Enhancing foci on breast MRI: Identifying criteria that increase levels of suspicion.

OBJECTIVE

Prior studies evaluating features of foci associated with malignancy have not been conclusive. This study evaluates foci that were deemed suspicious and assesses multiple imaging and clinical findings with the goal of identifying criteria that can increase diagnostic confidence when evaluating foci on breast MRI.

METHODS

After Institutional Review Board approval, a retrospective chart review was performed to identify patients who underwent an image-guided biopsy of an enhancing focus. To be included in the study, a breast MRI performed between 2012 and 2019 must have been classified as suspicious for an enhancing focus or foci, and a biopsy using imaging guidance must have been subsequently performed. Patient and imaging characteristics as well as the corresponding biopsy results were recorded and statistically analyzed.

RESULTS

There were 74 patients with 85 foci of enhancement who underwent biopsy within the study period. Thirteen of the 85 foci yielded malignant results for an overall positive predictive value of 15.3% (95% confidence interval: 7.7-22.9%). Additionally, twenty-six of the 85 cases (30.6%) yielded high risk lesions. There was a statistically significant negative correlation between screening breast MRIs and biopsies that yielded cancer or atypia (p = 0.04). There was also a significant association between foci and malignant results if the focus was in the same quadrant of a known malignancy (p = 0.001).

CONCLUSION

Clinical information, such as the indication for a breast MRI or the location of a focus relative to a known cancer, can play an important role in evaluating foci of enhancement. Diagnostic confidence in identifying suspicious foci can be aided by incorporating clinical context with imaging findings deemed suspicious by prior research studies.