Dynamic contrast enhanced MRI breast for lesion detection and characterization with histopathological co relation: preliminary experience at tertiary care hospital

OBJECTIVE: To determine the morphological and enhancement characteristics significantly associated with malignant breast lesions on dynamic contrast enhanced MRI by considering the histopathological findings as a gold standard. METHODS: A retrospective analysis was performed on 70 patients who underwent MRI breast during the study period because of suspicious mammographic abnormalities. MR imaging was performed on 1.5 tesla machine with dynamic contrast enhancement by using dedicated breast coil. MR Images of breast were evaluated on a workstation and reported on the basis of morphological appearance of lesion and time activity curves. Histopathological analysis of the lesion was done either after mastectomy or biopsy. About 66 MR suspicious lesions were biopsied in 58 patients. RESULTS: Total number of MRI breast performed from Jan 2007-June 2009 for suspicious abnormality was 70. Histopathology of 66 lesions was available in 58 patients. Twelve patients were lost to follow. On multiple logistic regression analysis, lesions with irregular margins and strong heterogeneous enhancement were associated with higher odd of malignancy than lesions with smooth margins and homogenous enhancement. The next most important feature was the qualitative assessment of kinetic curve. Type 111 and 11 curves showed significant association with malignancy with higher odd values and 95% CI. The sensitivity, specificity, positive and negative predictive values of MRI for breast lesions was found to be 94%, 85%, 90%, and 82% respectively. Overall accuracy of MRI breast was 90%. CONCLUSION: On dynamic contrast enhanced MR imaging morphological appearance of lesion and qualitative assessment of time activity curves are two major factors for differentiation of breast lesion as benign or malignant