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ECR 2010 / C-3264
The efficacy of 1 molar contrast material in the evaluation of breast lesions with MR imaging
Congress: ECR 2010
Poster No.: C-3264
Type: Scientific Exhibit
Topic: Breast - Your latest results
Keywords: Breast
Authors: O. Unal, N. Toprak, S. Avcu; Van/TR
DOI:10.1594/ecr2010/C-3264

Results

A total of 76 lesions in 37 women were observed on breast MRI examinations. Of the 76 lesions, 20 were malignant and 56 were benign based on MRI findings. Twenty-two of the benign lesions also had histopathologic diagnosis (3 granulomatous mastitis, 11 fibroadenoma, 3 adenosis, 2 papilloma, 1 intramammarian lymph node, 1 post-operative scar tissue and radiation necrosis (Tables 1 and 2).

Due to the analysis with Chi-square test, 55,4% of the benign lesions were displaying Type I, 33,9% Type II, and 10,7% Type III contrast-time curve, whereas 5% of the malignant lesions were displaying Type I, 50% Type II, and 45% Type III contrast-time curve. MR imaging findings were in harmony with histopathological results (p<0.01). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR imaging with 1 molar contrast agent in detecting malignant lesions were 45%, 89,3%,  60%,  82%, and 77,63%, respectively.

 

Table 1: Distribution of contrast–time curves in benign lesions

Histopathology

Type-I contrast –time curve

Type-II contrast –time curve

Type-III contrast–time curve

Total

Fibroadenoma

15

14

1

30

Adenosis

6

1

-

7

Fat necrosis

5

-

-

5

Mastitis

1

1

1

3

Intramammarian lymph node

-

-

3

3

Papilloma

-

2

1

3

Scar tissue

2

-

-

2

Fibroadenolipoma

2

-

-

2

Infected cyst

-

1

-

1

Total

31

19

6

56

 

Table 2: Distribution of contrast–time curves in malignant lesions

Histopathology

Type-I contrast–time curve

Type-II contrast –time curve

Type-III contrast–time curve

Total

Invasive ductal carcinoma

1

10

8

19

Mucinous adenocarcinoma

 

 

1

1

Total

1

10

9

20

 

 

One malignant lesion (invasive ductal carcinoma) displayed Type-I contrast–time curve, which was accompanied by enhancement on the breast skin at the level of the lesion. Six benign lesions showed Type-III contrast–time curve (1 fibroadenoma, 1 granulomatous mastitis, 3 intramammarian lymph nodes, and 1 papilloma).

                                                                       

Of the lesions with Type-I contrast–time curve, 31 (96,9%) were benign, and 1 (3,1%) was malign. Of the lesions with Type-II contrast–time curve 19 (65,5%) were benign, 10 (34,5%) were malign. Of the lesions with Type-III contrast–time curve, 6 (40%) were benign, while 9 (60%) were malignant. There was significant correlation between the types of contrast–time curve and histopathologic results (p<0.05) (Graphic 1).

 

In terms of diagnosing benign pathology, Type-I contrast–time curve had a sensitivity of 55%, specificity of 95%, positive predictive value of 96%, negative predictive value of 56%, and accuracy rate of 65%.

 

In terms of diagnosing malignant pathology, Type-II contrast–time curve had a sensitivity of 50%, specificity of 66%, positive predictive value of 34%, negative predictive value of 21%, and accuracy rate of 61%, whereas these values for Type-III contrast–time curve were 45%, 89%, 60%, 18%, and 77%, respectively.

 

 

 

In terms of diagnosing benign pathology,  sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of homogenous contrast enhancement were 54%, 75%, 86%, 63%, and 60%, respectively (p=0.059).

 

Positive predictive value of peripheral ring-like contrast enhancement to determine malignancy was found to be 41%.

 

 

Table 3: Histopathologic correlation of increased vascularity in the involved breast 

Increased vascularity

Histopathologically malignant

Histopathologically benign

present

11 (91%)

5 (20%)

absent

1 (8,3%)

20 (80%)

 

           

When increased vascularity was evaluated in terms of diagnosing malignancy, its sensitivity was 91%, specificity 80%, positive predictive value 68%, and negative predictive value 95% (p<0.05).

           

The mean increase in contrast-noise ratio (CNR) was significantly higher in malignant lesions (450%) than in benign lesions (60%) (p<0.05).

 

 

 

 

 

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