Diagnostic value of MRI in breast imaging reporting and data system 4 mammography-detected ultrasound-negative pure calcification lesions / 中华放射学杂志

ABSTRACT

Objective:To explore the diagnostic value of breast MRI in breast imaging reporting and data system (BI-RADS) 4 mammography-detected ultrasound-negative (MG+/US-) pure calcification lesions.Methods:The data of 51 patients (52 calcification lesions) who were diagnosed with BI-RADS 4 pure calcification by mammography, had no significant abnormality on ultrasonography, and finally obtained pathological results at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2013 to December 2019 were retrospectively analyzed. Of the 52 calcification lesions, 40 were benign and 12 were malignant. The mammographic findings (breast composition, calcification morphology, and distribution) and MR findings (enhancement pattern), of benign and malignant lesions were analyzed and compared with the histopathological results. The diagnostic performance of MRI was calculated.Results:There was a significant difference between benign and malignant calcification lesions in calcification morphology on mammography and enhancement pattern on MRI ( P<0.05). On breast MRI, malignant calcifications lesions showed mass or non-mass enhancement (12/12), while benign calcified lesions mostly showed no enhancement or punctate enhancement (27/40). The sensitivity, specificity, positive predictive value, and negative predictive value of breast MRI in the diagnosis of BI-RADS 4 MG+/US- pure calcification lesions were 66.7% (8/12), 75.0% (30/40), 44.4% (8/18) and 88.2% (30/34), respectively; The sensitivity, specificity, positive predictive value and negative predictive value for BI-RADS 4A calcifications were 66.7% (2/3), 74.2% (23/31), 20.0% (2/10) and 95.8% (23/24), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for BI-RADS 4B calcifications were 66.7% (4/6), 85.7%(6/7),80.0% (4/5) and 75.0% (6/8), respectively. Conclusions:MRI has a high differential diagnostic value for mammographic BI-RADS 4 pure calcifications with ultrasound-negative, especially for BI-RADS 4A calcifications. Follow-up instead of biopsy is recommended for lesions with no enhancement or punctate enhancement on MRI.