Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast.
OBJECTIVE
The purpose of our study was to assess the prevalence, characteristics, and clinical consequence of incidentally detected enhancing lesions on MRI of the breast. SUBJECTS AND METHODS. MRI of the breast (1.0-T scanner, dynamic gadolinium-enhanced T1-weighted three-dimensional gradient-echo sequence, double breast coil) was performed on 1273 women for different indications. Enhancing incidental lesions were defined as enhancing lesions on MRIs that were not expected from findings on the previous conventional imaging. They were classified in five assessment categories using a scoring system based on morphologic and kinetic enhancement characteristics. Detection of enhancing incidental lesions resulted in a review of mammograms and sonograms with the aim of also localizing these lesions on conventional imaging. The lesions were either biopsied or followed up.


RESULTS
Twenty-five percent (274/1086) of all enhancing lesions detected in the study population were enhancing incidental lesions. Enhancing incidental lesions were found in 16% (210/1273) of all study patients. Forty-one percent (113/274) of the enhancing incidental lesions were histologically confirmed. Forty-eight percent (54/113) of the biopsied and 20% (54/274) of all enhancing incidental lesions were malignant. Eleven percent (54/508) of all malignant lesions occurring in the 1273 women were detected solely through additional MRI. Fifty-seven percent (31/54) of these MRI-detected malignant lesions could be identified on a reevaluation of sonograms and mammograms.


CONCLUSIONS
Detection of enhancing incidental lesions should lead to a thorough reevaluation of mammograms and sonograms. If not reidentified, suspicious enhancing incidental lesions should be biopsied, and enhancing incidental lesions that are probably benign should be carefully followed up. Indeterminate enhancing incidental lesions should be histologically examined by minimally invasive techniques or, if they are small, followed up by another MRI 6 months later.
Teifke
Andrea
A
Department of Radiology, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, Mainz D-55131, Germany.
Lehr
Hans Anton
HA
Vomweg
Toni Werner
TW
Hlawatsch
Alexander
A
Thelen
Manfred
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index
D003287:Contrast Media