Neeti R Bagadiya1, Laura Heacock1, Yiming Gao1, Meghan Jardon1, Samantha Heller1, and Linda Moy1
Breast MRI allows preoperative identification of patients who may have
extensive disease at presentation and allows for appropriate surgical planning
and treatment. Despite the high sensitivity of MRI, the role
of preoperative surgical staging of breast cancer patients is controversial. There
is concern that the high false positive rates of breast MRI lead to additional
biopsy procedures and surgeries [1,2]. Abbreviated breast MRI (AB-MR), defined
as the first post-contrast scan, has been proposed as an exam that may have a
higher specificity compared to conventional breast MRI [3,4].
Two recent studies show that AB-MR has a high PPV for and may preferentially
selects for biologically significant tumors, thereby reducing overdiagnosis and
overtreatment. The concept of a biologically significant breast cancer has not
been defined. We hypothesized that since
invasive carcinomas usually demonstrate fast initial uptake of contrast, a
threshold of enhancement as determined by initial enhancement ratio (IER) may
be associated with the identification of biologically significant breast
cancers [5]. We evaluated a cohort of
women with known cancer who underwent MRI guided needle localization (MRNL) for
a finding that was suspicious for additional disease. We examined whether there was an association with the IER and the likelihood that it would be detected on AB-MR exam. Using Dynacad software we retrospectively
reviewed the IER of MRI detected synchronous cancers that underwent MRNL. We found there is a significant correlation
between invasive cancers and IER that can aid in the detection of biologically
significant synchronous cancers on MRI.
