Breast Cancer Research and Treatment

, Volume 103, Issue 3, pp 269–281 | Cite as

Dynamic contrast-enhanced MR imaging in screening detected microcalcification lesions of the breast: is there any value?

  • Takayoshi Uematsu
  • Sachiko Yuen
  • Masako Kasami
  • Yoshihiro Uchida
Preclinical Study



To prospectively evaluate whether dynamic contrast-enhanced magnetic resonance (MR) imaging findings can help predict the presence of malignancy when screening detected microcalcification lesions, and its contribution to patient management of stereotactic vacuum-assisted breast biopsy (SVAB).

Materials and methods

Dynamic contrast-enhanced breast MR imaging was performed when screening 100 detected microcalcification lesions not visualized by ultrasonography with 11-gauge SVAB. Definitive surgery was performed on all patients with the biopsy resulting in the diagnosis of breast cancer or atypical ductal hyperplasia (ADH). Positive predictive values (PPVs) and negative predictive values (NPVs) were calculated on the basis of a BI-RADS (Breast Imaging Reporting and Data System) category and the absence or presence of contrast uptake in the area of microcalcification.


The BI-RADS mammography category correlated with the diagnosis of breast cancer (ADH excluded): category 3 = 7% (4/55); category 4 = 48% (13/27); category 5 = 94% (17/18). After dynamic contrast-enhanced MR imaging, three of four malignancies with BI-RADS mammography category 3 were diagnosed as true positive. Therefore, the PPV of BI-RADS mammography category 3 with MR imaging was 1.8% (1/55). The PPV of contrast uptake of MR imaging was 86% (32/37), significantly higher than the 67% (30/45) PPV of BI-RADS mammography 4 and 5 (P = 0.033). The NPV of BI-RADS mammography 3 was 93% (51/55) versus 97% (61/63) NPV of MR imaging (P = 0.167).


In the evaluation of screening detected microcalcification lesions, dynamic contrast-enhanced breast MR imaging provides additional information with high PPV and NPV, and may therefore offer an alternative to SVAB for women who do not want to undergo SVAB with equivocal findings following full diagnostic mammographic assessment, but breast MR imaging with imperfect PPV and NPV cannot replace SVAB.

Clinical relevance

Dynamic contrast-enhanced breast MR imaging can demonstrate malignant microcalcifications detected by screening mammography and can be recommended in the evaluation of equivocal microcalcifications prior to SVAB.


MR imaging Screening mammography Microcalcification Stereotactic vacuum-assisted breast biopsy BI-RADS Positive predictive value Negative predictive value 


