title: Breast cancers not detected at MRI: review of false-negative lesions.
abstract: OBJECTIVE
  The objective of our study was to determine the sensitivity of cancer detection at breast MRI using current imaging techniques and to evaluate the characteristics of lesions with false-negative examinations.
  
  
  METHODS
  Two hundred seventeen patients with 222 newly diagnosed breast cancers or highly suspicious breast lesions that were subsequently shown to be malignant underwent breast MRI examinations for staging. Two breast imaging radiologists performed a consensus review of the breast MRI examinations. The absence of perceptible contrast enhancement at the expected site was considered to be a false-negative MRI. Histology of all lesions was reviewed by an experienced breast pathologist.
  
  
  RESULTS
  Enhancement was observed in 213 (95.9%) of the 222 cancer lesions. Of the nine lesions without visible enhancement, two lesions were excluded because the entire tumor had been excised at percutaneous biopsy performed before the MRI examination and no residual tumor was noted on the final histology. The overall sensitivity of MRI for the known cancers was 96.8% (213/220); for invasive cancer, 98.3% (176/179); and for ductal carcinoma in situ, 90.2% (37/41).
  
  
  CONCLUSIONS
  In a population of 220 sequentially diagnosed breast cancer lesions, we found seven (3.2%) MRI-occult cancers, fewer than seen in other published studies. Small tumor size and diffuse parenchymal enhancement were the principal reasons for these false-negative results. Although the overall sensitivity of cancer detection was high (96.8%), it should be emphasized that a negative MRI should not influence the management of a lesion that appears to be of concern on physical examination or on other imaging techniques.
authors.affiliation: Department of Radiology, The University of Chicago, Chicago, IL 60637, USA. ashimauc@radiology.bsd.uchicago.edu
authors.forename: Akiko
authors.initials: A
authors.lastname: Shimauchi
authors.forename: Sanaz A
authors.initials: SA
authors.lastname: Jansen
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Abe
authors.forename: Nora
authors.initials: N
authors.lastname: Jaskowiak
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schmidt
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Newstead
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA