Korean J Radiol.  2016 Feb;17(1):59-68. 10.3348/kjr.2016.17.1.59.

Features of Undiagnosed Breast Cancers at Screening Breast MR Imaging and Potential Utility of Computer-Aided Evaluation

• Seo M
• Cho N
• Bae MS
• Koo HR
• Kim WH
• Lee SH
• Chu A

• KMID: 2351164
• DOI: http://doi.org/10.3348/kjr.2016.17.1.59

Abstract

OBJECTIVE
To retrospectively evaluate the features of undiagnosed breast cancers on prior screening breast magnetic resonance (MR) images in patients who were subsequently diagnosed with breast cancer, as well as the potential utility of MR-computer-aided evaluation (CAE).
MATERIALS AND METHODS
Between March 2004 and May 2013, of the 72 consecutive pairs of prior negative MR images and subsequent MR images with diagnosed cancers (median interval, 32.8 months; range, 5.4-104.6 months), 36 (50%) had visible findings (mean size, 1.0 cm; range, 0.3-5.2 cm). The visible findings were divided into either actionable or underthreshold groups by the blinded review by 5 radiologists. MR imaging features, reasons for missed cancer, and MR-CAE features according to actionability were evaluated.
RESULTS
Of the 36 visible findings on prior MR images, 33.3% (12 of 36) of the lesions were determined to be actionable and 66.7% (24 of 36) were underthreshold; 85.7% (6 of 7) of masses and 31.6% (6 of 19) of non-mass enhancements were classified as actionable lesions. Mimicking physiologic enhancements (27.8%, 10 of 36) and small lesion size (27.8%, 10 of 36) were the most common reasons for missed cancer. Actionable findings tended to show more washout or plateau kinetic patterns on MR-CAE than underthreshold findings, as the 100% of actionable findings and 46.7% of underthreshold findings showed washout or plateau (p = 0.008).
CONCLUSION
MR-CAE has the potential for reducing the number of undiagnosed breast cancers on screening breast MR images, the majority of which are caused by mimicking physiologic enhancements or small lesion size.

Keyword

False negative breast cancer; Magnetic resonance imaging; Computer-aided evaluation

MeSH Terms

Adult
Aged
Breast/*pathology
Breast Neoplasms/*diagnosis/pathology/radiography
Diagnosis, Computer-Assisted/*methods
False Negative Reactions
Female
Humans
Magnetic Resonance Imaging/*methods
Mammography/*methods
Middle Aged
Retrospective Studies

Figure

• 

  Fig. 1 Screening breast MR images of 31-year-old woman with personal history of contralateral breast cancer. Breast MRI was reported as negative finding with severe background parenchymal enhancement. This case was classified as actionable and reason for undiagnosis was determined as severe background parenchymal enhancement. Pre-contrast (A), early post-contrast (B), and delayed post-contrast (C) phase sagittal MR images show focal heterogeneous non-mass enhancement in upper breast (arrows). D. Retrospectively applied MR-computer-aided evaluation image shows lesion displaying mixed red, yellow, and blue color codings indicative of washout kinetic pattern based on most suspicious feature (arrows). E. Seven months later, patient was diagnosed with 1.6 cm high-grade invasive ductal carcinoma. Diagnostic MR image shows irregular, rim-enhancing mass (arrow).

• 

  Fig. 2 Screening breast MR images of 46-year-old woman with personal history of contralateral breast cancer. Breast MRI was reported as multiple benign findings in both breasts. This case was classified as actionable and reason for missed cancer was determined as multiple distracting lesions. A. Three-dimensional maximum intensity projection image of early post-contrast phase, sagittal MR images show multiple enhancing foci and masses in breast (arrow). B. Retrospectively applied MR-computer-aided evaluation image shows lesion displaying mixed red, yellow, and blue color codings indicative of washout kinetic patterns based on most suspicious feature (arrow). C. Seven months later, she was diagnosed with 1.0 cm intermediate grade invasive ductal carcinoma. Diagnostic MR image shows irregular, heterogeneously enhancing mass (arrow).

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