False-positive Extra-Mammary Findings in Breast MRI: Another Cause for Concern.
Breast magnetic resonance imaging (MRI) has been repeatedly shown to have a high false-positive rate for additional findings in the breast resulting in additional breast imaging and biopsies. We hypothesize that breast MRI is also associated with a high rate of false-positive findings outside of the breast requiring additional evaluation, interventions, and delays in treatment. We performed a retrospective review of all breast MRIs performed on breast cancer patients in 2010 at a single institution. MRI reports were analyzed for extra-mammary findings. The timing and yield of the additional procedures was also analyzed. Three hundred and twenty-seven breast cancer patients (average age = 53.53 ± 11.08 years) had a breast MRI. Incidental, extra-mammary findings were reported in 35/327 patients (10.7%) with a total of 38 incidental findings. The extra-mammary findings were located in the liver (n = 21, 60.0%), thoracic cavity (n = 12, 34.3%), kidneys (n = 1, 2.9%), musculoskeletal system (n = 3, 8.6%), and neck (n = 1, 2.9%). Eighteen of the 35 patients (51.4%) received additional radiographic imaging, 3 (8.6%) received additional laboratory testing, 2 (5.7%) received additional physician referrals and 2 (5.7%) received a biopsy of the finding. The average time to additional procedures in these patients was 14.5 days. None of the incidental, extra-mammary findings were associated with breast cancer or other malignancy. Breast MRI was associated with a high rate (10.7%) of extra-mammary findings, which led to costly additional imaging studies, referrals, and tests. These findings were not associated with breast cancer or other malignancies. Extra-mammary findings highlight an unrecognized adverse consequence of breast MRI.
Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio.
Shilpa A
SA
Padia
Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio.
Mary
M
Freyvogel
Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio.
Jill
J
Dietz
Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio.
Stephanie
S
Valente
Department of General Surgery and Quantitative Health Sciences, The Cleveland Clinic, Cleveland, Ohio.
Colin
C
O'Rourke
Division of Breast Surgery, The Cleveland Clinic, Cleveland, Ohio.
Stephen R
SR
Grobmyer
D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D006278:Medicare; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography / Q000191:economics; D012189:Retrospective Studies; D014481:United States
MRI; cost; delay; extra-mammary; incidental