6, 12 The indication for breast DCE-MRI prior to biopsy was to evaluate the local extent of the lesion in the dense breast on mammography (32 patients) or suspected multifocal lesions on mammography and/or ultrasonography(14 patients). The lesions were presented as calcifications or asymmetric tissue on mammography and hypo-echoic non-mass lesions on ultrasonography (BI-RADS 4a to BI-RADS 4c categories according to the ACR BI-RADS lexicon). All patients initially had unilateral breast lesion suspicious of malignancy either on clinical examination, mammography or ultrasonography. None of the patients had previous breast biopsy, breast surgery or current hormone replacement therapy. In all premenopausal women DCE-MRI was performed in the second and third week of the menstrual cycles. The age of the patients was 50.78 ± 8.99 years. All patients gave written informed consent to participate in DCE-MRI examination. The study was performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board Committee (No.4502-01/2011). From this group, 46 patients with FCCs presenting as NME were selected and retrospectively reviewed. In the period of two years (January 2010 to January 2012) a total of 947 patients were examined by two radiologists (MZC and NMM) using the standardized breast DCE-MRI full diagnostic protocol. Our study of pathologically confirmed FCCs presenting as NME in DCE-MRI examination has two goals: 1) to analyse morphological and enhancement kinetics features of FCCs, 2) to compare these features between nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia. The mass enhancement is usually confined to malignant or benign tumors. 6, 7 The causes of NME include FCCs, inflammatory benign lesions, in situ ductal carcinoma (DCIS), invasive lobular carcinoma and some cases of oestrogen receptor-negative invasive ductal carcinoma. On the contrary, a mass enhancement is a three-dimensional space occupying lesion. The enhancement pattern of NME is distinct from normal surrounding breast parenchyma and may contain interspersed fat. NME refers to the lesion that is seen only on post-contrast DCE-MRI sequences and does not have space-occupying effect. 5 The major cause of false positive findings in DCE-MRI examination and consecutive unnecessary biopsies are the lesions with non-mass enhancement (NME). Nevertheless, the specificity in the differentiation between benign and malignant lesions is lower, up to 75%. 2 - 4Ĭombining morphological and enhancement kinetics features of the breast lesions, dynamic contrast-enhanced MRI (DCE-MRI) shows the highest sensitivity of all imaging methods in detecting breast diseases, up to 100%. On the contrary, women whose breast biopsies show proliferative lesions with or without atypia are at risk of developing cancer, with relative risk ranging from 3.9-13.0 and 1.3-1.9 respectively. 1 Based on a classification system of FCCs proposed by Dupont and Page and according to other studies, women with histologically confirmed nonproliferative lesions have no increased breast cancer risk. Second, some types of FCCs represent a risk factor for the subsequent development of breast cancer. First, FCCs can mimic breast cancer on clinical examination, mammography and breast ultrasonography, leading to unnecessary breast biopsies and patient anxiety. These benign disorders have two important implications from the point of view of breast cancer diagnosis and management. Fibrocystic changes (FCCs) are the most frequent benign conditions of breast, diagnosed in 50% of women examined clinically and in 90% of women in histopathological studies.
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