies from the same patients. RNA was derived from whole tissue sections from the initial biopsies, and profiled using NanoString IO360 and BC360, which were normalized using RUVg methods. Differentially expressed genes associated with LI stagnation were defined as having two-tailed, unpaired p-values less than 0.05. RESULTS/ANTICIPATED RESULTS: Analysis showed subsetting patient sets by time between biopsies improves classification of stagnant vs. progression. Differential gene analysis identified 37 genes associated with LI stagnation and LI progression, and 20 of these genes were found to overlap a set of 128 gnese that were differentially expressed between women who subsequently developed breast cancer vs remained cancer-free. These genes represent potential biomarkers of processes that link LI stagnation and increased breast cancer risk. DISCUSSION/SIGNIFICANCE: In future studies, we intend to study these genes that were shown to be upregulated in LI stagnation for their association with subsequent development of breast cancer in independent cohorts of women with BBD. We will use this knowledge to improve individualized risk assessment, which will help focus surveillance and prevention strategies.

Identification of prolactin receptor variants with diverse effects on receptor signalling.

The prolactin receptor (PRLR) signals predominantly through the JAK2-STAT5 pathway regulating multiple physiological functions relating to fertility, lactation, and metabolism. However, the molecular pathology and role of PRLR mutations and signalling are incompletely defined, with progress hampered by a lack of reported disease-associated PRLR variants. To date, two common germline PRLR variants are reported to demonstrate constitutive activity, with one, Ile146Leu, overrepresented in benign breast disease, while a rare activating variant, Asn492Ile, is reported to be associated with an increased incidence of prolactinoma. In contrast, an inactivating germline heterozygous PRLR variant (His188Arg) was reported in a kindred with hyperprolactinaemia, while an inactivating compound heterozygous PRLR variant (Pro269Leu/Arg171Stop) was identified in an individual with hyperprolactinaemia and agalactia. We hypothesised that additional rare germline PRLR variants, identified from large-scale sequencing projects (ExAC and GnomAD), may be associated with altered in vitro PRLR signalling activity. We therefore evaluated >300 previously uncharacterised non-synonymous, germline PRLR variants and selected 10 variants for in vitro analysis based on protein prediction algorithms, proximity to known functional domains and structural modelling. Five variants, including extracellular and intracellular domain variants, were associated with altered responses when compared to the wild-type receptor. These altered responses included loss- and gain-of-function activities related to STAT5 signalling, Akt and FOXO1 activity, as well as cell viability and apoptosis. These studies provide further insight into PRLR structure-function and indicate that rare germline PRLR variants may have diverse modulating effects on PRLR signalling, although the pathophysiologic relevance of such alterations remains to be defined.

Automatic deep learning method for detection and classification of breast lesions in dynamic contrast-enhanced magnetic resonance imaging.

The purpose of this study was to develop a deep learning-based system with a cascade feature pyramid network for the detection and classification of breast lesions in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). This retrospective study enrolled 191 consecutive patients with pathological confirmed breast lesions who underwent preoperative magnetic resonance imaging (MRI) at the Second Affiliated Hospital of Xi'an Jiaotong University. Patients were randomly divided into a training set comprising 153 patients with 126 malignant and 27 benign lesions and a validation set containing 38 patients with 31 malignant and 7 benign lesions under 5-fold cross-validation. Two radiologists annotated the location and classification of all lesions. After augmentation with pseudo-color image fusion, MRI images were fed into the developed cascade feature pyramid network system, feature pyramid network, and faster region-based convolutional neural network (CNN) for breast lesion detection and classification, respectively. The performance on large (>2 cm) and small (≤2 cm) breast lesions was further evaluated. Average precision (AP), mean AP, F1-score, sensitivity, and false positives were used to evaluate different systems. Cohen's kappa scores were calculated to assess agreement between different systems, and Student's t-test and the Holm-Bonferroni method were used to compare multiple groups. The cascade feature pyramid network system outperformed the other systems with a mean AP and highest sensitivity of 0.826±0.051 and 0.970±0.014 (at 0.375 false positives), respectively. The F1-score of the cascade feature pyramid network in real detection was also superior to that of the other systems at both the slice and patient levels. The mean AP values of the cascade feature pyramid network reached 0.779±0.152 and 0.790±0.080 in detecting large and small lesions, respectively. Especially for small lesions, the cascade feature pyramid network achieved the best performance in detecting benign and malignant breast lesions at both the slice and patient levels. The deep learning-based system with the developed cascade feature pyramid network has the potential to detect and classify breast lesions on DCE-MRI, especially small lesions.

