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High-risk lesions in the breast diagnosed by MRI-guided core biopsy: upgrade rates and features associated with malignancy

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Abstract

Purpose

This study assessed the upgrade rates of high-risk lesions (HRLs) in the breast diagnosed by MRI-guided core biopsy and evaluated imaging and clinical features associated with upgrade to malignancy.

Methods

This IRB-approved, retrospective study included MRI-guided breast biopsy exams yielding HRLs from August 1, 2011, to August 31, 2020. HRLs included atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS), atypical lobular hyperplasia (ALH), radial scar, and papilloma. Only lesions that underwent excision or at least 2 years of MRI imaging follow-up were included. For each HRL, patient history, imaging features, and outcomes were recorded.

Results

Seventy-two lesions in 65 patients were included in the study, with 8/72 (11.1%) of the lesions upgraded to malignancy. Upgrade rates were 16.7% (2/12) for ADH, 100% (1/1) for pleomorphic LCIS, 40% (2/5) for other LCIS, 0% (0/19) for ALH, 0% (0/18) for papilloma, and 0% (0/7) for radial scar/complex sclerosing lesion. Additionally, two cases of marked ADH bordering on DCIS and one case of marked ALH bordering on LCIS, were upgraded. Lesions were more likely to be upgraded if they presented as T2 hypointense (versus isotense, OR 6.46, 95% CI 1.27–32.92) or as linear or segmental non-mass enhancement (NME, versus focal or regional, p = 0.008).

Conclusion

Our data support the recommendation that ADH and LCIS on MRI-guided biopsy warrant surgical excision due to high upgrade rates. HRLs that present as T2 hypointense, or as linear or segmental NME, should be viewed with suspicion as these were associated with higher upgrade rates to malignancy.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript relevant to the topic of this research.

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA

    Eumee Cha

  2. Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA

    Emily B. Ambinder, Eniola T. Oluyemi, Lisa A. Mullen, Babita Panigrahi, Joanna Rossi, Philip A. Di Carlo & Kelly S. Myers

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  1. Eumee Cha
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  2. Emily B. Ambinder
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  3. Eniola T. Oluyemi
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  4. Lisa A. Mullen
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  6. Joanna Rossi
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  7. Philip A. Di Carlo
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Correspondence to Kelly S. Myers.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. Author KM receives research funding from receives funding from the National Institutes of Health for work unrelated to this project. Author LM received research funding from Cepheid, Inc., IBM Research and Hologic, Inc., for work unrelated to this project.

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Ethics approval was waived by the Institutional Review Board for this retrospective chart review.

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Cha, E., Ambinder, E.B., Oluyemi, E.T. et al. High-risk lesions in the breast diagnosed by MRI-guided core biopsy: upgrade rates and features associated with malignancy. Breast Cancer Res Treat 196, 517–525 (2022). https://doi.org/10.1007/s10549-022-06761-7

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  • DOI: https://doi.org/10.1007/s10549-022-06761-7

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