Nicola Verardi MD, Presenter: Nothing to Disclose

Rubina Manuela Trimboli, Abstract Co-Author: Nothing to Disclose

Luca Alessandro Carbonaro MD, Abstract Co-Author: Nothing to Disclose

Gianni Di Leo, Abstract Co-Author: Nothing to Disclose

Francesco Sardanelli MD, Abstract Co-Author: Consultant, Bracco Group

To estimate the diagnostic value of vessels feeding breast lesions as a marker of malignancy.

We reviewed a series of 94 1.5-T breast MR examinations (patients’ mean age 53±13 years) in which at least a mass-like lesion was detected and pathological examination was available from core-needle or excisional biopsy. The imaging protocol included a dynamic study with 0.1 mmol/kg of gadobenate dimeglumine using a 3D FLASH (TR/TE=11/4.76 ms, matrix 384×384 or 512×512) sequence. Using maximum intensity projection reconstructions, we counted the number of vessels feeding the lesion and the diameter of the largest of them. Spearman correlation coefficient , χ2 test and 95% confidence intervals (95% CIs) were used.

Out of 94 breast index lesions, 82 (87%) were malignant 64 invasive cancers, 18 DCIS), while the remaining 12 (13%) were fibroadenomas (n=6), papillomas (n=5), and phyllodes (n=1). At least one feeding vessel was detected in 41/82 (50% sensitivity, 95% CI 39%-61%) malignant lesions, while no feeding vessels were associated (P<.001) with the 12 benign lesions (100% specificity, 95% CI 73%-100%). Positive and negative predictive values were 41/41 (100%, 95% CI 91%-100%) and 12/53 (23%, 95% CI 12%-36%), respectively. The pathological grade of malignant lesions correlated with both the number of feeding vessels (r=0.392, P<.001) and the maximal diameter (r=0.364, P<.001). Malignant lesions without feeding vessels had a median diameter lower than those with at least a feeding vessel (15 mm versus 25 mm, P<.001). The maximal diameter of feeding vessels correlated with the lesion diameter (r=0.419, P<.001). There was no significant difference between invasive and in situ cancers in terms of both the presence of feeding vessels (P=.283) and the maximal feeding vessel diameter (P=.342).

While only 50% of cancers were associated with feeding vessels, breast lesions with at least one feeding vessel showed a high probability of being malignant. Moreover, the higher the histological lesion grade, the larger the number and diameter of feeding vessels.

When assessing breast mass-like lesions with contrast-enhanced MRI, the presence of feeding vessels should be considered as a marker of malignancy to be added to the established BI-RADS descriptors.

Verardi, N, Trimboli, R, Carbonaro, L, Di Leo, G, Sardanelli, F, Contrast-enhanced Breast MRI: Association between Feeding Vessels and Malignancy.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9014084.html