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Unveiling the potential of breast MRI: a game changer for BI-RADS 4A microcalcifications

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Abstract

Purpose

To assess the diagnostic performance of breast MRI for BI-RADS 4A microcalcifications on mammography and propose a potential clinical pathway to avoid unnecessary biopsies.

Methods

Bibliometrics analysis of breast MRI and BI-RADS 4 was provided. A retrospective analysis was conducted on 139 women and 142 cases of BI-RADS 4A microcalcifications on mammography from Fudan University Shanghai Cancer Center. The mammographic BI-RADS level and the MRI reports were compared with the final pathological diagnosis.

Results

Much attention has been given to breast MRI and BI-RADS 4 in the literature. However, studies on BI-RADS 4A are limited. Pathological results showed 117 cases (82.4%) were benign lesions, malignant cases of 25 (17.6%) in our study. The positive predictive values (PPV), specificity, sensitivity and negative predictive values (NPV) of MRI were 44.2% (23/52), 75.2% (88/117), 92.0% (23/25), and 97.8% (88/90), respectively. Therefore, 75.2% (88/117) of biopsies for benign lesions could potentially be avoided. There were 2.2% (2/90) malignant lesions missed. Logistic regression indicated that patients who are postmenopausal (HR = 2.655, p = 0.012), have a history of breast cancer (family history) (HR = 2.833, p = 0.029), and exhibit clustered microcalcifications (HR = 2.179, p = 0.046) are more likely to have a higher MRI BI-RADS level.

Conclusions

Breast MRI has the potential to improve the diagnosis of BI-RADS 4A microcalcifications on mammography. We propose a potential clinical pathway that patients with BI-RADS 4A on mammography who are premenopausal, have no personal history of breast cancer (family history) or have non-clustered distribution of calcifications can undergo MRI to avoid unnecessary biopsies.

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Data availability

The datasets generated during the current study are no publicly available due to protect study participant privacy but they are available from the corresponding author on reasonable request.

Abbreviations

BI-RADS:

Breast Imaging and Reporting System

DCIS:

Ductal carcinoma in situ

DCIS-IM:

DCIS with microinvasion

IDC:

Invasive ductal carcinoma

MRI:

Breast magnetic resonance imaging

NPV:

Negative predictive values

PPV:

Positive predictive values

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Acknowledgements

We thank all patients for participating in the study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Shiping Li and Yihao Lin have been contributed equally.

Authors and Affiliations

  1. Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

    Shiping Li, Guangyu Liu, Zhimin Shao & Yinlong Yang

  2. Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China

    Shiping Li, Guangyu Liu, Zhimin Shao & Yinlong Yang

  3. The First School of Medicine, Wenzhou Medical University, Wenzhou, China

    Yihao Lin

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  1. Shiping Li
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Contributions

SPL, YHL and YLY drafted the manuscript. YLY designed study. SPL, YHL were responsible for data collection and statistical analysis. GYL, ZMS and YLY revised the manuscript and all authors agreed to be responsible for all aspects of the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yinlong Yang.

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Conflicts of Interest

The authors have no conflicts of interest.

Ethical Approval

Ethical approval was not provided for this study on human participants because as a retrospective cohort study, all the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

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Li, S., Lin, Y., Liu, G. et al. Unveiling the potential of breast MRI: a game changer for BI-RADS 4A microcalcifications. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07320-y

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