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  • Title: BI-RADS category 3, 4, and 5 lesions identified at preoperative breast MRI in patients with breast cancer: implications for management.
    Author: Lee SE, Lee JH, Han K, Kim EK, Kim MJ, Moon HJ, Yoon JH, Park VY.
    Journal: Eur Radiol; 2020 May; 30(5):2773-2781. PubMed ID: 32006168.
    Abstract:
    OBJECTIVES: To investigate outcomes and retrospectively evaluate characteristics of additional lesions initially assessed as BI-RADS category 3, 4, and 5 at preoperative MRI to determine appropriate follow-up management. METHODS: We retrospectively reviewed 429 lesions other than primary cancer initially assessed as BI-RADS category 3, 4, and 5 at preoperative MRI in 391 patients with breast cancer from March 2012 to December 2013. We investigated their malignancy rate and outcome according to BI-RADS category assessments. We also analyzed clinical and imaging characteristics of each lesion. Pathological results and imaging follow-up of at least 2 years were used as reference standards. RESULTS: Of 429 lesions in 391 patients (mean 48.1 years ± 9.4), the malignancy rate of BI-RADS 3, 4, and 5 lesions was 1.4% (3/213), 17.8% (38/214), and 50% (1/2), respectively. Of BI-RADS 3 lesions or BI-RADS 4 or 5 lesions that were followed up after benign-concordant biopsy (n = 114), two contralateral masses (2/306, 0.7%) were diagnosed as malignancy at 13.3 and 33.2 months after initial detection, within a median follow-up of 63.3 months. None of the NME or foci or lesions followed up after benign-concordant biopsy had a delayed diagnosis of malignancy. Of the 391 patients, 97.4% (381/391) received at least one type of adjuvant therapy. CONCLUSION: The incidence of delayed cancer diagnosis among additionally detected lesions other than primary cancer is very low and short-term follow-up is unnecessary. Contralateral masses which were not confirmed by biopsy may need annual follow-up. KEY POINTS: • 1.4% (3/213) of BI-RADS 3 lesions were malignant including 2 delayed diagnoses after 13.2 months and 33.2 months, and 17.8% (38/214) of BI-RADS 4 lesions and 50% (1/2) of BI-RADS 5 lesions were malignant. • The incidence of delayed diagnosis from additional MRI-detected lesions was very low (0.7%, 2/306) during follow-up, which were all T1N0 contralateral cancer. • Annual follow-up might be adequate for preoperative MRI-detected BI-RADS 3 lesions and BI-RADS 4 lesions followed up after benign-concordant biopsy.
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