Contrast-enhanced MRI provides useful findings in discordant core biopsy management

March 29, 2019

An essential part of breast intervention is the process of assessing concordance between imaging findings and core biopsy results. When pathology results are considered benign discordant, current standard of care is surgical excision, even though many of these lesions will ultimately be found benign.

A new study published in the April 2019 issue of the American Journal of Roentgenology (AJR) investigates whether including contrast-enhanced MRI in the assessment process might significantly benefit patient care.

The authors hypothesized that contrast-enhanced MRI -- used in high-risk screening and widely considered the most sensitive detection method of invasive breast cancer -- could provide useful findings to successfully triage patients with discordant benign biopsy results to surgical or nonsurgical management.

The study, "Use of Contrast-Enhanced MRI in Management of Discordant Core Biopsy Results," identified 45 patients (46 lesions) who received discordant ultrasound or stereotactic biopsy results and subsequently underwent contrast-enhanced MRI between 2012 and mid-2018. Findings at diagnostic imaging prior to MRI were classified BI-RADS category 4 -- suspicious abnormality (between 2-95% likelihood of malignancy).

31 patients had negative or benign MRI findings (32 lesions), confirmed stable at follow-up imaging of at least 6 months in four patients and at least 1 year in 27 patients. Fourteen patients had suspicious MRI findings and proceeded to surgery. All malignancies and borderline lesions necessitating surgery (atypia, papilloma) were defined as disease-positive. Eight of the 14 lesions were ultimately malignant, 4 lesions were borderline. There were two false positive MRIs.

Excluding the four patients with only 6 month follow up confirming stability, sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated as 100%, 93.3%, 85.7%, and 100%. The false-positive rate of MRI was 2 of 30 (6.7%); the false-negative rate was 0%.

In conclusion, the authors found that contrast-enhanced MRI in the management of discordant benign core biopsy results did allow a significant number of patients -- 31 of the original 45 patients (68.9%) -- to avoid unnecessary surgery.

"MRI is the most sensitive test for diagnosis of breast malignancy," Linda Sanders, MD--one of the authors of the study--said. "Further investigation is recommended to evaluate the use of MRI in specific diagnostic situations, particularly those nine scenarios that the American Society of Breast Surgeons considers indications for surgical excision, including anatomic inaccessibility of lesion, or interval change in a lesion previously diagnosed as benign by core biopsy. An achievable goal is to reduce the frequency of surgery performed on patients with benign disease. A more ambitious goal is to reduce the frequency of benign core biopsies by incorporating MRI into the management algorithm of BI-RADS 4 lesions."
-end-
Founded in 1900, ARRS is the first and oldest radiology society in the United States, and is an international forum for progress in radiology. The Society's mission is to improve health through a community committed to advancing knowledge and skills in radiology. ARRS achieves its mission through an annual scientific and educational meeting, publication of the American Journal of Roentgenology (AJR) and InPractice magazine, topical symposia and webinars, and print and online educational materials. ARRS is located in Leesburg, VA.

American Roentgen Ray Society

Related MRI Articles from Brightsurf:

Does MRI have an environmental impact?
Researchers from Tokyo Metropolitan University have surveyed the amount of gadolinium found in river water in Tokyo.

MRI predict intelligence levels in children?
A group of researchers from the Skoltech Center for Computational and Data-Intensive Science and Engineering (CDISE) took 4th place in the international MRI-based adolescent intelligence prediction competition.

7T MRI offers new insights into multiple sclerosis
Investigators from Brigham and Women's Hospital have completed a new study using 7 Tesla (7T) MRI -- a far more powerful imaging technology -- to further examine LME in MS patients

Magnetic eyelashes: A new source of MRI artifacts
American Journal of Roentgenology researchers used a phantom to show that magnetic eyelashes worn during MRI can cause substantial artifact and that detachment of the eyelashes from the phantom can occur.

High-strength MRI tracks MS progression
The development of scars, or lesions, in the brain's cortical gray matter is a powerful predictor of neurological disability for people with multiple sclerosis (MS), according to new study.

Non-contrast MRI is effective in monitoring MS patients
Brain MRI without contrast agent is just as effective as the contrast-enhanced approach for monitoring disease progression in patients with multiple sclerosis (MS), according to a new study.

Researchers use MRI to predict Alzheimer's disease
MRI brain scans perform better than common clinical tests at predicting which people will go on to develop Alzheimer's disease, according to a new study.

Monitoring electromagnetic signals in the brain with MRI
MIT engineers have devised a new technique to detect either electrical activity or optical signals in the brain, using a minimally invasive technique based on magnetic resonance imaging (MRI).

MRI 'glove' provides new look at hand anatomy
A new kind of MRI component in the shape of a glove delivers the first clear images of bones, tendons and ligaments moving together.

Why we need erasable MRI scans
Gas-filled protein structures could one day be used as 'erasable' contrast agents for MRI scans.

Read More: MRI News and MRI Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.