"10-15% of DCIS present as non-calcifying DCIS and are undetected on mammogram but detected on MRI. 70 -80% of cases of DCIS on MRI present as non-mass enhancement in a ductal or segmental distribution with a clumped or stippled morphological appearance. The remaining 20-30% present various enhancement patterns such as focus or a mass in a focal area or regional distribution.15"
"metastatic axillary lymphadenopathy of unknown primary (75 - 80% sensitive) - can spare a patient from having management because may be able to undergo BCT; management path only finds cancer in two-thirds"
"recurrent breast cancer/scar changes (not usual before 2 - 3 years; peak 5 - 7 years; increased risk if EIC, younger age, positive margins (wait at least 1 month postop to scan), no radiotherapy)"
"recurrent breast cancer/scar changes (not usual before 2 - 3 years; peak 5 - 7 years; increased risk if EIC, younger age, positive margins (wait at least 1 month postop to scan), no radiotherapy)"
"BIRADS 0: incomplete/non-diagnostic - this category should not be used for marked background parenchymal enhancement (BPE), motion artifacts etc."
"BIRADS I: negative (no enhancing lesions, no benign changes such as scars, cysts etc.)"
"BIRADS II: benign (lymph nodes, inflamed cysts, fibroadenoma, fat necrosis, foci/stippled enhancement, patchy BPE)."
"BIRADS III: probably benign, requiring short-term follow-up in 6 months. If the finding is visible (e.g. on ultrasound), the most widely available method should be used for follow-up (should be applied only to lesions not fitting category II and IV, probably benign findings in high-risk screening should rather be biopsied than followed-up)"
"BIRADS IV: suspicious finding requiring biopsy (biopsy should always be tried by ultrasound first as the majority of MRI lesions can be localised by targeted ultrasound)"
"BIRADS V: highly suspicious, biopsy mandatory"
"BIRADS VI: known, histologically-verified cancer"
"BIRADS II: benign (lymph nodes, inflamed cysts, fibroadenoma, fat necrosis, foci/stippled enhancement, patchy BPE)."
"positive predictive value higher the closer the lesion is to the index cancer."
"20% positive predictive value (biopsy recommended in 1/3) (NEJM 29/3/2007: biopsy recommended in 12% PPV 25%);"
"in patients with a personal history of breast cancer, MRI sensitivity ranges from 80–100%, whereas mammography sensitivity ranges from 0–53%; specificities for MRI screening in this population are relatively high but still lower than for mammography 16"
"in patients with a personal history of breast cancer, MRI sensitivity ranges from 80–100%, whereas mammography sensitivity ranges from 0–53%; specificities for MRI screening in this population are relatively high but still lower than for mammography 16"
"T2W-TSE or STIR sequences"
"almost entirely fat: ACR a"
"scattered fibroglandular tissue: ACR b"
"heterogeneous fibroglandular tissue: ACR c"
"extreme amount of fibroglandular tissue: ACR d"
"internal enhancement pattern: homogeneous (rather benign), heterogeneous (non-specific), rim (rather suspicious, in particular, if centripetal, filling up over time), dark internal septations (rather benign), old BI-RADS included central enhancement (part of the lesion enhances, highly specific for fibroadenoma)"
"internal enhancement pattern: homogeneous (rather benign), heterogeneous (non-specific), clumped (rather suspicious), clustered ring (rather suspicious, seldom seen), old BI-RADS included stippled, a homogeneous grainy enhancement typically benign"
"MRI BI-RADS assessment categories"
"BIRADS 0: incomplete/non-diagnostic - this category should not be used for marked background parenchymal enhancement (BPE), motion artifacts etc."
"BIRADS I: negative (no enhancing lesions, no benign changes such as scars, cysts etc.)"
"BIRADS II: benign (lymph nodes, inflamed cysts, fibroadenoma, fat necrosis, foci/stippled enhancement, patchy BPE)."
"BIRADS III: probably benign, requiring short-term follow-up in 6 months. If the finding is visible (e.g. on ultrasound), the most widely available method should be used for follow-up (should be applied only to lesions not fitting category II and IV, probably benign findings in high-risk screening should rather be biopsied than followed-up)"
"BIRADS IV: suspicious finding requiring biopsy (biopsy should always be tried by ultrasound first as the majority of MRI lesions can be localised by targeted ultrasound)"
"BIRADS V: highly suspicious, biopsy mandatory"
"BIRADS VI: known, histologically-verified cancer"
"Clinical history and correlation with mammography are not only diagnostically useful (e.g. to reduce the number of BIRADS III category assignments) but should be considered in the report as well in order to demonstrate to the referring physician that the clinical question has been answered."
