Anna Linda MD, Presenter: Nothing to Disclose

Luisa Battigelli, Abstract Co-Author: Nothing to Disclose

Viviana Londero MD, Abstract Co-Author: Nothing to Disclose

Rossano Girometti MD, Abstract Co-Author: Nothing to Disclose

Chiara Zuiani MD, Abstract Co-Author: Nothing to Disclose

Massimo Bazzocchi MD, Abstract Co-Author: Nothing to Disclose

To investigate whether magnetic resonance (MR) imaging of the breast can safely rule out malignancy in patients with radial scars and papillomas diagnosed at imaging-guided core-needle-biopsy (CNB).

This prospective study was approved by the institutional review board; all patients gave written informed consent. Between October 2004 and January 2011, we included consecutive women with radial scars and papillomas diagnosed at mammographically- or sonographically-guided CNB, who subsequently underwent contrast-enhanced breast MR imaging and surgical excision. MR studies were reviewed by two experienced breast radiologists according to the BIRADS- MRI lexicon; lesions assessed as BI-RADS≤3 were considered as negative for malignancy, whereas BI-RADS 4 or 5 indicated malignant lesions. Histologic findings at surgical excision were the reference standard. MR imaging sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the detection of associated malignancy were calculated for each histological subtype.  

Among 3559 lesions that underwent imaging-guided CNB during the study period, 56 (1.6%) -in 56 women- were radial scars and 72 (2%) -in 69 women- were papillomas. At MR imaging analysis, 42 (75%) radial scars and 42 (58.3%) papillomas were considered negative for malignancy, and the remaining 14 (25%) radial scars and 30 (41.7%) papillomas as malignant. At surgical excision, there were 2 (3.6%) malignant lesions among radial scars (1 DCIS and 1 invasive lobular carcinoma) and 6 (8.3%) malignant lesions among papillomas (all DCIS). Sensitivity, specificity, PPV and NPV of MR were 50% (1/2), 75.9%(41/54), 7.1% (1/14) and 97.6% (41/42) for radial scars, and 66.7% (4/6), 60.6% (40/66), 13.3% (4/30), and 95.2% (40/42), respectively, for papillomas.  

In women with papillomas and RS diagnosed at imaging-guided CNB, breast MR imaging rules out malignancy with high NPV. Therefore, in case of non-suspicious MR findings, papillomas and RS can be safely addressed to follow-up instead of surgical excision.  

MR imaging is able to identify papillomas and RS diagnosed at CNB that can be safely managed with non-surgical approach (i.e., follow-up).

Linda, A, Battigelli, L, Londero, V, Girometti, R, Zuiani, C, Bazzocchi, M, Radial Scars and Papillomas Diagnosed at Core Needle Biopsy: Can Breast MR Imaging Safely Rule-out Malignancy? Results of a Prospective Study.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005096.html