A Diagnostic Dilemma: New Enhancing Suspicious Findings on Breast MRI Following Neoadjuvant Chemotherapy

Author:

LaRoy Jennifer R1,Tadros Audree B2,Sevilimedu Varadan3,Mango Victoria L1ORCID

Affiliation:

1. Memorial Sloan Kettering Cancer Center, Department of Radiology , New York, NY , USA

2. Memorial Sloan Kettering Cancer Center, Department of Surgery , New York, NY , USA

3. Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics , New York, NY , USA

Abstract

Abstract Objective Evaluate the incidence and outcome of new enhancing findings on breast MRI after neoadjuvant chemotherapy (NAC). Methods This IRB-approved retrospective review included women with breast cancer undergoing MRI to evaluate NAC response at our institution from January 1, 1998 to March 3, 2021. Post-NAC MRIs given BI-RADS 4 or 5 with new enhancing findings were identified. Patients were excluded if they lacked pretreatment MRI or insufficient follow-up, or if the finding was a satellite of the primary tumor. Medical records and imaging studies were reviewed to identify patients and to find characteristics and outcomes. Results Over the study period, 2880 post-NAC breast MRIs were performed. Of 128 post-NAC MRIs given BI-RADS 4 or 5 (4.4%), 35 new suspicious findings were found on 32 MRIs, incidence rate 1.1% (32/2880). Most were characterized as nonmass enhancement (17/35, 49%), followed by mass (11/35, 31%), and then focus (7/35, 20%), with an average maximum dimension of 1.3 cm (range 0.3–7.1 cm). New findings were ipsilateral to the index cancer in 20/35 (57%) of cases. Of the 35 suspicious findings, 22 underwent image-guided biopsy (62%), 1 was surgically excised (3%), 7 underwent mastectomy (20%), 5 were stable or resolved on follow-up (8%), and none were malignant. Thirty-three were benign (94%), and two were benign high-risk lesions (atypical ductal hyperplasia, radial scar) (6%). Conclusion New suspicious breast MRI findings after NAC are uncommon with a low likelihood of malignancy. Further study is warranted using multi-institutional data for this low incidence finding.

Funder

P30 Cancer Center Support Grant

Publisher

Oxford University Press (OUP)

Subject

Radiology, Nuclear Medicine and imaging,Radiological and Ultrasound Technology

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