Diagnostic and Interventional Radiology
Breast Imaging - Original Article

Can unenhanced breast MRI be used to decrease negative biopsy rates?

1.

Department of Radiology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey

2.

Department of Radiology, Karadeniz Technical University, Farabi Hospital, Trabzon, Turkey

Diagn Interv Radiol 2015; 21: 287-292
DOI: 10.5152/dir.2014.14333
Read: 444 Downloads: 125 Published: 03 September 2019

Abstract

PURPOSE

We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates.

 

METHODS

After institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging characteristics, masses were classified as either malignant or benign. Unenhanced MRI results were compared with final diagnoses obtained by histopathology or imaging surveillance, and diagnostic values were calculated.

 

RESULTS

Of 156 masses, 112 underwent biopsy. Four malignancies were diagnosed, three of which having ADC values lower than the cutoff. In women who rejected the biopsy, masses were stable during a follow-up of at least two years (n=44). MRI revealed 91% specificity and 99% negative predictive value (NPV) for detection of breast cancer.

 

CONCLUSION

Combination of T2-weighted imaging with DWI is a feasible method to further characterize breast masses with a low probability of malignancy. With the use of unenhanced MRI instead of immediate biopsy, it might be possible to decrease negative biopsy rates of low-risk breast masses.

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