"20% positive predictive value (biopsy recommended in 1/3) (NEJM 29/3/2007: biopsy recommended in 12% PPV 25%);"
"additional sites of ipsilateral cancer more frequent if +FH (42%) & ILC (55%)"
"ACR guidelines"
"high-risk lesions: ADH/ALH/LCIS"
"high-risk lesions: ADH/ALH/LCIS"
"extent of disease (EOD) evaluation in ipsilateral and contralateral breast"
"ACS recommendations"
"BRCA+ : BRCA1 or BRCA2"
"first-degree relative BRCA+ and untested"
"recurrent breast cancer/scar changes (not usual before 2 - 3 years; peak 5 - 7 years; increased risk if EIC, younger age, positive margins (wait at least 1 month postop to scan), no radiotherapy)"
"BI-RADS category 5 lesions have a PPV of 0.714"
"BI-RADS category 4 lesions have a PPV of 0.205 17"
"BI-RADS category 1 and 2 lesions have an NPV of 99%"
"benign high-risk causes: ADH, LCIS"
"positive predictive value 24% (½ invasive 4 mm median size / ½ DCIS)"
"positive predictive value 24% (½ invasive 4 mm median size / ½ DCIS)"
"ipsilateral multifocal ¾ (same quadrant >1 cm from index CA or contiguous but extends >4 cm) multicentric ¼; distribution similar to recurrent disease"
"ipsilateral multifocal ¾ (same quadrant >1 cm from index CA or contiguous but extends >4 cm) multicentric ¼; distribution similar to recurrent disease"
"additional sites of ipsilateral cancer more frequent if +FH (42%) & ILC (55%)"
"BRCA1 / BRCA2 gene positivity"
"BRCA+ : BRCA1 or BRCA2"
"Cowden and Bannayan-Riley-Ruvalcaba syndromes and first-degree relatives"
"posterior lesion to assess chest wall invasion (pectoralis can be resected so not considered chest wall stage IIIB - serratus anterior muscle, rib, intercostal muscles)"
"In non-masslike enhancement lesions, the ductal enhancement possesses the highest PPV (0.500) follow by clumped enhancement (PPV, 0.304) 17."
Expected headings
"Use of breast MRI"
"Sequences used"
"Lexicon"
"General breast composition"
"Lesions"
"MRI BI-RADS assessment categories"
"Interpretation points"
"Positive predictive value (PPV) of MRI"
"Extent of disease"
"MRI sensitivity"
"Indications for breast MRI"
"ACR guidelines"
"ACS recommendations"
"Other indications"
"Non-mass"
"Ductal enhancement"
"MRI-detected cancers"
"False negatives"
"Ultrasound correlation"
"internal enhancement pattern: homogeneous (rather benign), heterogeneous (non-specific), rim (rather suspicious, in particular, if centripetal, filling up over time), dark internal septations (rather benign), old BI-RADS included central enhancement (part of the lesion enhances, highly specific for fibroadenoma)"
"internal enhancement pattern: homogeneous (rather benign), heterogeneous (non-specific), clumped (rather suspicious), clustered ring (rather suspicious, seldom seen), old BI-RADS included stippled, a homogeneous grainy enhancement typically benign"
"washout (rather suspicious), plateau (non-specific), persistent (rather benign) (caveat: lymph nodes show washout but typical morphology)"
"internal enhancement pattern: homogeneous (rather benign), heterogeneous (non-specific), rim (rather suspicious, in particular, if centripetal, filling up over time), dark internal septations (rather benign), old BI-RADS included central enhancement (part of the lesion enhances, highly specific for fibroadenoma)"
"internal enhancement pattern: homogeneous (rather benign), heterogeneous (non-specific), clumped (rather suspicious), clustered ring (rather suspicious, seldom seen), old BI-RADS included stippled, a homogeneous grainy enhancement typically benign"
"non-mass enhancement (best diagnostic clue: margins cannot be assessed due to diffuse enhancement or grouped multiple spots; non-mass are far more difficult to distinguish and reflect different pathological entities)"
"ipsilateral multifocal ¾ (same quadrant >1 cm from index CA or contiguous but extends >4 cm) multicentric ¼; distribution similar to recurrent disease"
"metastatic axillary lymphadenopathy of unknown primary (75 - 80% sensitive) - can spare a patient from having management because may be able to undergo BCT; management path only finds cancer in two-thirds"
"recurrent breast cancer/scar changes (not usual before 2 - 3 years; peak 5 - 7 years; increased risk if EIC, younger age, positive margins (wait at least 1 month postop to scan), no radiotherapy)"
"recurrent breast cancer/scar changes (not usual before 2 - 3 years; peak 5 - 7 years; increased risk if EIC, younger age, positive margins (wait at least 1 month postop to scan), no radiotherapy)"
"breast MRI is better than clinical assessment, mammogram, and ultrasound in correlation with pathology; pretreatment MRI should be performed and compared with MRI done after neoadjuvant chemotherapy, this is particularly useful to monitor response to neoadjuvant chemotherapy allowing to identify non-responders early and to delineate the residual tumour after neoadjuvant chemotherapy to determine the appropriate extent of surgical excision 15"
"in patients with a personal history of breast cancer, MRI sensitivity ranges from 80–100%, whereas mammography sensitivity ranges from 0–53%; specificities for MRI screening in this population are relatively high but still lower than for mammography 16"
"BIRADS III: probably benign, requiring short-term follow-up in 6 months. If the finding is visible (e.g. on ultrasound), the most widely available method should be used for follow-up (should be applied only to lesions not fitting category II and IV, probably benign findings in high-risk screening should rather be biopsied than followed-up)"
"problem-solving (e.g. post-operative breasts with distortion)"
"to assess for synchronous, multifocal or multicentric disease"