title: Magnetic Resonance Imaging-Directed Ultrasound Imaging of Non-Mass Enhancement in the Breast: Outcomes and Frequency of Malignancy.
abstract: OBJECTIVE
  This study was performed to determine the frequency, predictors, and outcomes of ultrasound (US) correlates for non-mass enhancement.
  
  
  METHODS
  From January 2005 to December 2011, a retrospective review of 5837 consecutive breast magnetic resonance imaging examinations at our institution identified 918 non-mass enhancing lesions for which follow-up or biopsy was recommended. Retrospective review of the images identified 879 of 918 lesions (96%) meeting criteria for non-mass enhancement. Patient demographics, pathologic results, and the presence of an adjacent landmark were recorded. Targeted US examinations were recommended for 331 of 879 cases (38%), and 284 of 331 women (86%) underwent US evaluations.
  
  
  RESULTS
  The US correlate rate for non-mass enhancement was 23% (64 of 284). An adjacent landmark was significantly associated with a US correlate (P < .001). Biopsy was recommended for 43 of 64 correlates (67%). Ultrasound-guided biopsy was performed on 39 of 43 (91%); 7 of 39 (18%) were malignant. No correlate was seen for 220 of 284 lesions (77%). At magnetic resonance imaging-guided biopsy, 14 of 117 (12%) were malignancies. For all biopsied non-mass enhancements, the malignancy rate was 18% (55 of 308) and was significantly more prevalent in the setting of a known index cancer (P < .001), older age (P < .001), the presence of a landmark (P = .002), and larger lesion size (P = .019).
  
  
  CONCLUSIONS
  Non-mass enhancement with an adjacent landmark is more likely to have a US correlate compared to non-mass enhancement without an adjacent landmark. Non-mass enhancement in the setting of a known index cancer, older age, a landmark, and larger lesion size is more likely to be malignant. However, no statistical difference was detected in the rate of malignancy between non-mass enhancement with (18%) or without (12%) a correlate. Absence of a correlate does not obviate the need to biopsy suspicious non-mass enhancement.
authors.affiliation: Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Adrienne R
authors.initials: AR
authors.lastname: Newburg
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York, USA.
authors.forename: Chloe M
authors.initials: CM
authors.lastname: Chhor
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York, USA.
authors.forename: Leng Leng
authors.initials: LL
authors.lastname: Young Lin
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York, USA.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Heller
authors.affiliation: Department of Internal Medicine, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gillman
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York, USA.
authors.forename: Hildegard K
authors.initials: HK
authors.lastname: Toth
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York, USA.|Department of Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, New York, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Moy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult
keywords: breast ultrasound; correlate; magnetic resonance imaging-directed ultrasound; non-mass enhancement