Advertisement

La radiologia medica

, Volume 119, Issue 6, pp 393–399 | Cite as

Role of magnetic resonance imaging in probably benign (BI-RADS category 3) microcalcifications of the breast

  • Anna LindaEmail author
  • Chiara Zuiani
  • Viviana Londero
  • Eleonora Di Gaetano
  • Anna Dal Col
  • Rossano Girometti
  • Massimo Bazzocchi
Breast Radiology

Abstract

Purpose

This study was undertaken to evaluate whether magnetic resonance (MR) imaging is able to rule out malignancy in the case of BI-RADS 3 microcalcifications, providing a sufficient negative predictive value (NPV) for early work-up, and to reduce unnecessary stereotactically guided vacuum-assisted biopsy (SVAB) procedures.

Materials and methods

We prospectively enrolled consecutive women with BI-RADS 3 microcalcifications, who subsequently underwent MR imaging and SVAB. The MR studies were reviewed according to the MR-BI-RADS classification system; lesions assessed as MR-BI-RADS 1 and 2 were considered negative for malignancy, categories MR-BI-RADS 3, 4 and 5 indicated malignant lesions. The presence of additional findings was recorded. Histologic analysis and follow-up were the reference standard. MR sensitivity, specificity, positive predictive value (PPV) and NPV were calculated.

Results

The final population consisted of 71 lesions. Histologic analysis showed malignancy in six cases (malignancy rate 8 %). At MR analysis, 60 (85 %) lesions were considered negative for malignancy and 11 (15 %) malignant. Additional MR imaging findings were identified in 19 (27 %) patients, all corresponding to nonmalignant lesions. MR sensitivity was 33 %, specificity 86 %, PPV 18 % and NPV 93 %.

Conclusions

Because of its relatively low NPV, MR imaging is not able to safely exclude malignancy in the case of BI-RADS 3 microcalcifications. The relatively high malignancy rate found in this study might support SVAB in the case of BI-RADS 3 microcalcifications.

Keywords

BI-RADS 3 Microcalcifications Breast MRI Stereotactically guided vacuum-assisted-biopsy DCIS 

Notes

Conflict of interest

Anna Linda, Chiara Zuiani, Viviana Londero, Eleonora Di Gaetano, Anna Dal Col, Rossano Girometti, Massimo Bazzocchi declare that they have no conflict of interest related to the publication of this article.

References

  1. 1.
    Sickles EA (1991) Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology 179:463–468PubMedGoogle Scholar
  2. 2.
    Varas X, Leborgne F, Leborgne JH (1992) Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology 184:409–414PubMedGoogle Scholar
  3. 3.
    Kettritz U, Morack G, Decker T (2005) Stereotactic vacuum-assisted breast biopsies in 500 women with microcalcifications: radiological and pathological correlations. Eur J Radiol 55:270–276PubMedCrossRefGoogle Scholar
  4. 4.
    Pijnappel RM, Peeters PH, Hendriks JH, Mali WP (2004) Reproducibility of mammographic classifications for non-palpable suspect lesions with microcalcifications. Br J Radiol 77:312–314PubMedCrossRefGoogle Scholar
  5. 5.
    Mendez A, Cabanillas F, Echenique M et al (2004) Mammographic features and correlation with biopsy findings using 11-gauge stereotactic vacuum-assisted breast biopsy (SVABB). Ann Oncol 15:450–454PubMedCrossRefGoogle Scholar
  6. 6.
    Zuiani C, Mazzarella F, Londero V et al (2007) Stereotactic vacuum-assisted breast biopsy: results, follow-up and correlation with radiological suspicion. Radiol Med 112:304–317PubMedCrossRefGoogle Scholar
  7. 7.
    Uematsu T, Yuen S, Kasami M, Uchida Y (2007) Dynamic contrast-enhanced MR imaging in screening detected microcalcification lesions of the breast: is there any value? Breast Cancer Res Treat 103:269–281PubMedCrossRefGoogle Scholar
  8. 8.
    Fondrinier E, Lorimier G, Guerin-Boblet V et al (2002) Breast microcalcifications: multivariate analysis of radiologic and clinical factors for carcinoma. World J Surg 26:290–296PubMedCrossRefGoogle Scholar
  9. 9.
    Peters NH, Borel Rinkes IH, Zuithoff NP et al (2008) Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology 246:116–124PubMedCrossRefGoogle Scholar
  10. 10.
    Gökalp G, Topal U (2006) MR imaging in probably benign lesions (BI-RADS category 3) of the breast. Eur J Radiol 57:436–444PubMedCrossRefGoogle Scholar
  11. 11.
    Dorrius MD, Pijnappel RM, Sijens PE et al (2012) The negative predictive value of breast magnetic resonance imaging in noncalcified BIRADS 3 lesions. Eur J Radiol 81:209–213PubMedCrossRefGoogle Scholar
  12. 12.
    Dorrius MD, Pijnappel RM, Jansen-van der Weide MC, Oudkerk M (2010) Breast magnetic resonance imaging as a problem-solving modality in mammographic BI-RADS 3 lesions. Cancer Imaging 10:S54–S58PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Ikeda DM, Hylton NM, Kuhl CK et al (2003) BI-RADS: magnetic resonance imaging. In: D’Orsi CJ, Mendelson EB, Ikeda DM et al (eds) Breast imaging reporting and data system: ACR BI-RADS—breast imaging atlas, 1st edn. American College of Radiology, RestonGoogle Scholar
  14. 14.
    Akita A, Tanimoto A, Jinno H et al (2009) The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography? Eur Radiol 19:2089–2096PubMedCrossRefGoogle Scholar
  15. 15.
    Kuhl CK, Schrading S, Bieling HB et al (2007) MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 370:485–492PubMedCrossRefGoogle Scholar
  16. 16.
    Neubauer H, Li M, Kuehne-Heid R et al (2003) High grade and non-high grade ductal carcinoma in situ on dynamic MR mammography: characteristic findings for signal increase and morphological pattern of enhancement. Br J Radiol 76:3–12PubMedCrossRefGoogle Scholar
  17. 17.
    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
  18. 18.
    Sanders ME, Schuyler PA, Dupont WD, Page D (2005) The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer 103:2481–2484PubMedCrossRefGoogle Scholar
  19. 19.
    Hall FM (2002) Malignancy in BI-RADS category 3 mammographic lesions. Radiology 225:918–919PubMedCrossRefGoogle Scholar
  20. 20.
    Baum JK, Hanna LG, Acharyya S et al (2011) Use of BI-RADS 3-probably benign category in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial. Radiology 260:61–67PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2013

Authors and Affiliations

  • Anna Linda
    • 1
    Email author
  • Chiara Zuiani
    • 1
  • Viviana Londero
    • 1
  • Eleonora Di Gaetano
    • 1
  • Anna Dal Col
    • 1
  • Rossano Girometti
    • 1
  • Massimo Bazzocchi
    • 1
  1. 1.Institute of Diagnostic RadiologyAzienda Ospedaliero-Universitaria Santa Maria della MisericordiaUdineItaly

Personalised recommendations