Pathologic correlates of false positive breast magnetic resonance imaging findings: which lesions warrant biopsy?
BACKGROUND
Contrast-enhanced breast magnetic resonance imaging (MRI) is highly sensitive for breast cancer. However, adoption of breast MRI is hampered by frequent false positive (FP) findings. Though ultimately proven benign, these suspicious findings require biopsy due to abnormal morphology and/or kinetic enhancement curves that simulate malignancy on MRI. We hypothesized that analysis of a series of FP MRI findings could reveal a pattern of association between certain "suspicious" lesions and benign disease that might help avoid unnecessary biopsy of such lesions in the future.


METHODS
A retrospective chart review identified women undergoing breast MRI between June 1995 and March 2002 with FP findings identified by MRI alone. Lesions were retrospectively characterized according to an MRI Breast Imaging-Reporting and Data System lexicon and matched to pathology.


RESULTS
Twenty-two women were identified with 29 FP lesions. Morphology revealed 1 focus (3.5%), 5 masses less than 5 mm (17%), 11 masses greater than 5 mm (38%), 1 (3.5%) linear enhancement, and 11 (38%) non-mass-like enhancement. Kinetic curves were suspicious in 15 (52%). Histology demonstrated 20 (69%) variants of normal tissue and 9 (31%) benign masses. MRI lesions less than 5 mm (n = 6, 20.5%) were small, well-delineated nodules of benign breast tissue.


CONCLUSIONS
Suspicious MRI lesions less than 5 mm often represent benign breast tissue and could potentially undergo surveillance instead of biopsy.
Langer
Samantha A
SA
Department of Surgery, Stanford Cancer Center and Stanford University School of Medicine, Stanford, CA 94305, USA.
Horst
Kathleen C
KC
Ikeda
Debra M
DM
Daniel
Bruce L
BL
Kong
Christina S
CS
Dirbas
Frederick M
FM
D000328:Adult; D000368:Aged; D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000175:diagnosis / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012189:Retrospective Studies