The contribution and histopathological correlation of MRI in BI-RADS category 4 solid lesions detected by ultrasonography
Keywords:BI-RADS Category 4, Breast Ultrasonography, Breast MRI, Breast cancer, Solid breast lesions
Background/Aim: BI-RADS category 4 breast lesions have widely varying malignancy rates and they are almost always evaluated with biopsy. However, especially in the 4a subgroup with a benign character of up to 98%, many patients undergo unnecessary invasive procedures. Breast MRI can be a good problem-solving method to reduce unnecessary invasive procedures, but there are very few publications on BI-RADS category 4 solid lesions. This study aimed to investigate the contribution of breast MRI in Breast Imaging Reporting and Data System (BI-RADS) category 4 solid mass lesions detected by Mammography and Ultrasonography. Methods: In this retrospective cohort study, ultrasound reports of patients examined in the radiology breast imaging unit between January 2015 and December 2017 were reviewed. Cases reported as BI-RADS category 4 with a solid mass on ultrasonography were determined. Patients without histopathological diagnosis and/or breast MRI were excluded from the study. After the implementation of the exclusion criteria, 121 solid lesions of 104 female patients were included in the study. US and MRI images of the patients were re-evaluated by two radiologists and BI-RADS scoring was performed again. The obtained data were analyzed statistically together with histopathological data. Results: With breast MRI, 74 of 121 BI-RADS category 4 lesions were downgraded while 13 lesions were upgraded. Of the 74 downgraded lesions, 61 were BI-RADS category 2 and 3, which do not require a biopsy. Only one of these lesions was histopathologically malignant. Of the 13 lesions upgraded, 6 were in BI-RADS category 5, two of which were benign. The sensitivity, specificity, positive and negative predictive values of MRI were 93.8%, 56.2%, 24.6%, and 98.3%, respectively. Conclusion: In our study, breast MRI reduced the BI-RADS categories to 2 and 3 in approximately half of the BI-RADS category 4 solid lesions detected by ultrasound. Therefore, problem-solving MRI may be useful to avoid unnecessary invasive procedures in these patients.
Ackermann S, Schoenenberger CA, Zanetti-Dällenbach R. Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions. Ultrasound Int Open. 2016;2:E83-9. doi: 10.1055/s-0042-110657.
Peters NH, Borel Rinkes IH, Zuithoff NP, Mali WP, Moons KG, Peeters PH. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology. 2008;246:116-24. doi: 10.1148/radiol.2461061298.
Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830-49. doi: 10.1148/radiol.2333031484.
Dietzel M, Baltzer PA, Schön K, Kaiser WA. MR-Mammography: high sensitivity but low specificity? New thoughts and fresh data on an old mantra. Eur J Radiol. 2012;81:30-2. doi: 10.1016/S0720-048X(12)70012-8.
Benndorf M, Baltzer PA, Vag T, Gajda M, Runnebaum IB, Kaiser WA. Breast MRI as an adjunct to mammography: Does it really suffer from low specificity? A retrospective analysis stratified by mammographic BI-RADS classes. Acta Radiol. 2010;51:715-21. doi: 10.3109/02841851.2010.497164.
Vassiou K, Kanavou T, Vlychou M, Poultsidi A, Athanasiou E, Arvanitis DL, et al. Characterization of breast lesions with CE-MR multimodal morphological and kinetic analysis: comparison with conventional mammography and high-resolution ultrasound. Eur J Radiol. 2009;70:69-76. doi: 10.1016/j.ejrad.2008.01.012.
Bruening W, Launders J, Pinkney N, Kostinsky H, Schoelles K, Turkelson C. Agency for health care research and quality: comparative effectiveness of non-invasive diagnostic tests for breast abnormalities-an update of a 2006 report. (2010) http:// effectivehealthcare.ahrq.gov
Kuhl CK. Current status of breast MR imaging. Part 2. Clinical applications. Radiology. 2007;244:672–91. doi: 10.1148/radiol.2443051661.
de Almeida JR, Gomes AB, Barros TP, Fahel PE, Rocha Mde S. Predictive performance of BI-RADS magnetic resonance imaging descriptors in the context of suspicious (category 4) findings. Radiol Bras. 2016;49:137-43. doi: 10.1590/0100-3984.2015.0021.
D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA. ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology (2013) http://www.acr.org/Quality-Safety/Resources/BIRADS.
Sickles EA, D’Orsi CJ, Bassett LW. ACR BI-RADS Mammography, In: ACR BI-RADS atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology (2013) http://www.acr.org/Quality-Safety/Resources/BIRADS.
Mendelson EB, Böhm-Vélez M, Berg WA. ACR BI-RADS Ultrasound. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology (2013) http://www.acr.org/Quality-Safety/Resources/BIRADS.
Morris EA, Comstock CE, Lee CH. ACR BI-RADS Magnetic Resonance Imaging. In: ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology (2013) http://www.acr.org/Quality-Safety/Resources/BIRADS.
Lee CH, Smith RC, Levine JA, Troiano RN, Tocino I. Clinical usefulness of MR imaging of the breast in the evaluation of the problematic mammogram. AJR. 1999;173:1323–9. doi: 10.2214/ajr.173.5.10541112.
Moy L, Elias K, Patel V, Lee J, Babb JS, Toth HK, et al. Is breast MRI helpful in the evaluation of inconclusive mammographic findings? AJR Am J Roentgenol. 2009;193:986–93. doi: 10.2214/AJR.08.1229.
Spick C, Szolar DH, Preidler KW, Tillich M, Reittner P, Baltzer PA. Breast MRI used as a problem-solving tool reliably excludes malignancy. Eur J Radiol. 2015;84:61–4. doi: 10.1016/j.ejrad.2014.10.005.
Turnaoglu H, Ozturk E, Yucesoy C, Teber MA, Turan A, Ozbalcı AB, et al. Can Breast Magnetic Resonance Imaging Prevent Biopsy or Change the Management of BI-RADS® Category 4 Breast Lesions? Indian J Surg. 2018;5:505-12. doi: 10.1007/s12262-017-1654-7.
Strobel K, Schrading S, Hansen NL, Barabasch A, Kuhl CK. Assessment of BI-RADS category 4 lesions detected with screening mammography and screening US: utility of MR imaging. Radiology. 2015;274:343-51. doi: 10.1148/radiol.14140645.
Giess CS, Chikarmane SA, Sippo DA, Birdwell RL. Clinical Utility of Breast MRI in the Diagnosis of Malignancy After Inconclusive or Equivocal Mammographic Diagnostic Evaluation. AJR Am J Roentgenol. 2017;208:1378-85. doi: 10.2214/AJR.16.16751.
How to Cite
Copyright (c) 2021 Ersen Ertekin, Figen Tunalı Türkdoğan
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.