title: Can unenhanced breast MRI be used to decrease negative biopsy rates?
abstract: OBJECTIVE
  We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates.
  
  
  METHODS
  After institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging characteristics, masses were classified as either malignant or benign. Unenhanced MRI results were compared with final diagnoses obtained by histopathology or imaging surveillance, and diagnostic values were calculated.
  
  
  RESULTS
  Of 156 masses, 112 underwent biopsy. Four malignancies were diagnosed, three of which having ADC values lower than the cutoff. In women who rejected the biopsy, masses were stable during a follow-up of at least two years (n=44). MRI revealed 91% specificity and 99% negative predictive value (NPV) for detection of breast cancer.
  
  
  CONCLUSIONS
  Combination of T2-weighted imaging with DWI is a feasible method to further characterize breast masses with a low probability of malignancy. With the use of unenhanced MRI instead of immediate biopsy, it might be possible to decrease negative biopsy rates of low-risk breast masses.
authors.affiliation: Department of Radiology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. sibel_ozy@yahoo.com.
authors.forename: Sibel
authors.initials: S
authors.lastname: Kul
authors.forename: Şükrü
authors.initials: Ş
authors.lastname: Oğuz
authors.forename: İlker
authors.initials: İ
authors.lastname: Eyüboğlu
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Kömürcüoğlu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001941:Breast Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D055815:Young Adult
references.citation: J Magn Reson Imaging. 2002 Aug;16(2):172-8
references.pmid: 12203765
references.citation: Radiology. 2011 Jul;260(1):61-7
references.pmid: 21502382
references.citation: Breast Cancer Res Treat. 2003 May;79(2):199-206
references.pmid: 12825854
references.citation: AJR Am J Roentgenol. 2012 Oct;199(4):936-42
references.pmid: 22997390
references.citation: Radiology. 2012 Dec;265(3):696-706
references.pmid: 23033500
references.citation: J Ultrasound Med. 2012 Dec;31(12):1943-9
references.pmid: 23197547
references.citation: BMC Cancer. 2013;13:159
references.pmid: 23530903
references.citation: Eur J Radiol. 2013 Aug;82(8):1231-5
references.pmid: 23540948
references.citation: Radiology. 2013 Dec;269(3):701-12
references.pmid: 23962417
references.citation: AJR Am J Roentgenol. 2014 Sep;203(3):674-81
references.pmid: 25148175
references.citation: J Magn Reson Imaging. 2014 Nov;40(5):1158-64
references.pmid: 24923252
references.citation: Eur J Radiol. 1997 Feb;24(2):94-108
references.pmid: 9097051
references.citation: Radiology. 2004 Dec;233(3):850-6
references.pmid: 15486217
references.citation: Radiology. 2005 Mar;234(3):684-92
references.pmid: 15734926
references.citation: Radiology. 2005 Sep;236(3):779-88
references.pmid: 16118160
references.citation: J Magn Reson Imaging. 2006 Aug;24(2):319-24
references.pmid: 16786565
references.citation: Magn Reson Med Sci. 2007;6(1):21-7
references.pmid: 17510539
references.citation: Radiology. 2007 Aug;244(2):356-78
references.pmid: 17641361
references.citation: Eur Radiol. 2007 Oct;17(10):2646-55
references.pmid: 17356840
references.citation: Radiology. 2008 Sep;248(3):773-81
references.pmid: 18647850
references.citation: AJR Am J Roentgenol. 2009 Dec;193(6):1723-30
references.pmid: 19933671
references.citation: Eur Radiol. 2010 May;20(5):1101-10
references.pmid: 19936758
references.citation: J Med Assoc Thai. 2010 Jul;93(7):830-7
references.pmid: 20649064
references.citation: Radiographics. 2010 Oct;30(6):1689-702
references.pmid: 21071383
references.citation: Eur Radiol. 2011 Jan;21(1):11-7
references.pmid: 20640898
references.citation: Ultraschall Med. 2011 Jan;32 Suppl 1:S8-13
references.pmid: 20603785
references.citation: BMC Cancer. 2010;10:693
references.pmid: 21189150
references.citation: Ultrasound Med Biol. 2011 May;37(5):693-9
references.pmid: 21458145
references.citation: Am J Surg. 2002 Oct;184(4):353-5
references.pmid: 12383901