Abstract #2486

Does the Initial Enhancement Ratio (IER) Predict which Malignancies are Biologically Significant on a Pre-operative Breast MRI?

Neeti R Bagadiya¹, Laura Heacock¹, Yiming Gao¹, Meghan Jardon¹, Samantha Heller¹, and Linda Moy¹

¹Radiology, New York University, New York, NY, United States

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.

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