title: Contrast-enhanced magnetic resonance mammography: does it affect surgical decision-making in patients with breast cancer?
abstract: BACKGROUND
  Diagnostic imaging in women with suspected breast cancer should accurately detect and diagnose malignant tumors and facilitate the correct choice of therapy. Contrast-enhanced magnetic resonance mammography (CE-MRM) is potentially the imaging modality of choice for accurate patient management decisions.
  
  
  METHODS
  A total of 164 women with suspected breast cancer based on clinical examination, conventional mammography and/or ultrasound each underwent preoperative bilateral CE-MRM using an axial 3D dynamic T1-weighted gradient-echo sequence and gadobenate dimeglumine as contrast agent. Images were evaluated by two readers in consensus. Histological evaluation of detected lesions was performed on samples from core biopsy or surgery. Determinations were made of the sensitivity, accuracy and positive predictive value of CE-MRM compared to mammography/ultrasound for the detection of malignant lesions and of the impact of CE-MRM for surgical decision-making.
  
  
  RESULTS
  Conventional mammography/ultrasound detected 175 lesions in the 164 evaluated patients. CE-MRM revealed 51 additional lesions in 34/164 patients; multifocal and multicentric cancer was detected in 7 and 4 additional patients, respectively, contralateral foci in 21 additional patients and pectoral muscle infiltration in 2 additional patients. CE-MRM also confirmed the absence or benignity of 3 and 1 lesions suspected of malignancy on mammography/ultrasound. The sensitivity and accuracy for malignant lesion detection and identification was 100% and 93.4%, respectively, for CE-MRM compared to 77.3% and 72.1% for mammography/ultrasound, respectively. Patient management was altered for 32/164 (19.5%) patients as a result of CE-MRM.
  
  
  CONCLUSIONS
  CE-MRM positively impacts patient management decisions and should be performed in all women with suspected breast cancer based on clinical examination, mammography and/or ultrasound.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, V.le Regina Elena, 324, Rome, 00161, Italy. federica.pediconi@uniroma1.it
authors.forename: Federica
authors.initials: F
authors.lastname: Pediconi
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Simona
authors.initials: S
authors.lastname: Padula
authors.forename: Antonella
authors.initials: A
authors.lastname: Roselli
authors.forename: Enrica
authors.initials: E
authors.lastname: Moriconi
authors.forename: Valeria
authors.initials: V
authors.lastname: Dominelli
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Pronio
authors.forename: Miles A
authors.initials: MA
authors.lastname: Kirchin
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008408:Mastectomy; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D018579:Patient Selection; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine