[Value of MR tomography in inconclusive mammography findings]

Abstract

Purpose: To evaluate the usefulness of magnetic resonance (MR) imaging in the assessment of inconclusive findings at mammography, such as indeterminate focal or diffuse breast abnormalities, post-treatment breasts with extensive scarring, dense breasts, and findings suggesting multifocal or multicentric breast cancer.

Material and methods: 254 patients underwent mammography, sonography, and MRI of the breast. Dynamic MR imaging was done using a thin-section three-dimensional gradient-echo sequence (FLASH, TR = 11.8 ms; TE = 5 ms; flip angle = 25 degrees) which was applied in a dynamic fashion before and every 90 seconds after injection of gadopentetate dimeglumine. Diagnoses were confirmed at biopsy (n = 165) or by follow-up (n = 89).

Results: Among various breast anomalies, the highest proportion of breast cancers was associated with dense breast tissue (27.8%), architectural distortion (26.9%), and irregular scars (15.8%). Sensitivity of dynamic MR imaging was 93.7%, and specificity was 83.3%. As compared to mammography and sonography, MR detected 6 occult carcinomas, and showed additional malignant lesions in 19/63 women (30.2%) with biopsy-proven breast cancer.

Conclusion: MR imaging of the breast may provide valuable additional information in indeterminate breast anomalies. However, because of its inherent limitations, it should not replace core needle biopsy in all lesions which are amenable to biopsy. Because of its high sensitivity in the detection of invasive carcinomas in any type of breast tissue, MR imaging is considered the modality of choice in the evaluation of dense breasts in high-risk patients or in patients with clinical suspicion of occult breast cancer, and for preoperative tumor staging.