Claudio Spick MD, Presenter: Nothing to Disclose

Dieter H. M. Szolar MD, Abstract Co-Author: Nothing to Disclose

Klaus Werner Preidler MD, Abstract Co-Author: Nothing to Disclose

Pia Reittner, Abstract Co-Author: Nothing to Disclose

Manfred Tillich, Abstract Co-Author: Nothing to Disclose

Pascal Andreas Thomas Baltzer MD, Abstract Co-Author: Nothing to Disclose

The use of breast MRI as a problem-solving tool in BI-RADS 0 cases has been the subject of controversy. The purpose of this study was to provide empirical data about the diagnostic use of breast MRI for problem-solving in BI-RADS 0 cases.

In this IRB-approved, single-center study, 687 women prospectively underwent high-resolution, 3D, dynamic contrast-enhanced breast MRI between January 2012 and December 2012. We analyzed 111 consecutive patients (mean age, 51±12 years; range, 20-83 years) categorized as BI-RADS 0. Breast MRI findings were stratified by clinical presentations, conventional imaging findings, and breast density. MRI results were compared to the reference standard, defined as histopathology or an imaging follow-up of at least one year.

One-hundred-eleven patients with BI-RADS 0 conventional imaging findings revealed 30 (27%) mammographic masses, 57 (51.4%) mammographic architectural distortions, 5 (4.5%) mammographic microcalcifications, 17 (15.3%) ultrasound only findings, and two palpable findings without imaging correlates. No cancers were detected in breast cancer ACR category I. There were 15 true-positive, 85 true-negative, 11 false-positive, and zero false-negative breast MRI findings, resulting in a sensitivity, specificity, PPV, and NPV of 100% (95% CI: 78.2-100%), 88.5% (95% CI: 80.4%-94.1%), 57.7% (95% CI: 36.9%-76.7%), and 100% (95% CI: 95.8%-100%). The general rate of malignancy was higher in mass lesions (22.6%, 12 of 53) compared to non-mass lesions (5.2%, 3 of 58). Lesions presenting as mammographic mass or microcalcification had the highest probability for malignancy, followed by architectural distortions. Lesions presenting without mammographic correlate showed the lowest probability of malignancy. Breast density and reasons for referral had no significant influence on diagnostic performance of breast MRI (p>0.05). ROC-analysis revealed an area under the ROC-curve of 0.966 (95% CI 0.913-0.991).

Breast MRI reliably excludes malignancy in conventional BI-RADS 0 cases.

 Due to its high negative predictive value, breast MRI is suitable as a problem-solving tool for conventional BI-RADS 0 findings.

Spick, C, Szolar, D, Preidler, K, Reittner, P, Tillich, M, Baltzer, P, Breast MRI Reliably Excludes Malignancy in Conventional BI-RADS 0 Cases.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003392.html