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. 2023 Jul 28;5(4):453-458.
doi: 10.1093/jbi/wbad035.

A Diagnostic Dilemma: New Enhancing Suspicious Findings on Breast MRI Following Neoadjuvant Chemotherapy

Jennifer R LaRoy  1 , Audree B Tadros  2 , Varadan Sevilimedu  3 , Victoria L Mango  1
Affiliations

A Diagnostic Dilemma: New Enhancing Suspicious Findings on Breast MRI Following Neoadjuvant Chemotherapy

Jennifer R LaRoy et al. J Breast Imaging. .

Abstract

Objective: Evaluate the incidence and outcome of new enhancing findings on breast MRI after neoadjuvant chemotherapy (NAC).

Methods: This IRB-approved retrospective review included women with breast cancer undergoing MRI to evaluate NAC response at our institution from January 1, 1998 to March 3, 2021. Post-NAC MRIs given BI-RADS 4 or 5 with new enhancing findings were identified. Patients were excluded if they lacked pretreatment MRI or insufficient follow-up, or if the finding was a satellite of the primary tumor. Medical records and imaging studies were reviewed to identify patients and to find characteristics and outcomes.

Results: Over the study period, 2880 post-NAC breast MRIs were performed. Of 128 post-NAC MRIs given BI-RADS 4 or 5 (4.4%), 35 new suspicious findings were found on 32 MRIs, incidence rate 1.1% (32/2880). Most were characterized as nonmass enhancement (17/35, 49%), followed by mass (11/35, 31%), and then focus (7/35, 20%), with an average maximum dimension of 1.3 cm (range 0.3-7.1 cm). New findings were ipsilateral to the index cancer in 20/35 (57%) of cases. Of the 35 suspicious findings, 22 underwent image-guided biopsy (62%), 1 was surgically excised (3%), 7 underwent mastectomy (20%), 5 were stable or resolved on follow-up (8%), and none were malignant. Thirty-three were benign (94%), and two were benign high-risk lesions (atypical ductal hyperplasia, radial scar) (6%).

Conclusion: New suspicious breast MRI findings after NAC are uncommon with a low likelihood of malignancy. Further study is warranted using multi-institutional data for this low incidence finding.

Keywords: breast MRI; breast cancer; neoadjuvant chemotherapy.

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Conflict of interest statement

Conflict of Interest Statement

V.L.M. is a consultant for Bayer and receives unrelated research support from Pfizer. The remaining authors have no conflicts to declare.

Figures

Figure 1.
Figure 1.
Flowchart showing exclusion criteria used to identify the 35 new enhancing MRI findings.
Figure 2.
Figure 2.
Images of a 56-year-old woman with a new rim-enhancing mass (arrow) in the left breast, upper inner quadrant, at the 11 o’clock position, found on post-neoadjuvant chemotherapy (NAC) postcontrast subtraction MRI. The index cancer decreased in size after NAC (not shown). Biopsy of this new mass yielded cyst wall and duct ectasia.
Figure 3.
Figure 3.
Images of a 42-year-old woman with new nonmass enhancement (arrow) in the right breast, lower outer quadrant, at the 7 o’clock position, identified on post-neoadjuvant chemotherapy (NAC) postcontrast subtraction MRI. The contralateral index cancer decreased in size after NAC (not shown). This new nonmass enhancement underwent biopsy yielding usual ductal hyperplasia, cyst formation, and stromal sclerosis.
See this image and copyright information in PMC

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