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Synchronous BI-RADS category 3 lesions detected by preoperative breast MRI in patients with breast cancer: may follow-up be adequate?

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Abstract

Objective

The purpose of this study was to analyze the rate of malignancy of synchronous Breast Imaging Reporting and Data System (BI-RADS) category 3 lesions identified by preoperative magnetic resonance imaging (MRI) in patients with breast cancer that were followed up rather than biopsied.

Methods

From electronic medical records, we identified 99 patients treated in our institution for whom preoperative breast MRI identified synchronous BI-RADS 3 lesions. Lesion characteristics, rate of second-look ultrasonography (US), rate of collegial decision-making, and rate of biopsies performed during the period of monitoring were analyzed.

Results

Second-look US was performed in 96 of 99 patients and did not reveal any lesion. Collegial decision-making for follow-up validation was asked in 32%. The median time to last MRI was 24.4 months (interquartile range [IQR] [19.3; 36.3]). The median follow-up was 39 months (IQR [28; 52]). Two cancers were diagnosed, one at 5 months and one at 26 months of follow-up. The incidence of malignancy of followed up synchronous BI-RADS category 3 lesions was 1.0% (95% CI [0.1%; 7.1%]) at 6 months and 2.2% (95% CI [0.6%; 8.6%]) at 30 months.

Conclusion

Monitoring could be proposed for synchronous BI-RADS category 3 lesions detected in preoperative breast cancer patients. A continued follow-up beyond 2 years could be of benefit.

Key Points

• Follow-up can be proposed for MRI BI-RADS category 3 lesions not detected at second-look ultrasound, possibly after a collegial decision.

• Follow-up should be continued annually since cancer may occur beyond 2 years.

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Abbreviations

BI-RADS:

Breast Imaging Reporting and Data System

CI:

Confidence interval

ER:

Estrogen receptor

HAS:

Haute Autorité de Santé

HER2:

Human epidermal growth factor receptor 2

IQR:

Interquartile range

MRI:

Magnetic Resonance Imaging

NME:

Non-mass enhancement

PR:

Progesterone receptor

US:

Ultrasonography

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Funding

The authors state that this work has not received any funding

Author information

Author notes

  1. Elena Martin and Philippe Henrot contributed equally to this work.

Authors and Affiliations

  1. Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne, 54 519, Vandoeuvre-les-Nancy, France

    Elena Martin, Julia Salleron & Philippe Henrot

  2. Maternité Régionale Universitaire – CHRU Nancy, 10 avenue du Dr Heydenreich, 54000, Nancy, France

    Juliette Boudier

Authors
  1. Elena Martin
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  2. Juliette Boudier
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  3. Julia Salleron
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  4. Philippe Henrot
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Corresponding author

Correspondence to Elena Martin.

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Guarantor

The scientific guarantor of this publication is Philippe HENROT, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Julia Salleron provided statistical advice for this manuscript.

Ethical approval

This study has been declared to the French National Commission on Information Technology and Liberties (CNIL) on August 12 2019 and has been registered as a CNIL compliance declaration (MR004-2203860) by the Data Protection Officer of the Cancer Institute of Lorraine French Region (Number 2203860). According to the CNIL MR004 compliance declaration, all patients are informed of the potential retrospective use of their clinical data for research purposes and of their right to refuse. In the present study, no refusal was received.

Methodology

• Unicentric

• retrospective

• observational study

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Supplementary information

ESM 1

eTable 1 in Supplement: MR acquisition parameters. *TR, repetition time; TE, echo time; FA, flip angle; FOV: field of view. eTable 2 in Supplement: Details of the 4 lesions biopsied during follow-up with a benign histology. *US, ultrasound; MRI, magnetic resonance imaging; BI-RADS, Breast Imaging Reporting and Data System (DOCX 24.3 kb)

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Martin, E., Boudier, J., Salleron, J. et al. Synchronous BI-RADS category 3 lesions detected by preoperative breast MRI in patients with breast cancer: may follow-up be adequate?. Eur Radiol 31, 9489–9498 (2021). https://doi.org/10.1007/s00330-021-07983-x

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  • DOI: https://doi.org/10.1007/s00330-021-07983-x

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