Discriminative Factors of Malignancy of Ipsilateral Nonmass Enhancement in Women With Newly Diagnosed Breast Cancer on Initial Staging Breast MRI

Abstract

BackgroundNonmass enhancement (NME) on breast MRI impacts surgical planning.PurposeTo evaluate positive predictive values (PPVs) and identify malignancy discriminators of NME ipsilateral to breast cancer on initial staging MRI.Study TypeRetrospective.SubjectsEighty‐six women (median age, 48 years; range, 26–75 years) with 101 NME lesions (BI‐RADS 4 and 5) ipsilateral to known cancers and confirmed histopathology.Field Strength/Sequence1.5 T and 3.0 T dynamic contrast‐enhanced fat‐suppressed T1‐weighted fast spoiled gradient‐echo.AssessmentThree radiologists blinded to pathology independently reviewed MRI features (distribution, internal enhancement pattern, and enhancement kinetics) of NME, locations relative to index cancers (contiguous, non‐contiguous, and different quadrants), associated mammographic calcifications, lymphovascular invasion (LVI), axillary node metastasis, and radiology‐pathology correlations. Clinical factors, NME features, and cancer characteristics were analyzed for associations with NME malignancy.Statistical TestsFisher's exact, Chi‐square, Wilcoxon rank sum tests, and mixed‐effect multivariable logistic regression were used. Significance threshold was set at P < 0.05.ResultsOverall NME malignancy rate was 48.5% (49/101). Contiguous NME had a significantly higher malignancy rate (86.7%) than non‐contiguous NME (25.0%) and NME in different quadrants (10.7%), but no significant difference was observed by distance from cancer for non‐contiguous NME, P = 0.68. All calcified NME lesions contiguous to the calcified index cancer were malignant. NME was significantly more likely malignant when index cancers were masses compared to NME (52.9% vs. 21.4%), had mammographic calcifications (63.2% vs. 39.7%), LVI (81.8% vs. 44.4%), and axillary node metastasis (70.8% vs. 41.6%). NME features with highest PPVs were segmental distribution (85.7%), clumped enhancement (66.7%), and nonpersistent kinetics (77.1%). On multivariable analysis, contiguous NME, segmental distribution, and nonpersistent kinetics were associated with malignancy.Data ConclusionMalignancy discriminators of ipsilateral NME on staging MRI included contiguous location to index cancers, segmental distribution, and nonpersistent kinetics.Evidence Level3Technical EfficacyStage 2