title: Value of breast MRI for patients with a biopsy showing atypical ductal hyperplasia (ADH).
abstract: To evaluate the diagnostic value of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for patients with atypical ductal hyperplasia (ADH) in predicting malignant upgrade.
  
  
  
  3T DCE-MRI was performed for 17 patients with ADH (median age 52, range 42-76) proven by stereotactic biopsy (n = 15), and ultrasound-guided biopsy (n = 2) from January 2011 to April 2015. All patients underwent surgical excision after the MRI. Two radiologists prospectively reviewed the MRI to determine the presence or absence of suspicious findings at the site of biopsy, and evaluated the MR features of any lesion present according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. MRI findings and clinical information were correlated with the final surgical pathology by multivariate analysis.
  
  
  
  Nine of 17 lesions were upgraded to malignancy. MRI demonstrated suspicious nonmass enhancement (NME) at the site of biopsy in all upgraded patients. The median size was 19.5 mm (range, 9-44 mm). In the eight patients without upgrade, no enhancement (n = 2), linear enhancement along the biopsy track (n = 4), thin rim enhancement around hematoma (n = 1), and a focal NME (n = 1) were seen. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI findings were 100, 87.5, 90, and 100%, respectively. Multivariate analysis revealed that the presence of suspicious enhancement on MRI was the most significant predictor of upgrade to malignancy (P = 0.0006) CONCLUSION: Our study revealed a high NPV of DCE-MRI for patients with ADH in terms of malignant upgrade at subsequent surgery. This suggests that patients with ADH without suspicious enhancement on DCE-MRI might be followed with DCE-MRI rather than undergoing surgical excision.
  
  
  
  1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1738-1747.
authors.affiliation: Department of Radiology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Keiko
authors.initials: K
authors.lastname: Tsuchiya
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Mori
authors.affiliation: Department of Radiology, University of Chicago, Chicago, Illinois, USA.
authors.forename: David V
authors.initials: DV
authors.lastname: Schacht
authors.affiliation: Department of Radiology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Sheth
authors.affiliation: Department of Radiology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Karczmar
authors.affiliation: Department of Radiology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Newstead
authors.affiliation: Department of Radiology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Abe
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001940:Breast; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: atypical ductal hyperplasia; breast dynamic contrast enhanced MRI; high risk lesion