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Frequency, upgrade rates, and characteristics of high-risk lesions initially identified with breast MRI.
AJR Am J Roentgenol. 2010 Sep; 195(3):792-8.AA

Abstract

OBJECTIVE

The purpose of this article is to determine the frequency, outcomes, and imaging features of high-risk lesions initially detected by breast MRI, including atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar.

MATERIALS AND METHODS

A retrospective review of our MRI pathology database was performed to identify all lesions initially detected with MRI (January 2003 through May 2007) that underwent imaging-guided needle biopsy yielding high-risk histopathologic abnormalities. Patient age, clinical indication, MRI BI-RADS lesion features, biopsy method, and histopathologic diagnosis were recorded. The frequencies of high-risk findings at needle biopsy and rates of upgrade to malignancy at surgical excision were compared across lesion imaging features with Fisher's exact test.

RESULTS

Four hundred eighty-two MRI-detected suspicious lesions underwent needle biopsy. High-risk histopathologic abnormalities were present in 61 (12.7%) of 482 lesions: 51 (10.6%) atypical ductal hyperplasias, six (1.2%) atypical lobular hyperplasias, three (0.6%) lobular carcinomas in situ, and one (0.2%) radial scar. Correlation between the lesion site and pathology at surgical excision was confirmed for 39 of 61 lesions. Twelve (30.8%) of those 39 lesions were upgraded to malignancy (11 atypical ductal hyperplasias and one atypical lobular hyperplasia); five (41.7%) of the 12 malignancies were invasive cancer, and seven (58.3%) were ductal carcinomas in situ. No significant lesion features predictive of subsequent upgrade to malignancy were discovered.

CONCLUSION

There are no specific imaging features that predict upgrade for high-risk lesions when detected with MRI. Therefore, surgical excision is recommended because upgrade to invasive carcinoma or ductal carcinoma in situ can occur in up to 31% of cases, regardless of biopsy technique.

Authors+Show Affiliations

Department of Radiology, University of Washington Medical Center, Seattle, WA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20729462

Citation

Strigel, Roberta M., et al. "Frequency, Upgrade Rates, and Characteristics of High-risk Lesions Initially Identified With Breast MRI." AJR. American Journal of Roentgenology, vol. 195, no. 3, 2010, pp. 792-8.
Strigel RM, Eby PR, Demartini WB, et al. Frequency, upgrade rates, and characteristics of high-risk lesions initially identified with breast MRI. AJR Am J Roentgenol. 2010;195(3):792-8.
Strigel, R. M., Eby, P. R., Demartini, W. B., Gutierrez, R. L., Allison, K. H., Peacock, S., & Lehman, C. D. (2010). Frequency, upgrade rates, and characteristics of high-risk lesions initially identified with breast MRI. AJR. American Journal of Roentgenology, 195(3), 792-8. https://doi.org/10.2214/AJR.09.4081
Strigel RM, et al. Frequency, Upgrade Rates, and Characteristics of High-risk Lesions Initially Identified With Breast MRI. AJR Am J Roentgenol. 2010;195(3):792-8. PubMed PMID: 20729462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frequency, upgrade rates, and characteristics of high-risk lesions initially identified with breast MRI. AU - Strigel,Roberta M, AU - Eby,Peter R, AU - Demartini,Wendy B, AU - Gutierrez,Robert L, AU - Allison,Kimberly H, AU - Peacock,Sue, AU - Lehman,Constance D, PY - 2010/8/24/entrez PY - 2010/8/24/pubmed PY - 2010/9/30/medline SP - 792 EP - 8 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 195 IS - 3 N2 - OBJECTIVE: The purpose of this article is to determine the frequency, outcomes, and imaging features of high-risk lesions initially detected by breast MRI, including atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. MATERIALS AND METHODS: A retrospective review of our MRI pathology database was performed to identify all lesions initially detected with MRI (January 2003 through May 2007) that underwent imaging-guided needle biopsy yielding high-risk histopathologic abnormalities. Patient age, clinical indication, MRI BI-RADS lesion features, biopsy method, and histopathologic diagnosis were recorded. The frequencies of high-risk findings at needle biopsy and rates of upgrade to malignancy at surgical excision were compared across lesion imaging features with Fisher's exact test. RESULTS: Four hundred eighty-two MRI-detected suspicious lesions underwent needle biopsy. High-risk histopathologic abnormalities were present in 61 (12.7%) of 482 lesions: 51 (10.6%) atypical ductal hyperplasias, six (1.2%) atypical lobular hyperplasias, three (0.6%) lobular carcinomas in situ, and one (0.2%) radial scar. Correlation between the lesion site and pathology at surgical excision was confirmed for 39 of 61 lesions. Twelve (30.8%) of those 39 lesions were upgraded to malignancy (11 atypical ductal hyperplasias and one atypical lobular hyperplasia); five (41.7%) of the 12 malignancies were invasive cancer, and seven (58.3%) were ductal carcinomas in situ. No significant lesion features predictive of subsequent upgrade to malignancy were discovered. CONCLUSION: There are no specific imaging features that predict upgrade for high-risk lesions when detected with MRI. Therefore, surgical excision is recommended because upgrade to invasive carcinoma or ductal carcinoma in situ can occur in up to 31% of cases, regardless of biopsy technique. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/20729462/Frequency_upgrade_rates_and_characteristics_of_high_risk_lesions_initially_identified_with_breast_MRI_ L2 - https://www.ajronline.org/doi/10.2214/AJR.09.4081 DB - PRIME DP - Unbound Medicine ER -