Evaluation of Features in Probably Benign and Malignant Nonmass Enhancement in Breast MRI

Abstract

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a highly sensitive breast imaging modality in detecting breast carcinoma. Nonmass enhancement (NME) is uniquely seen on MRI of the breast. The correlation between NME features and pathologic results has not been extensively explored. Our goal was to evaluate the characteristics of probably benign and suspicious NME lesions in MRI and determine which features are more associated with malignancy. We performed a retrospective research after approval by the hospital ethics committee on women who underwent breast MRI from March 2017 to March 2020 and identified 63 lesions of all 400 NME that were categorized as probably benign or suspicious according to the BI-RADS classification (version 2013). MRI features of NME findings including the location, size, distribution and enhancement pattern, kinetic curve, diffusion restriction, and also pathology result or 6-12-month follow-up MRI were evaluated and analyzed in each group (probably benign or suspicious NME). Vacuum-guided biopsies (VAB) were performed under mammographic or sonographic guidance and confirmed with MRI by visualization of the inserted clips. Segmental distribution and clustered ring internal enhancement were significantly associated with malignancy ($p$ value<0.05), while linear distribution or homogeneous enhancement patterns were associated with benignity ($p$ value <0.05). Additionally, the plateau and washout types in the dynamic curve were only seen in malignant lesions ($p$ value <0.05). The presence of DWI restriction in NME lesions was also found to be a statistically important factor. Understanding the imaging findings of malignant NME is helpful to determine when biopsy is indicated. The correlation between NME features and pathologic results is critical in making appropriate management.