Diagnostic value of combined use of abbreviated breast MRI and diffusion-weighted MRI in the prediction of breast cancer

Purpose: The aim of this study was to compare the diagnostic performances of abbreviated protocol (AP) magnetic resonance imaging (MRI), AP combined with diffusion-weighted imaging (DWI), and full dynamic protocol (FDP) in the differentiation of breast cancers from benign breast diseases.
 Materials and Methods: The total study population consisted of 68 patients who underwent breast MRI (1.5 Tesla) between January 2016 and December 2021 for the evaluation of suspicious findings on mammography or ultrasonography. All lesions were evaluated by 2 radiologists using AP, AP+DWI, and FDP. The reader sensitivity, specificity, and accuracy were analyzed using the “Chi-squared” test. The inter-observer agreement (IOA) between the Breast Imaging Reporting and Data System (BI-RADS) category assessments of the two readers was evaluated by using the “Kappa statistics”.
 Results: Sixty-eight patients with 72 lesions (31 malignant and 41 benign) were analyzed. The sensitivity/specificity for AP and AP+DWI for reader 1 was 67.7/90.2% and 80.6/87.8%, respectively, and for reader 2 was 67.7/92.6% and 70.9/90.2%, respectively. The sensitivity/specificity for FDP for reader 1 was 83.7/85.3% and for reader 2 was 80.6/90.2%. The IOA in the BI-RADS category assessment was almost perfect in all models between two readers (the kappa value was 0.907, 0.825, and 0.858 in AP, AP+DWI, and FDP, respectively).
 Conclusion: FDP showed greater diagnostic efficiency in the characterization of tumor biology as compared to AP and AP +DWI. Combining AP with DWI improved the diagnostic performance of MRI for the determination of malignancy.

Evaluation of benign breast diseases.

Objectives: To find the frequency of benign breast diseases presented to outdoor patient department and to exclude malignancy. Study Design: Descriptive Case Series Study. Setting: Department of General Surgery, Hayatabad Medical Complex, Peshawar. Period: July 2021 to June 2022. Material & Methods: Ninety five females presented to OPD with complaints of breast pain, lumpy, nipple and breast discharge. All patients were investigated through triple assessment. Mammography and trucat biopsy were performed in selected cases. Diagnosed cases of breast cancer and those picked up through investigations, were excluded. Data was analyzed through SPSS. Results: The age range was 11 years to 71 years with a mean age of 28 years (SD ± 7.55 years). Forty three (45.3%) patients presented in the 3rd decade, followed by 26 (27.4%) in the 2nd decade of life. The most common conditions encountered were fibroadenoma in 42.17% (n=40) cases, mainly in 3rd decade. Inflammatory conditions like acute mastitis and abscess formation was found in 21.05% (n=20) Cases. Fifteen (15.8%) patients had fibrocystic diseases, in the 3rd and 4th decades. Conclusion: Fibroadenoma is the commonly encountered benign breast disease in women in the 3rd decade. FNAC is a quick and reliable investigation to exclude malignancy and relieve mental stress in women.

