title: PPV(3) of suspicious breast MRI findings.
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) characteristics of Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 lesions were evaluated to identify characteristics that may improve the positive predictive value (PPV) of a biopsy.
  
  
  METHODS
  MRI BI-RADS 4 or 5 breast findings in 101 women who underwent biopsy leading to a diagnosis of cancer within 1 year (PPV3; n = 115 cases) were reviewed. Patient history, lesion morphology, enhancement pattern and kinetics, and T2 characteristics were examined.
  
  
  RESULTS
  The PPV3 of all BI-RADS 4 and 5 breast lesions seen on MRI was 22.6% (26 of 115). Excluding lesions with second-look imaging correlates decreased the PPV3 to 11.8% (6/51). Of the MRI-guided biopsies, 20.9% (24 of 115) yielded a high-risk lesion, altering surgical management. MRI lesion type did not significantly affect the PPV3: the PPV3 was 26.3% (15 of 57) for masses, 21.4% (9 of 42) for non mass enhancement (NME) and 12.5% (2 of 16) for suspicious foci. The PPV3 for lesions found on diagnostic MRI in women with newly diagnosed cancer was 30.8% (20 of 65) which was statistically significantly greater compared to a PPV3 of 11.9% (5 of 42) for lesions identified on high-risk screening MRI.
  
  
  CONCLUSIONS
  Suspicious MRI findings identified on a second-look examination are more likely malignant than those seen only on MRI. Suspicious MRI findings discovered in patients with concurrent malignancy have a greater PPV3 than those detected on high-risk screening MRIs. However, the type of MRI finding (mass vs. NME vs. foci) does not significantly affect the PPV3 and should not be used as a discriminator for determining biopsy threshold.
authors.affiliation: Department of Chemistry, Clemson University, Clemson, South Carolina.
authors.forename: Haydan
authors.initials: H
authors.lastname: Smith
authors.affiliation: Department of Radiology, Penn State Hershey Breast Imaging, Penn State Milton S. Hershey Medical Center, EC 008, 30 Hope Drive, Suite 1800, Hershey, PA 17033-0859. Electronic address: achetlen@hmc.psu.edu.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Chetlen
authors.affiliation: Department of Radiology, Penn State Hershey Breast Imaging, Penn State Milton S. Hershey Medical Center, EC 008, 30 Hope Drive, Suite 1800, Hershey, PA 17033-0859.
authors.forename: Susann
authors.initials: S
authors.lastname: Schetter
authors.affiliation: Department of Radiology, Penn State Hershey Breast Imaging, Penn State Milton S. Hershey Medical Center, EC 008, 30 Hope Drive, Suite 1800, Hershey, PA 17033-0859.
authors.forename: Julie
authors.initials: J
authors.lastname: Mack
authors.affiliation: Department of Radiology, Penn State Hershey Breast Imaging, Penn State Milton S. Hershey Medical Center, EC 008, 30 Hope Drive, Suite 1800, Hershey, PA 17033-0859.
authors.forename: Meredith
authors.initials: M
authors.lastname: Watts
authors.affiliation: Biostatistics Core, Penn State Hershey Cancer Institute, Hershey, Pennsylvania.
authors.forename: Junjia Jay
authors.initials: JJ
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Breast MRI; breast biopsy; positive predictive value