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. 2017 Jun;90(1074):20170102.
doi: 10.1259/bjr.20170102. Epub 2017 May 25.

MRI appearance of invasive subcentimetre breast carcinoma: benign characteristics are common

Matthias Meissnitzer  1 , D David Dershaw  1 , Kimberly Feigin  1 , Blanca Bernard-Davila  1 , Filipe Barra  1 , Elizabeth A Morris  1
Affiliations

MRI appearance of invasive subcentimetre breast carcinoma: benign characteristics are common

Matthias Meissnitzer et al. Br J Radiol. 2017 Jun.

Abstract

Objective: This study was undertaken to examine the characteristics of cancers detected at the earliest possible point on MRI and to determine their significance.

Methods: This institutional review board-approved Health Insurance Portability and Accountability Act-compliant retrospective study evaluated invasive breast cancers ≤1 cm histologically. MRI was performed within 6 months before diagnosis. Between 1 January 2005 and 31 December 2015, 163 cancers in 161 patients were evaluated. Breast Imaging-Reporting and Data System lesion characteristics were assessed by two radiologists independently. In cases of disagreement, arbitration by a third reader was performed.

Results: Cancers ≤1 cm became more obviously malignant as they enlarged with regard to shape (p = 0.021), margin (p = 0.0006), internal enhancement (p = 0.0158) and kinetics (p = 0.0001). Cancers ≤5 mm had benign characteristics of circumscribed margins in 71% (71/100), round/oval shape in 67% (67/100) and persistent enhancement in 41% (41/100). High T2 signal was found in 17% (28/62), distributed equally among different sizes (p = 0.3920). In ≤5-mm cancers (59%, 12/29), a comparison study to show interval growth was more often needed to determine the need for biopsy. When interval growth determined biopsy, this was evident within 24 months and cancers remained node negative despite this delay.

Conclusion: Benign characteristics are present in most invasive cancers ≤5 mm. Small cancers on MRI may need to demonstrate growth to determine need for biopsy. Advances in knowledge: MR lesion characteristics may not be helpful in determining whether small lesions on MR are benign or malignant. However, as 97% of cancers in our study showed interval change when a prior MR for comparison was available, new lesions or increasing size should lead to consideration of biopsy.

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Figures

Figure 1.
Figure 1.
A 64-year-old patient with positive family history of breast cancer and new nipple discharge for diagnostic MRI. T1 post-contrast study shows a focus that was a 3-mm invasive ductal carcinoma.
Figure 2.
Figure 2.
A 33-year-old BRCA-positive female for screening. T1 fat suppressed first post-contrast images. (a) Baseline study showing indeterminate solitary focus of enhancement. (b) 6 months later, the lesion is now slightly larger and spiculated. Biopsy showed a 5-mm invasive ductal carcinoma.
Figure 3.
Figure 3.
A 60-year-old BRCA-positive female with personal history of breast cancer for screening. T1 post-contrast fat-suppressed study show solitary enhancing mass which, when windowed and levelled, has non-enhancing septations. Biopsy showed a 5-mm invasive ductal carcinoma (arrow).
Figure 4.
Figure 4.
A 50-year-old female with positive family history and the initial screening MRI showing rim-enhancing mass which was a 6-mm invasive ductal carcinoma on biopsy.
Figure 5.
Figure 5.
A 43-year-old female with extensive ductal carcinoma in situ in the opposite breast; work-up for extent of disease. (a) T2 weighted image shows solitary lesion with high signal. (b) Irregular enhancing mass on T1 fat-suppressed first post-contrast image. Biopsy showed a 6-mm poorly differentiated invasive ductal carcinoma.
Figure 6.
Figure 6.
A 46-year-old female with positive family history and the initial screening MRI showing (a) enhancing focus interpreted as Breast Imaging-Reporting and Data System 3. (b) 6 months later, some enlargement noted. Biopsy showed a 4-mm invasive ductal carcinoma.
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