Associations of alcohol consumption with breast tissue composition

BackgroundWe investigated the associations of alcohol with percentage of epithelium, stroma, fibroglandular tissue (epithelium + stroma), and fat in benign breast biopsy samples.MethodsWe included 857 cancer-free women with biopsy-confirmed benign breast disease within the Nurses’ Health Study (NHS) and NHSII cohorts. Percentage of each tissue was measured on whole slide images using a deep-learning algorithm and then log-transformed. Alcohol consumption (recent and cumulative average) was assessed with semi-quantitative food frequency questionnaires. Regression estimates were adjusted for known breast cancer risk factors. All tests were 2-sided.ResultsAlcohol was inversely associated with % of stroma and fibroglandular tissue (recent ≥ 22 g/day vs. none: stroma: β = − 0.08, 95% Confidence Interval [CI] − 0.13; − 0.03; fibroglandular: β = − 0.08, 95% CI − 0.13; − 0.04; cumulative ≥ 22 g/day vs. none: stroma: β = − 0.08, 95% CI − 0.13; − 0.02; fibroglandular: β = − 0.09, 95% CI − 0.14; − 0.04) and positively associated with fat % (recent ≥ 22 g/day vs. none: β = 0.30, 95% CI 0.03; 0.57; cumulative ≥ 22 g/day vs. none: β = 0.32, 95% CI 0.04; 0.61). In stratified analysis, alcohol consumption was not associated with tissue measures in premenopausal women. In postmenopausal women, cumulative alcohol use was inversely associated with % of stroma and fibroglandular tissue and positively associated with fat % (≥ 22 g/day vs. none: stroma: β = − 0.16, 95% CI − 0.28; − 0.07; fibroglandular: β = − 0.18, 95% CI − 0.28; − 0.07; fat: β = 0.61, 95% CI 0.01; 1.22), with similar results for recent alcohol use.ConclusionOur findings suggest that alcohol consumption is associated with smaller % of stroma and fibroglandular tissue and a greater % of fat in postmenopausal women. Future studies are warranted to confirm our findings and to elucidate the underlying biological mechanisms.

Trans-axillary single port insufflation technique-assisted endoscopic surgery for breast diseases: Clinic experience, cosmetic outcome and oncologic result.

With an increasing demand for postoperative cosmetic effects in breast diseases, the single port by trans-axillary incision and air-inflation system, which provided better space and spared the assistant the effort of retraction, is widely used in clinic surgical treatment for multiple breast diseases. According to inclusion and exclusion criteria, patients who underwent trans-axillary single-incision surgery at Tianjin Medical University Cancer Hospital between December 2020 and July 2022 were included in the study. We collected and analyzed data on age, fertility history, ultrasound grade, clinical stage, pathological results, oncological prognosis, patient-centered cosmetic outcome, etc. A total of 115 cases were included, of which 33 patients with benign disease underwent mass resection, 68 patients with malignant tumors underwent mastectomy. 10 patients had a special type of breast lesion. A mastectomy was performed in 4 patients with male mammary gland development. Of the 115 cases, the maximum mass diameter was 3.00 ± 1.644 (0.6-8.5) cm. Blood loss during surgery was 85.77 ± 50.342 (10-200) ml. The surgery took 131.84 ± 59.332 (30-280) minutes to complete. The patient spent a total of 5.05 ± 2.305 (2-18) days in the hospital. And the length of surgical incision in all patients was 3.83 ± 0.884 (3-8) cm. All patients were very satisfied with the appearance of their breasts after dressing. 94.78% of patients were satisfied with the position of the incision. Through this study, we believe that in benign breast diseases and malignant breast tumors, trans-axillary single port insufflation technique-assisted endoscopic surgery has oncological safety and an aesthetic effect for most people with breast diseases.

Персонифицированный подход к верификации диагноза и патогенетической терапии при доброкачественных заболеваниях молочной железы (обзор литературы)

The review presents data on the tactics of managing patients with benign breast diseases aimed at reducing the incidence of breast cancer. Particular attention is paid to the use of non-hormonal herbal preparations with a favorable safety profile, the components of which suppress the hyperproliferation of the mammary gland epithelium, lead to regression of cysts in its tissue, and reduce mammographic density, which is a protector of the development of malignant processes.

The estetrol-drospirenone-containing contraceptive as a drug of choice for patients with mastalgia

The problem of mastalgia is widespread: up to 70% of women report regular or episodic pain in the mammary gland. The role of benign breast disease in the occurrence of these complaints was noted only in 10–30% of cases, while in most women mastalgia is a manifestation of premenstrual syndrome caused by excessive water retention in the body. As a therapy for such patients, the optimal solution would be to prescribe a new combined oral contraceptive containing 15 mg of estetrol and 3 mg of drospirenone. The uniqueness of this combination in this situation lies in the pronounced antimineralocorticoid effect of drospirenone, supported by a high safety profile of estetrol, including a reduced risk of developing breast cancer compared to other combined oral contraceptive.

Fusion deep learning approach combining diffuse optical tomography and ultrasound for improving breast cancer classification.

