The added diagnostic value of dynamic contrast-enhanced MRI at 3.0 T in nonpalpable breast lesions.
OBJECTIVE
To investigate the added diagnostic value of 3.0 Tesla breast MRI over conventional breast imaging in the diagnosis of in situ and invasive breast cancer and to explore the role of routine versus expert reading.


METHODS
We evaluated MRI scans of patients with nonpalpable BI-RADS 3-5 lesions who underwent dynamic contrast-enhanced 3.0 Tesla breast MRI. Initially, MRI scans were read by radiologists in a routine clinical setting. All histologically confirmed index lesions were re-evaluated by two dedicated breast radiologists. Sensitivity and specificity for the three MRI readings were determined, and the diagnostic value of breast MRI in addition to conventional imaging was assessed. Interobserver reliability between the three readings was evaluated.


RESULTS
MRI examinations of 207 patients were analyzed. Seventy-eight of 207 (37.7%) patients had a malignant lesion, of which 33 (42.3%) patients had pure DCIS and 45 (57.7%) invasive breast cancer. Sensitivity of breast MRI was 66.7% during routine, and 89.3% and 94.7% during expert reading. Specificity was 77.5% in the routine setting, and 61.0% and 33.3% during expert reading. In the routine setting, MRI provided additional diagnostic information over clinical information and conventional imaging, as the Area Under the ROC Curve increased from 0.76 to 0.81. Expert MRI reading was associated with a stronger improvement of the AUC to 0.87. Interobserver reliability between the three MRI readings was fair and moderate.


CONCLUSIONS
3.0 T breast MRI of nonpalpable breast lesions is of added diagnostic value for the diagnosis of in situ and invasive breast cancer.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Laura G
LG
Merckel
Imaging division, University Medical Center Utrecht, Utrecht, The Netherlands.
Helena M
HM
Verkooijen
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Nicky H G M
NH
Peters
Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Ritse M
RM
Mann
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Wouter B
WB
Veldhuis
Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Remmert K
RK
Storm
Department of Radiology, Diakonessen Hospital, Utrecht, The Netherlands.
Teun
T
Weits
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
Katya M
KM
Duvivier
Department of Surgery, Diakonessen Hospital, Utrecht, The Netherlands.
Thijs
T
van Dalen
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Willem P Th M
WP
Mali
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Petra H M
PH
Peeters
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Maurice A A J
MA
van den Bosch
D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008327:Mammography; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D047368:Tumor Burden