  1. 1.
    Berry DA, Cronin KA, Plevritis SK, et al (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353(17):1784–1792PubMedCrossRefGoogle Scholar
  2. 2.
    Humphrey LL, Helfand M, Chan BK, et al (2002) Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137:347–360PubMedGoogle Scholar
  3. 3.
    Morrow M, Schnitt SJ, Harris JR (2000) Ductal carcinoma in situ and microinvasive carcinoma. In: Harris JR (ed) Disease of the breast, 2nd edn. Lippincott Williams and Wilkins, PhiladelphiaGoogle Scholar
  4. 4.
    Bassett LW (1992) Mammographic analysis of calcifications. Radiol Clin North Am 30(1):93–105PubMedGoogle Scholar
  5. 5.
    American College of Radiology (2003) Breast imaging reporting and data system (BI-RADS), 4th edn. American College of Radiology, RestonGoogle Scholar
  6. 6.
    Olsen O, Gotzsche PC (2001) Cochrane review on screening for breast cancer with mammography. Lancet 358(9290):1340–1342PubMedCrossRefGoogle Scholar
  7. 7.
    Kettritz U, Rotter K, Schreer I, et al (2004) Stereotactic vacuum-assisted breast biopsy in 2874 patients. Cancer 100(2):245–251PubMedCrossRefGoogle Scholar
  8. 8.
    Liberman L, Abramson AF, Squires FB, et al (1998) The breast imaging reporting and data system: positive predictive value of mammographic features and final assessment categories. AJR Am J Roentgenol 171(1):35–40PubMedGoogle Scholar
  9. 9.
    Orel SG, Kay N, Reynolds C, et al (1999) BI-RADS categorization as a predictor of malignancy. Radiology 211(3):845–850PubMedGoogle Scholar
  10. 10.
    Mendez A, Cabanillas F, Echenique M, et al (2004) Evaluation of breast imaging reporting and data system category 3 mammograms and the use of stereotactic vacuum-assisted breast biopsy in a nonacademic community practice. Cancer 100(4):710–714PubMedCrossRefGoogle Scholar
  11. 11.
    Mendez A, Cabanillas F, Echenique M, et al (2003) Mammographic features and correlation with biopsy findings using 11-gauge stereotactic vacuum-assisted breast biopsy (SVABB). Ann Oncol 15(3):450–454CrossRefGoogle Scholar
  12. 12.
    Sickles EA (1991) Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology 179(2):463–468PubMedGoogle Scholar
  13. 13.
    Varas X, Leborgne F, Leborgne JH (1992) Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology 184(2):409–414PubMedGoogle Scholar
  14. 14.
    Pijnappel RM, Peeters PH, Hendriks JH, et al (2004) Reproducibility of mammographic classifications for non-palpable suspect lesions with microcalcifications. Br J Radiol 77(916):312–314PubMedCrossRefGoogle Scholar
  15. 15.
    Fondrinier E, Lorimier G, Guerin-Boblet V, et al (2002) Breast microcalcifications: multivariate analysis of radiologic and clinical factors for carcinoma. World J Surg 26(3):290–296PubMedCrossRefGoogle Scholar
  16. 16.
    Liberman L (2004) Breast cancer screening with MRI—what are the data for patients at high risk? N Engl J Med 351(5):497–500PubMedCrossRefGoogle Scholar
  17. 17.
    Orel SG, Schnall MD (2001) MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 220:13–30PubMedGoogle Scholar
  18. 18.
    Kneeshaw PJ, Lowry M, Manton D, et al (2006) Differentiation of benign from malignant breast disease associated with screening detected microcalcifications using dynamic contrast enhanced magnetic resonance imaging. Breast 15(1):29–38PubMedCrossRefGoogle Scholar
  19. 19.
    Westerhof JP, Fischer U, Moritz JD, et al (1998) MR imaging of mammographically detected clustered microcalcifications: is there any value? Radiology 207(3):675–681PubMedGoogle Scholar
  20. 20.
    Gilles R, Meunier M, Lucidarme O, et al (1996) Clustered breast microcalcifications: evaluation by dynamic contrast-enhanced subtraction MRI. J Comput Assist Tomogr 20(1):9–14PubMedCrossRefGoogle Scholar
  21. 21.
    Nakahara H, Namba K, Fukami A, et al (2001) Three-dimensional MR imaging of mammographically detected suspicious microcalcifications. Breast Cancer 8:116–124PubMedCrossRefGoogle Scholar
  22. 22.
    Bazzocchi M, Zuiani C, Panizza P, et al (2006) Contrast-enhanced breast MRI in patients with suspicious microcalcifications on mammography: results of a multicenter trial. AJR Am J Roentgenol 186:1723–1732PubMedCrossRefGoogle Scholar
  23. 23.
    Rubin E (1999) Six-month follow-up: an alternative view. Radiology 213:15–18PubMedGoogle Scholar
  24. 24.
    Hall FM (2002) Malignancy in BI-RADS category 3 mammographic lesions. Radiology 225(3):918–919PubMedCrossRefGoogle Scholar
  25. 25.
    Liberman L, Dershaw DD, Morris EA, et al (1997) Clip placement after stereotactic vacuum-assisted breast biopsy. Radiology 205(2):417–422PubMedGoogle Scholar
  26. 26.
    D’Orsi CJ (1996) The American College of Radiology mammography lexicon: an initial attempt to standardize terminology. AJR Am J Roentgenol 166(4):779–780PubMedGoogle Scholar
  27. 27.
    Berg WA, Arnoldus CL, Teferra E, et al (2001) Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology 221:495–503PubMedCrossRefGoogle Scholar
  28. 28.
    Liberman L, Morris EA, Lee MJ, et al (2002) Breast lesions detected on MR imaging: features and positive predictive value. AJR Am J Roentgenol 179(1):171–178PubMedGoogle Scholar
  29. 29.
    Nunes LW, Schnall MD, Orel SG, et al (1997) Breast MR imaging: interpretation model. Radiology 202:833–841PubMedGoogle Scholar
  30. 30.
    Nunes LW, Schnall MD, Siegelman ES, et al (1997) Diagnostic performance characteristics of architectural features revealed by high spatial-resolution MR imaging of the breast. AJR Am J Roentgenol 169(2):409–415PubMedGoogle Scholar
  31. 31.
    Liberman L, Morris EA, Dershaw DD, et al (2003) Ductal enhancement on MR imaging of the breast. AJR Am J Roentgenol 181(2):519–525PubMedGoogle Scholar
  32. 32.
    Liberman L, Morris EA, Benton CL, et al (2003) Probably benign lesions at breast magnetic resonance imaging. Cancer 98(2):377–388PubMedCrossRefGoogle Scholar
  33. 33.
    Kuhl CK, Bieling HB, Gieseke J, et al (1997) Healthy premenopausal breast parenchyma in dynamic contrast-enhanced MR imaging of the breast: normal contrast medium enhancement and cyclical-phase dependency. Radiology 203:137–144PubMedGoogle Scholar
  34. 34.
    Echevarria JJ, Martin M, Saiz A, et al (2006) Overall breast density in MR mammography: diagnostic and therapeutic implications in breast cancer. J Comput Assist Tomogr 30(1):140–147PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Takayoshi Uematsu
    • 1
  • Sachiko Yuen
    • 1
  • Masako Kasami
    • 2
  • Yoshihiro Uchida
    • 3
  1. 1.Department of Diagnostic RadiologyShizuoka Cancer Center HospitalNaga-izumiJapan
  2. 2.Department of PathologyShizuoka Cancer Center HospitalNaga-izumiJapan
  3. 3.Department of Breast SurgeryShizuoka Cancer Center HospitalNaga-izumiJapan

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