Diffuse optical tomography (DOT) is a promising technique that provides functional information related to tumor angiogenesis. However, reconstructing the DOT function map of a breast lesion is an ill-posed and underdetermined inverse process. A co-registered ultrasound (US) system that provides structural information about the breast lesion can improve the localization and accuracy of DOT reconstruction. Additionally, the well-known US characteristics of benign and malignant breast lesions can further improve cancer diagnosis based on DOT alone. Inspired by a fusion model deep learning approach, we combined US features extracted by a modified VGG-11 network with images reconstructed from a DOT deep learning auto-encoder-based model to form a new neural network for breast cancer diagnosis. The combined neural network model was trained with simulation data and fine-tuned with clinical data: it achieved an AUC of 0.931 (95% CI: 0.919-0.943), superior to those achieved using US images alone (0.860) or DOT images alone (0.842).

The effectiveness of an ultrafast breast MRI protocol in the differentiation of benign and malignant breast lesions

To evaluate the effectiveness of an ultrafast breast magnetic resonance imaging (MRI) protocol in differentiating benign and malignant breast lesions. Fifty-four patients with Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 lesions were recruited between July 2020 to May 2021. A standard breast MRI was performed with the inclusion of the ultrafast protocol between the unenhanced sequence and the first contrast-enhanced sequence. Three radiologists performed image interpretation in consensus. Ultrafast kinetic parameters analysed included the maximum slope (MS), time to enhancement (TTE), and arteriovenous index (AVI). These parameters were compared using receiver operating characteristics with p-values of <0.05 considered to indicate statistical significance. Eighty-three histopathological proven lesions from 54 patients (mean age 53.87 years, SD 12.34, range 26-78 years) were analysed. Forty-one per cent (n=34) were benign and 59% (n=49) were malignant. All malignant and 38.2% (n=13) benign lesions were visualised on the ultrafast protocol. Of the malignant lesions, 77.6% (n=53) were invasive ductal carcinoma (IDC) and 18.4% (n=9) were ductal carcinoma in situ (DCIS). The MS for malignant lesions (13.27%/s) were significantly larger than for benign (5.45%/s; p<0.0001). No significant differences were seen for TTE and AVI. The area under the ROC curve (AUC) for the MS, TTE, and AVI were 0.836, 0.647, and 0.684, respectively. Different types of invasive carcinoma had similar MS and TTE. The MS of high-grade DCIS was also similar to that of IDC. Lower MS values were observed for low-grade (5.3%/s) compared to high-grade DCIS (14.8%/s) but the results were not significant statistically. The ultrafast protocol showed potential to discriminate between malignant and benign breast lesions with high accuracy using MS.

Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: breast conditions

The use of medical 3D printing has expanded dramatically for breast diseases. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides updated appropriateness criteria for breast 3D printing in various clinical scenarios. Evidence-based appropriateness criteria are provided for the following clinical scenarios: benign breast lesions and high-risk breast lesions, breast cancer, breast reconstruction, and breast radiation (treatment planning and radiation delivery).

Investigating the Link between Early Life and Breast Anomalies

Several factors during childhood and adolescence are thought to be associated with the development of proliferative benign breast diseases and breast cancer in adulthood. In order to identify them, the authors conducted an extensive review of the literature up to October 2022, searching for clinical studies, reports, and guidelines in English. A thorough Medline/Pubmed and Google scholar database research was performed, investigating the link between diet, exercise, age of menarche, body mass index, ionizing radiation exposure during childhood and adolescence, and proliferative breast diseases and breast cancer in adulthood. A list of keywords, including breast disorders, adolescence, childhood, and breast cancer was included in our search algorithm. Numerous studies concede that the development of breast disease in adulthood is influenced by various risk factors, whose influence begins during early childhood and adolescence.

