Can Follow-up be Avoided for Probably Benign US Masses with No Enhancement on MRI?
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Can Follow-up be Avoided for Probably Benign US Masses with No Enhancement on MRI? Daly Avendano 1,2 & Maria Adele Marino 1,3 & Natsuko Onishi 1 & Doris Leithner 1,4 & Danny F. Martinez 1 & Peter Gibbs 1 & Maxine Jochelson 1 & Katja Pinker 1 & Elizabeth A. Morris 1 & Elizabeth Jane Sutton 1 Received: 12 February 2020 / Revised: 13 July 2020 / Accepted: 20 August 2020 # European Society of Radiology 2020
Abstract Objectives To assess whether no enhancement on pre-treatment MRI can rule out malignancy of additional US mass(es) initially assessed as BI-RADS 3 or 4 in women with newly diagnosed breast cancer. Methods This retrospective study included consecutive women from 2010–2018 with newly diagnosed breast cancer; at least one additional breast mass (distinct from index cancer) assigned a BI-RADS 3 or 4 on US; and a bilateral contrast-enhanced breast MRI performed within 90 days of US. All malignant masses were pathologically proven; benign masses were pathologically proven or defined as showing at least 2 years of imaging stability. Incidence of malignant masses and NPV were calculated on a per-patient level using proportions and exact 95% CIs. Results In 230 patients with 309 additional masses, 140/309 (45%) masses did not enhance while 169/309 (55%) enhanced on MRI. Of the 140 masses seen in 105 women (mean age, 54 years; range 28–82) with no enhancement on MRI, all had adequate follow-up and 140/140 (100%) were benign, of which 89/140 (63.6%) were pathologically proven and 51/140 (36.4%) demonstrated at least 2 years of imaging stability. Pre-treatment MRI demonstrating no enhancement of US mass correlate(s) had an NPV of 100% (95% CI 96.7–100.0). Conclusions All BI-RADS 3 and 4 US masses with a non-enhancing correlate on pre-treatment MRI were benign. The incorporation of MRI, when ordered by the referring physician, may decrease unnecessary follow-up imaging and/or biopsy if the initial US BI-RADS assessment and management recommendation were to be retrospectively updated. Key Points • Of 309 BI-RADS 3 or 4 US masses with a corresponding mass on MRI, 140/309 (45%) demonstrated no enhancement whereas 169/309 (55%) demonstrated enhancement • All masses classified as BI-RADS 3 or 4 on US without enhancement on MRI were benign • MRI can rule out malignancy in non-enhancing US masses with an NPV of 100% Keywords Magnetic resonance imaging . Ultrasound . Breast neoplasm . Retrospective studies . Follow-up studies Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07216-7) contains supplementary material, which is available to authorized users. * Elizabeth Jane Sutton [email protected] 1
Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY 10065, USA
2
Department of Breast Imaging, Breast Cancer Center TecSalud, ITESM Monterrey, Monterrey, Nuevo Leon, Mexico
3
Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
4
Departme
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