title: Breast MRI used as a problem-solving tool reliably excludes malignancy.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of breast MRI if used as a problem-solving tool in BI-RADS 0 cases.
  
  
  METHODS
  In this IRB-approved, single-center study, 687 women underwent high-resolution-3D, dynamic contrast-enhanced breast magnetic resonance imaging (MRI) between January 2012 and December 2012. Of these, we analyzed 111 consecutive patients (mean age, 51 ± 12 years; range, 20-83 years) categorized as BI-RADS 0. Breast MRI findings were stratified by clinical presentations, conventional imaging findings, and breast density. MRI results were compared to the reference standard, defined as histopathology or an imaging follow-up of at least 1 year.
  
  
  RESULTS
  One hundred eleven patients with BI-RADS 0 conventional imaging findings revealed 30 (27%) mammographic masses, 57 (51.4%) mammographic architectural distortions, five (4.5%) mammographic microcalcifications, 17 (15.3%) ultrasound-only findings, and two palpable findings without imaging correlates. There were 15 true-positive, 85 true-negative, 11 false-positive, and zero false-negative breast MRI findings, resulting in a sensitivity, specificity, PPV, and NPV of 100% (15/15), 88.5% (85/96), 57.7% (15/26), and 100% (85/85), respectively. Breast density and reasons for referral had no significant influence on the diagnostic performance of breast MRI (p>0.05).
  
  
  CONCLUSIONS
  Breast MRI reliably excludes malignancy in conventional BI-RADS 0 cases resulting in a NPV of 100% (85/85) and a PPV of 57.7% (15/26).
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, 1090 Vienna, Austria. Electronic address: claudio.spick@meduniwien.ac.at.
authors.forename: Claudio
authors.initials: C
authors.lastname: Spick
authors.affiliation: Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz, Austria.
authors.forename: Dieter H M
authors.initials: DHM
authors.lastname: Szolar
authors.affiliation: Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz, Austria.
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Preidler
authors.affiliation: Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz, Austria.
authors.forename: Manfred
authors.initials: M
authors.lastname: Tillich
authors.affiliation: Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz, Austria.
authors.forename: Pia
authors.initials: P
authors.lastname: Reittner
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, 1090 Vienna, Austria. Electronic address: pascal.baltzer@meduniwien.ac.at.
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Baltzer
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
keywords: BI-RADS 0; Breast MRI; Breast cancer; Problem-solving; Sensitivity and specificity