Study of Histopathological Changes in Fibroadenoma of the Breast

Background: Fibroadenoma of the breast is a relatively frequently occurring tumor. Although often considered a benign tumour, several reports describe a higher risk of subsequent breast carcinoma in patients diagnosed with fibroadenoma. Increased risk depends on presence of complex changes within fibroadenoma, presence of hyperplasia and positive family history for breast cancer.&#x0D; Aims and Objectives: Our main aim was to study the histological variations within the fibroadenoma of the breast and also to identify those lesions with the possible risk of malignancy.&#x0D; Methods: Descriptive study of three years. A total of 250 cases of fibroadenoma were studied. Slides were stained with Hematoxylin and Eosin (H &amp; E) and were thoroughly reviewed. Slides were screened for proliferative epithelial changes, fibrocystic epithelial changes, stromal changes and various other changes such as foci of tubular adenoma and phyllodes tumour. Slides with invasive malignancies were excluded from the study.&#x0D; Result: Apocrine change among fibrocystic changes was the commonest variation within the fibroadenoma. Complex fibroadenoma, moderate and atypical ductal hyperplasia was seen in older age groups.&#x0D; Conclusion: Increased risk of breast cancer is seen patients with presence of hyperplasia and complex fibroadenoma of the breast. So exclusive study of histopathological changes in epithelial and stromal elements of fibroadenoma is required and are essential to be reported so as to alert the clinician for follow up of the patient. This will help in timely management to reduce morbidity and mortality.

The association between KRAS gene expression and breast tumors in a sample of Iraqi women

In Iraq, breast cancer is considered one of the most widespread cancer types causing death in women due to changes in the genes that control cell growth and proliferation. KRAS gene plays a role in 30% of human cancers. This study aims to evaluate the expression of the KRAS gene and its role in women with breast tumours. A total of 120 women (60 women with breast tumours and 60 samples from apparently healthy women) were enrolled in this study to determine the expression of the KRAS gene. The RT-qPCR was used for this purpose. Fibroadenoma (FA) was the most common tumours, accounting for 53% of cases, followed by fibrocystic change (26%). Other benign tumours accounted for 20% of the cases; however, IDC is the most common type of invasive breast cancer, accounting for 70% of all breast cancers. Moreover, KRAS gene expression in women with breast tumours (benign and malignant) was not- significantly different from that seen in normal healthy women.

Myoid hamartoma of breast clinically masquadering as phyllodes tumor- A rare case report

Mammary hamartoma (MH) is an infrequent form of breast tumor that accounts for approximately 4.8% of all benign breast lesions. Myoid (muscular) hamartomas are uncommon benign breast lesions that are considered to be a variant of mammary hamartomas. Since the pathogenesis of MH is poorly understood, its true incidence is under-reported by clinicians and as well as pathologists.Thus, we report this case of MH in a middle-aged female, who presented with a large breast mass mimicking phyllodes tumor and giant fibroadenoma, however, histopathology and immunohistochemical examination aided its diagnosis as Myoid Hamartoma. We present this case to highlight this rare benign breast lesion.

Decorin inhibits the formation of hard nodules after microwave ablation by inhibiting the TGF-β1/SMAD and MAPK signaling pathways: in a Bama miniature pig model of mammary gland hyperplasia

Background Benign breast lesions are often associated with hard nodule formation after microwave ablation (MWA), which persists for a long time and causes problems in patients. The aim of this study was to evaluate the efficacy of decorin in the treatment of hard nodule formation and its potential mechanism of action. Methods Using a Bama miniature pig model of mammary gland hyperplasia, immunohistochemistry, Masson’s trichrome and western blotting were firstly applied to compare the extent of fibrosis and activation of key members of the TGF-β1/SMAD and MAPK signaling pathways of hard nodule in the control and MWA groups, and then the extent of fibrosis and expression of signaling pathways in hard nodule were examined after application of decorin. Results The results showed that the MWA group had increased levels of TGF-β1, p-SMAD2/3, p-ERK1/2, and collagen I proteins and increased fibrosis at 2 weeks, 4 weeks, and 3 months after MWA. After decorin treatment, the expression levels of each protein were significantly downregulated, and the degree of fibrosis was reduced at 2 weeks, 4 weeks, and 3 months after MWA compared with the MWA group. Conclusion In conclusion, these results suggest that activation of TGF-β1 may play an important role in hard nodule formation and that decorin may reduce hard nodule formation after MWA in a model of mammary gland hyperplasia by inhibiting the TGF-β1/SMAD and MAPK signaling pathways.

Routine Pathology Examination of Breast Tissue in Adolescent Reduction Mammaplasty: Not Cost Effective in a 7-Year Review.

