Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control Study

<i>Purpose</i>: To determine if MRI features and molecular subtype influence the detectability of breast cancers on MRI in high-risk patients. <i>Methods and Materials</i>: Breast cancers in a high-risk population of 104 patients were diagnosed following MRI describing a BI-R...

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Main Authors: Julie Bilocq-Lacoste, Romuald Ferre, Grey Kuling, Anne L. Martel, Pascal N. Tyrrell, Siying Li, Guan Wang, Belinda Curpen
Format: Article
Language:English
Published: MDPI AG 2022-02-01
Series:Tomography
Subjects:
Online Access:https://www.mdpi.com/2379-139X/8/1/27
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author Julie Bilocq-Lacoste
Romuald Ferre
Grey Kuling
Anne L. Martel
Pascal N. Tyrrell
Siying Li
Guan Wang
Belinda Curpen
author_facet Julie Bilocq-Lacoste
Romuald Ferre
Grey Kuling
Anne L. Martel
Pascal N. Tyrrell
Siying Li
Guan Wang
Belinda Curpen
author_sort Julie Bilocq-Lacoste
collection DOAJ
description <i>Purpose</i>: To determine if MRI features and molecular subtype influence the detectability of breast cancers on MRI in high-risk patients. <i>Methods and Materials</i>: Breast cancers in a high-risk population of 104 patients were diagnosed following MRI describing a BI-RADS 4–5 lesion. MRI characteristics at the time of diagnosis were compared with previous MRI, where a BI-RADS 1–2–3 lesion was described. <i>Results</i>: There were 77 false-negative MRIs. A total of 51 cancers were overlooked and 26 were misinterpreted. There was no association found between MRI characteristics, the receptor type and the frequency of missed cancers. The main factors for misinterpreted lesions were multiple breast lesions, prior biopsy/surgery and long-term stability. Lesions were mostly overlooked because of their small size and high background parenchymal enhancement. Among missed lesions, 50% of those with plateau kinetics on initial MRI changed for washout kinetics, and 65% of initially progressively enhancing lesions then showed plateau or washout kinetics. There were more basal-like tumours in BRCA1 carriers (50%) than in non-carriers (13%), <i>p</i> = 0.0001, OR = 6.714, 95% CI = [2.058–21.910]. The proportion of missed cancers was lower in BRCA carriers (59%) versus non-carriers (79%), <i>p</i> < 0.05, OR = 2.621, 95% CI = [1.02–6.74]. <i>Conclusions</i>: MRI characteristics or molecular subtype do not influence breast cancer detectability. Lesions in a post-surgical breast should be assessed with caution. Long-term stability does not rule out malignancy and multimodality evaluation is of added value. Lowering the biopsy threshold for lesions with an interval change in kinetics for a type 2 or 3 curve should be considered. There was a higher rate of interval cancers in BRCA 1 patients attributed to lesions more aggressive in nature.
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spelling doaj.art-a2227dfaf43d4bc0ad89bf3166e9c5a92023-11-23T22:19:37ZengMDPI AGTomography2379-13812379-139X2022-02-018132934010.3390/tomography8010027Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control StudyJulie Bilocq-Lacoste0Romuald Ferre1Grey Kuling2Anne L. Martel3Pascal N. Tyrrell4Siying Li5Guan Wang6Belinda Curpen7Department of Diagnostic Radiology, University of Sherbrooke, Toronto, ON M4N 3M5, CanadaRadiology Department, University of Toronto, La Sarre Hospital, La Sarre, QC J9Z 2Y9, CanadaDepartment of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, CanadaDepartment of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, CanadaDepartment of Statistical Sciences, Institute of Medical Science, University of Toronto, Toronto, ON M5T 1W7, CanadaDepartment of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, CanadaDepartment of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, CanadaDepartment of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada<i>Purpose</i>: To determine if MRI features and molecular subtype influence the detectability of breast cancers on MRI in high-risk patients. <i>Methods and Materials</i>: Breast cancers in a high-risk population of 104 patients were diagnosed following MRI describing a BI-RADS 4–5 lesion. MRI characteristics at the time of diagnosis were compared with previous MRI, where a BI-RADS 1–2–3 lesion was described. <i>Results</i>: There were 77 false-negative MRIs. A total of 51 cancers were overlooked and 26 were misinterpreted. There was no association found between MRI characteristics, the receptor type and the frequency of missed cancers. The main factors for misinterpreted lesions were multiple breast lesions, prior biopsy/surgery and long-term stability. Lesions were mostly overlooked because of their small size and high background parenchymal enhancement. Among missed lesions, 50% of those with plateau kinetics on initial MRI changed for washout kinetics, and 65% of initially progressively enhancing lesions then showed plateau or washout kinetics. There were more basal-like tumours in BRCA1 carriers (50%) than in non-carriers (13%), <i>p</i> = 0.0001, OR = 6.714, 95% CI = [2.058–21.910]. The proportion of missed cancers was lower in BRCA carriers (59%) versus non-carriers (79%), <i>p</i> < 0.05, OR = 2.621, 95% CI = [1.02–6.74]. <i>Conclusions</i>: MRI characteristics or molecular subtype do not influence breast cancer detectability. Lesions in a post-surgical breast should be assessed with caution. Long-term stability does not rule out malignancy and multimodality evaluation is of added value. Lowering the biopsy threshold for lesions with an interval change in kinetics for a type 2 or 3 curve should be considered. There was a higher rate of interval cancers in BRCA 1 patients attributed to lesions more aggressive in nature.https://www.mdpi.com/2379-139X/8/1/27breast MRIhigh-risk screeningbreast cancerbreast lesion detectability
spellingShingle Julie Bilocq-Lacoste
Romuald Ferre
Grey Kuling
Anne L. Martel
Pascal N. Tyrrell
Siying Li
Guan Wang
Belinda Curpen
Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control Study
Tomography
breast MRI
high-risk screening
breast cancer
breast lesion detectability
title Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control Study
title_full Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control Study
title_fullStr Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control Study
title_full_unstemmed Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control Study
title_short Missed Breast Cancers on MRI in High-Risk Patients: A Retrospective Case–Control Study
title_sort missed breast cancers on mri in high risk patients a retrospective case control study
topic breast MRI
high-risk screening
breast cancer
breast lesion detectability
url https://www.mdpi.com/2379-139X/8/1/27
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AT pascalntyrrell missedbreastcancersonmriinhighriskpatientsaretrospectivecasecontrolstudy
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