The value of MRI contrast enhancement in biopsy decision of suspicious mammographic microcalcifications: a prospective m
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The value of MRI contrast enhancement in biopsy decision of suspicious mammographic microcalcifications: a prospective multicenter study Fusun Taskin 1,2 & Cem Burak Kalayci 3 Handan Kaya 6 & Erkin Aribal 7,8
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Nermin Tuncbilek 4
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Efe Soydemir 5
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Nazmi Kurt 4
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Received: 13 April 2020 / Revised: 23 July 2020 / Accepted: 4 September 2020 # European Society of Radiology 2020
Abstract Objectives To investigate the inclusion of breast MRI in radiological assessment of suspicious, isolated microcalcifications detected with mammography. Methods In this prospective, multicenter study, cases with isolated microcalcifications in screening mammography were examined with dynamic contrast-enhanced MRI (DCE-MRI) before biopsy, and contrast enhancement of the relevant calcification localization was accepted as a positive finding on MRI. Six experienced breast radiologists evaluated the images and performed the biopsies. Imaging findings and histopathological results were recorded. Sensitivity, specificity, NPV, and PPV of breast MRI were calculated and compared with histopathological findings. Results Suspicious microcalcifications, which were detected by screening mammograms of 444 women, were evaluated. Of these, 276 (62.2%) were diagnosed as benign and 168 (37.8%) as malignant. Contrast enhancement was present in microcalcification localization in 325 (73.2%) of the cases. DCE-MRI was positive in all 102 invasive carcinomas and in 58 (87.9%) of 66 DCIS cases. MRI resulted in false negatives in eight DCIS cases; one was high grade and the other seven were lowto-medium grade. The false-negative rate of DCE-MRI was 4.76%. The sensitivity, specificity, PPV, and NPV for DCE-MRI for mammography-detected suspicious microcalcifications were 95.2%, 40.2%, 49.2%, and 93.3%, respectively. Conclusions In this study, all invasive cancers and all DCIS except eight cases (12.1%) were detected with DCE-MRI. DCE-MRI can be used in the decision-making algorithm to decrease the number of biopsies in mammography-detected suspicious calcifications, with a tradeoff for overlooking a small number of DCIS cases that are of low-to-medium grade. Key Points • All invasive cancer cases and 87.8% of all in situ cancer cases were detected with MRI, showing a low false-negative rate of 4.7%. • Dynamic contrast-enhanced MRI can be used in the decision-making algorithm to decrease the number of biopsies in mammography-detected suspicious calcifications, with a tradeoff for overlooking a small number of DCIS cases that are predominantly low-to-medium grade.
* Fusun Taskin [email protected] 1
Department of Radiology, Acibadem M.A.A. University School of Medicine, Atakent University Hospital, 34755 Istanbul, Turkey
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Department of Radiology, Pendik Research Training Hospital, Marmara University School of Medicine, Muhsin Yazicioglu Cad 10, Pendik, 34899 Istanbul, Turkey
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Department of Pathology, Pendik Research Training Hospital, Marmara University, Muhsin Yazicioglu Cad. No: 10, Pendik, 34899 Istanbul, Turkey
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Acibadem M.A.A. U
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