Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging

Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging
Elke Hauth, Lale Umutlu, Sherko Kümmel, Rainer Kimmig, Michael Forsting
The Breast Journal 2010.16;3;:297-304

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The purpose of our study was to determine the frequency of BI-RADS 3 lesions in breast MR imaging in a clinical patient population and their frequency of malignancy in follow-up breast MR imaging. 

In 44/698 (6.3%) patients with breast MR imaging, 56 lesions were categorized to BI-RADS 3. These lesions were all not palpable and not detectable at conventional mammography or ultrasound. In follow-up, lesions were score in complete resolved (CRL), partial resolved (PRL), stable lesions (SL), and progressive lesions (PL). Initial signal enhancement of lesions was coded by color intensity (bright for high, medium for medium, dark for low), the postinitial signal enhancement by color hue (blue for increase, green for plateau, red for wash-out). In first follow-up breast MR imaging 23/56 (41%) lesions were PRL, 14/56 (25%) lesions were CRL, 14/56 (25%) lesions remained SL. In one of five PL lesions, histopathology revealed a malignant tumor. In initial breast MR imaging, CRL showed significant fewer high pixels (p = 0.002), medium pixels (p = 0.006) significant more low pixels (p = 0.005) and significant more increase pixels (p = 0.037) than PRL. 

In a clinical patient population the frequency of malignancy of BI-RADS 3 lesions in breast MR imaging and their frequency of malignancy are similar to that in conventional mammography. 

In initial breast MR imaging, complete resolved lesions showed less suspicious contrast kinetics than other lesions. In follow-up, the increase of lesion size should warrant histopathological diagnosis.

Mammographic Density, Estrogen Receptor Status and Other Breast Cancer Tumor Characteristics

Mammographic Density, Estrogen Receptor Status and Other Breast Cancer Tumor Characteristics
Jane Ding, Ruth Warren, Anne Girling, Deborah Thompson, Douglas Easton
The Breast Journal 2010. 16;3;:279-289

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Mammographic density was a stronger risk factor for ER positive [OR = 2.94; 95% CI = 1.94–4.43; p < 0.001] than ER negative cancers when comparing breasts with greater than 50% dense region to those with less than 10% density. No other tumor characteristic had a significant correlation with breast density. These results suggest that mammographic percent density may be more strongly related to ER positive than ER negative breast cancer, but otherwise is a risk factor for breast cancer independent of other tumor characteristics

Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions

Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions
Pascal A. T. Baltzer, Fan Yang, Matthias Dietzel, Aimée Herzog, Anke Simon, Tibor Vag, Mieczyslaw Gajda, Oumar Camara, Werner Alois Kaiser
The Breast Journal 2010. 16;3;:233–239
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Perifocal edema is specifically associated with malignancy and can therefore help to differentiate between benign and malignant breast disease. Furthermore, edema is associated with a higher grading and increased tumor size. These observations may be of prognostic value and should be considered in future investigations

Edema exhibits a clear signal difference to the surrounding tissue. This fact may be useful to quantify the amount of edema in the tissue analyzed.

Further study combining several morphologic and dynamic criteria is needed to fully estimate the full value of edema for MRM