MRI-detected Suspicious Lesions Research Articles

MRI-detected breast lesions: clinical implications and evaluation based on MRI/ultrasonography fusion technology.

Magnetic resonance imaging (MRI) is a highly sensitive imaging modality that frequently reveals additional breast lesions that are occult on mammography and ultrasonography (US) and are thus difficult to diagnose. It is important to investigate these MRI-detected suspicious lesions, which are associated with a fairly high rate of malignancy. In this review, we have discussed MRI/US fusion technology, a magnetic position tracking system that synchronizes real-time US and MRI to improve lesion detection and enables comparisons of MRI and US findings of the detected lesions. This combination increases the precision of second-look US. We hope that our review underscores the importance of understanding the US findings and histopathology of MRI-detected breast lesions, as this will enable radiologists to perform appropriate assessments.

Abstract P2-02-12: Utility of Targeted Sonography Using Real-Time Virtual Sonography (RVS) for Breast Lesions That Were Suspicious on MRI

Abstract PURPOSE : MRI-detected suspicious breast lesions that are not expected from previous MMG or sonography, are detectable initially on MRI in 48% maximum. Therefore, biopsy is required for definitive diagnosis of MRI-detected lesions. Although MRI-guided biopsy is often necessary, sonographically guided biopsy after targeted sonography is more broadly available and less time-consuming and costly. The aim of this study was to verify the utility of targeted sonography using Real-time Virtual Sonography (RVS) for the identification of MRI-detected suspicious lesions. METHOD AND MATERIALS : From 196 breast MRI examinations, all MRI-detected suspicious lesions and subsequent biopsy were identified between February 2006 and December 2009. All patients were examined using MMG, sonography, MRI and RVS that could synchronize a sonography image and the MRI cutaway images of the same site to be displayed in real time using magnetic navigation system. Following the conventional dynamic enhanced image, MRI was obtained on a 1.5-T imager in the supine position using a flexible body surface coil in order to achieve the same position as in sonography. We searched all cases for MRI-detected suspicious lesions and investigated targeted sonography with or without RVS in identifying the lesions. RESULTS : Of the 196 patients, MRI-detected suspicious lesions were detected in 55 (28%) patients. A total of 67 suspicious lesions in 55 patients comprised this analysis. Of the study lesions, 24 (36%) were malignant and 43 (64%) were benign. Overall mean lesion size was 6.7mm. A total of 46 (69%) mass lesions were identified, compared with 16 (24%) foci and 5 (7%) nonmasslike lesions. 18 (27%) lesions were detected in targeted sonography without RVS and were revealed as cancers in eight, benign lesions in 10. In contrast, 60 (90%) lesions were detected in targeted sonography with RVS and were revealed as cancers in 21, benign lesions in 39. Although seven (10%) lesions were not detected with RVS, all lesions were able to project enhanced MRI information onto a body surface correctly as we checked ultrasound form images without the use of large-scale equipment. CONCLUSION: The present results suggest that targeted sonography with RVS appears to be not time consuming technique which can identify a large part of MRI-detected suspicious lesions. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-02-12.

Frequency, Upgrade Rates, and Characteristics of High-Risk Lesions Initially Identified With Breast MRI

The purpose of this article is to determine the frequency, outcomes, and imaging features of high-risk lesions initially detected by breast MRI, including atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. A retrospective review of our MRI pathology database was performed to identify all lesions initially detected with MRI (January 2003 through May 2007) that underwent imaging-guided needle biopsy yielding high-risk histopathologic abnormalities. Patient age, clinical indication, MRI BI-RADS lesion features, biopsy method, and histopathologic diagnosis were recorded. The frequencies of high-risk findings at needle biopsy and rates of upgrade to malignancy at surgical excision were compared across lesion imaging features with Fisher's exact test. Four hundred eighty-two MRI-detected suspicious lesions underwent needle biopsy. High-risk histopathologic abnormalities were present in 61 (12.7%) of 482 lesions: 51 (10.6%) atypical ductal hyperplasias, six (1.2%) atypical lobular hyperplasias, three (0.6%) lobular carcinomas in situ, and one (0.2%) radial scar. Correlation between the lesion site and pathology at surgical excision was confirmed for 39 of 61 lesions. Twelve (30.8%) of those 39 lesions were upgraded to malignancy (11 atypical ductal hyperplasias and one atypical lobular hyperplasia); five (41.7%) of the 12 malignancies were invasive cancer, and seven (58.3%) were ductal carcinomas in situ. No significant lesion features predictive of subsequent upgrade to malignancy were discovered. There are no specific imaging features that predict upgrade for high-risk lesions when detected with MRI. Therefore, surgical excision is recommended because upgrade to invasive carcinoma or ductal carcinoma in situ can occur in up to 31% of cases, regardless of biopsy technique.

Clinical Indication and Patient Age Predict Likelihood of Malignancy in Suspicious Breast MRI Lesions

To evaluate the associations of patient age and clinical indication with the risk of malignancy for suspicious lesions initially detected on breast magnetic resonance imaging (MRI). After institutional review board approval, a retrospective review of our breast MRI database was performed to identify all nonpalpable, mammographically occult, MRI-detected suspicious lesions between January 1, 2003, and November 30, 2006, that underwent needle or excisional biopsy. Clinical indication and patient age were recorded and their associations with risk of malignancy were assessed using univariate and multivariate generalized estimating equations. The likelihood of malignancy was significantly higher (P = .0004) for suspicious lesions found on MRI examinations performed for a patient history of known cancer/evaluate extent of disease (130/309, 42%) compared to lesions identified on examinations conducted for high-risk screening (21/96, 22%). Suspicious lesions found in patients > or = 50 years of age were also more likely to be malignant (92/209, 44%) compared to those found in patients <50 years of age (59/196, 30%) (P = .004). In a multivariable model, both clinical indication of known cancer (OR 2.39, 95% CI 1.33-4.30) and age of 50 years or older (OR 1.66, 95% CI 1.03-2.68) were independently associated with greater risk of malignancy. The clinical indication of known cancer/evaluate extent of disease and patient age of 50 years or older significantly increase the risk of malignancy in suspicious MRI-detected lesions.

Utility of Targeted Sonography for Breast Lesions That Were Suspicious on MRI

Data remain sparse to guide the use of targeted sonography for suspicious breast lesions found with MRI. The purpose of our study was to determine the usefulness of sonography in this setting. Retrospective review of our breast MRI database was performed to identify all nonpalpable, mammographically occult MRI-detected suspicious lesions from January 1, 2003, to December 30, 2004, that underwent targeted sonography followed by imaging-guided biopsy. Frequency of sonography detection was determined, and MRI features (BI-RADS lesion type and size), histopathology outcomes, and positive biopsy rates of sonographically detected and occult findings were compared using chi-square analysis. Targeted sonography was performed for 167 of 201 MRI lesions. Outcomes were benign in 120 (72%) and malignant in 47 (28%) findings. Lesions assessed on sonography were 84 (50%) masses, 53 (32%) nonmasslike enhancements, and 30 (18%) foci, with mean size of 16 mm. Overall, 76 of 167 (46%) lesions were detected with sonography. Depiction was significantly more frequent for masses (58%) than for nonmasslike enhancement (30%) or foci (37%) (p = 0.003). Lesion size did not affect the frequency of detection. Sonographically depicted findings had a significantly higher positive biopsy rate (36%) than sonographically occult lesions (22%) (p = 0.05). Targeted sonography detected nearly half (46%) of MRI lesions evaluated, with depiction being most frequent for masses. Sonographically occult lesions had a probability of malignancy (22%), which warrants biopsy despite lack of sonographic detection.