False-positive incidental lesions detected on contrast-enhanced breast MRI: clinical and imaging features

• Published in: Breast cancer research and treatment 2023-04, Vol.198 (2), p.321-334
• Main Authors: Alikhassi, Afsaneh, Li, Xuan, Au, Frederick, Kulkarni, Supriya, Ghai, Sandeep, Allison, Grant, Freitas, Vivianne
• Format: Article
• Language: English
• Subjects: Age; Biopsy; Breast - diagnostic imaging; Breast - pathology; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Cancer research; Demography; Epidemiology; Female; Gene mutations; Histopathology; Humans; Lesions; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Mammography; Medical care, Cost of; Medical imaging equipment; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Oncology; Patients; Retrospective Studies; Sensitivity and Specificity; Statistical analysis; Ultrasonic imaging; Ultrasound
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-023-06861-y

Purpose To identify demographic and imaging features of MRI-detected enhancing lesions without clinical, ultrasound, and mammographic correlation associated with false-positive outcomes, impacting patient care. Materials and methods A retrospective multi-institutional study of imaging studies and patient’s chart review of consecutive women with MRI-detected enhancing lesions without clinical, mammogram, or ultrasound correlation between January and December 2018, who underwent MRI-guided biopsy. According to the BI-RADS lexicon, lesions’ frequency and imaging features were recorded. The demographic and imaging characteristics variables were correlated with histopathology as the gold standard and an uneventful follow-up of at least one year. Univariate logistic regression analysis was used to explore the correlation between the baseline variables such as age, genetic mutation, family history of breast cancer, personal history of breast cancer, MRI indication, background parenchymal enhancement, and MRI characteristic of the lesion with the false-positive results in main data and subgroup analysis. Results Two hundred nineteen women (median age 49 years; range 26–85 years) with 219 MRI-detected enhancing lesions that underwent MRI-guided vacuum-assisted biopsy during the study period fulfilled the study criteria and formed the study cohort. Out of 219, 180 lesions (82.2%) yielded benign pathology results, including 137 benign outcomes (76%) and 43 high-risk lesions (24%). Most demographic and imaging characteristics variables did not help to differentiate malignant from benign lesions. The variables that showed statistically significant association with true-positive results in univariate analyses were age (OR 1.05; 95% CI 1.02–1.08; p  = 0.0015 ) , irregular mass-lesion shape when compared with oval/round mass lesion (OR 11.2; 95% CI 1.6–78.4; p  = 0.015), and clumped and clustered ring of enhancement when compared with homogeneous (OR 3.22, 95% CI 1.40–7.40; p  = 0.0058) . For participants with mass breast lesion, the hyperintense signal on the T2-weighted sequence (compared to the normal fibroglandular signal) was significantly related to the false-positive result (OR 0.13; 95% CI 0.02–0.76; p  = 0.024). Conclusion Young patients, oval/round mass-lesion shape, and homogeneous pattern of non-mass enhancement showed the strongest association with false-positive results of enhancing lesions depicted by MRI. For participants with mass breast lesion, T2-bright