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Unveiling the histopathologic spectrum of MRI-guided breast biopsies: an institutional pathological-radiological correlation

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Abstract

Purpose

Breast magnetic resonance imaging (MRI) has high sensitivity but suffers from low specificity, resulting in many benign breast biopsies for MRI-detected lesions. We sought to compare histologic findings between patients who underwent MRI-guided breast biopsy versus biopsy via other imaging modalities as well as to examine features associated with malignancy in the MRI cohort to help inform MRI-biopsy practice.

Methods

A 2-year (2018–2019) retrospective review of breast biopsies at our enterprise was conducted. Biopsies were categorized as stereotactic, ultrasound, MRI, or palpation guided. Pathology was categorized as benign (further divided into nine categories), atypical, or malignant (subdivided into in situ and invasive carcinoma). Pathology was compared between biopsy groups. Clinical, pathologic, and imaging features were compared between pathology groups within the MRI cohort.

Results

5828 biopsies from 4154 patients were reviewed, including 548 MRI-guided biopsies with stratification of MRI-biopsy pathology as follows: 69% benign, 13.8% atypical, and 17.2% malignant. Among benign MRI biopsies, there was higher frequency of “clustered cysts with papillary apocrine metaplasia” (56/548; 10.2%) and lower rate of fibroadenoma/fibroadenomatous change (55/548; 10%) compared to other modalities (158 or 3% and 1144 or 21.7% of 5280 biopsies, respectively). Multivariate analysis revealed indication of breast cancer (p < .0001), ipsilateral cancer (p < .0001) and rapid initial phase kinetics (p = .017) to remain significantly associated with malignant MRI-biopsy pathology.

Conclusions

A concurrent or recent breast cancer diagnosis was most predictive of malignancy on MRI-guided breast biopsy. Combined MRI feature evaluation and radiologic-pathologic concordance activities may allow for prognostic refinement and improved risk stratification.

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Data availability

The dataset generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Not applicable (there were no external funding sources for this study).

Author information

Authors and Affiliations

  1. Department of Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Lab Building, Lower Level, Room L69, Milwaukee, WI, 53226, USA

    Gustavo Moreno, Mariel Molina & Julie M. Jorns

  2. Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA

    Ruizhe Wu

  3. Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA

    Julie R. Sullivan

Authors
  1. Gustavo Moreno
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  2. Mariel Molina
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  3. Ruizhe Wu
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  4. Julie R. Sullivan
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  5. Julie M. Jorns
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Contributions

Conceptualization: GM, JJ; Methodology: GM, JJ, RW, JS; Formal analysis and investigation: GM, MM, RW, JJ, JS; Writing—original draft preparation: GM, MM; Writing—review and editing: RW, JJ, JS.

Corresponding author

Correspondence to Julie M. Jorns.

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Conflicts of interest

None of the authors have any conflicts of interest to disclose.

Ethical approval

This research study was performed in accordance with the ethical standards of the Institutional Review Board (IRB) at the Medical College of Wisconsin. The study was conducted retrospectively from data obtained for clinical purposes, and IRB waiver was granted (IRB# PRO00023032).

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Moreno, G., Molina, M., Wu, R. et al. Unveiling the histopathologic spectrum of MRI-guided breast biopsies: an institutional pathological-radiological correlation. Breast Cancer Res Treat 187, 673–680 (2021). https://doi.org/10.1007/s10549-021-06251-2

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  • DOI: https://doi.org/10.1007/s10549-021-06251-2

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