title: Descriptors of Malignant Non-mass Enhancement of Breast MRI: Their Correlation to the Presence of Invasion.
abstract: This study aims to investigate the clinical significance of malignant non-mass enhancement (NME) descriptors in breast magnetic resonance images by assessing their correlation to the presence of invasion or lymph node metastasis.
  
  
  
  Three radiologists independently reviewed magnetic resonance images with malignant NMEs between January 2008 and December 2009. Distribution was assessed first, and then each of four internal enhancement patterns-clumped, clustered ring, branching, and hypointense area-was evaluated dichotomously (yes or no). Because clustered rings and hypointense areas were thought to be major structural elements of heterogeneous NMEs, they were also evaluated by integrating them into one collective descriptor we called the "heterogeneous structures." Chi-square test, Fisher exact test, or Student t test was used to analyze differences of variables by each reviewer. Positive predictive values (PPVs) of descriptors in predicting presence of invasion or lymph node metastasis were calculated. P < 0.05 was considered significant.
  
  
  
  We included 131 malignant NMEs (76 in situ and 55 invasive) in 129 patients (two bilateral). All three observers' results showed clustered rings (PPVs 54.5%, 54.5%, 50.0%) (P = 0.0005, 0.038, 0.029) and hypointense areas (PPVs 63.6%, 61.5%, 73.9%) (P = 0.004, 0.024, 0.0006) to be significantly associated with invasion. When clustered rings and hypointense areas were integrated into heterogeneous structures, they were significantly associated with invasion (PPVs 54.3%, 53.3%, 51.8%) (P = 0.0003, 0.016, 0.003).
  
  
  
  The NME descriptors clustered rings, hypoechoic areas, and heterogeneous structures, assessed collectively, were associated with invasive breast cancer.
authors.affiliation: Kameda Kyobashi Clinic, Tokyo Square Garden 4F, 3-1-1 Kyobashi, Chuo City, Tokyo 104-0031, Japan; Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296-0041, Japan. Electronic address: machida.yoichi@kameda.jp.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Machida
authors.affiliation: Kameda Kyobashi Clinic, Tokyo Square Garden 4F, 3-1-1 Kyobashi, Chuo City, Tokyo 104-0031, Japan; Tohoku University Hospital, Sendai City, Miyagi 980-8574, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Shimauchi
authors.affiliation: Kameda Kyobashi Clinic, Tokyo Square Garden 4F, 3-1-1 Kyobashi, Chuo City, Tokyo 104-0031, Japan; Sagara Hospital Affiliated Breast Center, Kagoshima City, Kagoshima 892-0845, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Tozaki
authors.affiliation: Kameda Kyobashi Clinic, Tokyo Square Garden 4F, 3-1-1 Kyobashi, Chuo City, Tokyo 104-0031, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kuroki
authors.affiliation: Kameda Kyobashi Clinic, Tokyo Square Garden 4F, 3-1-1 Kyobashi, Chuo City, Tokyo 104-0031, Japan.
authors.forename: Tamiko
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296-0041, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Fukuma
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging* / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies
keywords: Breast; descriptor; invasive breast cancer; magnetic resonance imaging; non-mass enhancement