Routine pathology examination of breast tissue in reduction mammaplasty (RM) is performed with aims of detecting incidental malignancy or risk-increasing lesions. In adolescent patients, the reported incidence ranges between 0% to 0.01%, and costs of pathology claims range between $23 and $614 per analysis. We aim to investigate the rate of incidental findings and the cost-effectiveness of routine pathology examination in adolescent RM. A single-center retrospective review of the pathology results for 132 breast specimens from 66 consecutive RM patients was performed. Data collected for analysis included breast cancer risk factors, demographic information, and operative variables. Zero cases of incidental malignant or risk-increasing lesions were found among the 132 breast specimens from 66 patients aged between 10 and 24 years. Of the 132 specimens, 34 (26%) contained benign fibrocystic disease, which was significantly associated a body mass index greater than 30 kg/m 2 and tissue resection weight greater than 1000 g per breast ( P = 0.003, P = 0.007) respectively. Based on the available data, the use of routine specimen analysis costs more than US $150 million for one breast cancer diagnosis during RM in this age group. In our study, zero atypical, precancerous, or cancerous lesions were detected in a 7-year analysis. The results of this study support the current literature, which reports no occurrence of incidental findings in young women and may promote a greater understanding of evidence-based healthcare spending while concomitantly decreasing the strain placed on histopathology services.

The dual-crosslinked prospective values of RAI14 for the diagnosis and chemosurveillance in triple negative breast cancer

Objective The exploration of non-invasive biomarkers for assessing tumor response is critical to optimize treatment decisions. In this study, we aimed at determining the potential role of RAI14 in the early diagnosis and evaluation of chemotherapy efficacy in triple-negative breast cancer (TNBC). Methods We recruited 116 patients newly diagnosed with breast cancer, 30 patients with benign breast disease and 30 healthy controls. In addition, 57 TNBC patients were collected in serum at different time points (C0, C2 and C4) for chemotherapy monitoring. The expression of serum RAI14 and CA15-3 were quantified by Elisa and electrochemiluminescence assay, respectively. Then we compared the performances of markers with the chemotherapy efficacy assessed by imaging. Results RAI14 is significantly overexpressed in TNBC and is linked to adverse clinicopathological features such as tumor burden, CA15-3 levels and the ER, PR, and HER2 status of the patients. ROC curve analysis showed that RAI14 improves the diagnostic performance for CA15-3(AUCRAI14 = 0.934 vs. AUCCA15-3 = 0.836), especially embodied in early-stage breast cancer diagnosis and patients with CA15-3 negativity. Furthermore, RAI14 behaves well in reproducing treatment response which was consistent with clinical Imaging assessment. Conclusions Recent studies showed that RAI14 has a complementary effect to CA15-3 and a test combining the two parameters can improve the detection rate of early triple-negative breast cancer. At the same time, RAI14 plays a more important role in chemotherapy monitoring than CA15-3 as the change in its concentration is in line with the tumor volume variation. Taken together, RAI14 is a reliable novel marker in the early diagnosis and chemotherapy monitoring of triple-negative breast cancer.

Can magnetic resonance imaging texture analysis change the breast imaging reporting and data system category of breast lesions?

PurposeThis study aimed to reveal magnetic resonance imaging (MRI) texture analysis (TA)'s contribution to categorizing breast lesions according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. MethodTwo hundred and seventeen women with BI-RADS category 3, 4, and 5 lesions on breast MRI were included in the study. For TA, the region of interest was drawn manually to encompass the entire lesion on the fat-suppressed T2W and the first post-contrast T1W images. To identify the independent predictors of breast cancer, multivariate logistic regression analyses were performed using texture parameters. Estimated benign and malignant groups were formed according to the TA regression model. ResultsTexture parameters extracted from T2WI, including median, gray-level co-occurrence matrix (GLCM) contrast, GLCM correlation, GLCM joint entropy, GLCM sum entropy, and GLCM sum of squares, and parameters extracted from T1WI, including maximum, GLCM contrast, GLCM joint entropy, GLCM sum entropy, were independent predictors of breast cancer. In the estimated new groups according to the TA regression model, 19 (91%) of the benign 4a lesions were downgraded to BI-RADS category 3. ConclusionsThe addition of quantitative parameters obtained by MRI TA to BI-RADS criteria significantly increased the accuracy rate in differentiating benign and malignant breast lesions. When categorizing BI-RADS 4a lesions, the use of MRI TA in addition to conventional imaging findings may reduce unnecessary biopsy rates.