Mammography is the primary imaging modality for the early detection of breast cancer, but still has its limitations with regard to sensitivity (39-86%) and specificity (88-94%), which depend on age and breast density. Mammograms and breast-MRI are coded using the ordered categories of the ACR BI-RADS lexicon. BI-RADS-3 lesions are the most difficult lesions to interpret. The probability of BI-RADS-3 lesions being cancer is <2 % and the majority of the patients referred for biopsy have a benign lesion. The focus of this PhD thesis is to prevent unnecessary invasive procedures in breast cancer diagnostic work-up for women with a probably benign (BI-RADS-3) breast lesion. Therefore, the usefulness of breast-MRI as a problem solving modality in patients with non-calcified mammographic BI-RADS-3 lesions is investigated. Breast-MRI can provide a sufficiently high negative predictive value (>98%) and thereby safely rule out malignancy in a majority of patients (68%) with non-calcified probably benign breast lesions, herewith avoiding unnecessary invasive diagnostic procedures. The use of a state of the art Computer-aided detection (CAD)-system should automatically identify (almost) all non-calcified lesions suspected of malignancy, but the implementation of a CAD system for these breast-MRIs’ evaluation has little influence on the accuracy of the performance of an experienced radiologist. However, short time (10min.), non-invasive quantitative multivoxel MR-spectroscopy on a 1.5T system can increase the accuracy of breast-MRI. A Cho concentration >1.5mM is not found in benign breast lesions with a volume ≥1cm3 and therefore these lesions can be excluded from further unnecessary invasive diagnostic procedures.
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