Flowchart displaying the formation of the study population.

<p>¹ None of these 70 cases had findings during the available follow-up period that would have induced a stage change to IVB. Follow-up of at least 6 months was available in 58/70 (82.9%) cases, including 6 of the 7 advanced cases (85.7%). ² In 20/23 chest CT (87.0%) and all PET-CT cases, imaging was already performed by the referring center. Consequently, chest radiography was not repeated upon formal staging at our institution. In 1 subject (3.8%) pulmonary metastases were found, though in none of the in total 5 FIGO IVB cases (19.2%) upstaging was performed based on chest imaging. ³ None of these cases had radiographic findings suspicious for pulmonary or thoracic skeletal metastases. Two patients did have stage IVB cervical cancer, but based on supraclavicular lymph nodal and intrahepatic metastases, not on pulmonary or skeletal metastases that could have been detected on a chest radiograph. CT: Computed tomography; PET: Positron Emission Tomography.</p

Craniocaudal (a) and mediolateral oblique (b) mammogram of a 52 year old patient with BI-RADS 5 microcalcifications in the left lateral upper quadrant.

<p>Ultrasound imaging was unremarkable (BI-RADS 1). During routine reading, the MRI examination was classified as BI-RADS 4. Both expert reader 1 and 2 classified the lesion as an area of non-mass like enhancement with clumped internal enhancement and a segmental distribution. Kinetics showed a rapid initial rise and a plateau stage during the delayed phase. A BI-RADS 4 and 5 classification was given by expert reader 1 and 2, respectively. Figure 1 shows the dynamic contrast-enhanced MRI (c) and the MR image imported in the CAD software (d). The color-coded overlay indicates the type of enhancement after contrast injection in the late phase. Red, yellow and blue illustrate a washout-, plateau- and persistent- enhancement curve, respectively. Stereotactic biopsy and surgery both showed DCIS without an invasive component.</p

ROC analysis shows an AUC of 0.76 for the model with clinical characteristics and conventional imaging, which is displayed as the green, dashed line in the three graphs (a-c).

<p>The red, solid lines show the AUC's for the models after addition of MRI reading. The model for routine reading has an AUC of 0.81 (a), both models with expert MRI reading have an AUC of 0.87 (b-c).</p

Craniocaudal (a) and mediolateral oblique (b) mammogram of a 40 year old, asymptomatic woman underwent mammography during follow-up after right-sided breast cancer, for which she underwent mastectomy.

<p>Mammography showed BI-RADS 4 microcalcifications in the lateral upper quadrant of the left breast. Ultrasound imaging was unremarkable (BI-RADS 1). During routine MRI reading, a BI-RADS 1 classification was assigned. Expert reader 1 reported an area of non-mass-like enhancement with a diffuse distribution, heterogeneous internal enhancement and classified MR imaging as BI-RADS 4. In addition, expert reader 2 described an area of non-mass-like enhancement with a segmental distribution and clumped internal enhancement, and reported a BI-RADS 4. Kinetics showed a rapid initial rise and a plateau stage during the delayed phase. Figure 2 shows the dynamic contrast-enhanced MRI (c) and the MR image imported in the CAD software (d). The color-coded overlay indicates the type of enhancement after contrast injection in the late phase. Yellow and blue illustrate a plateau- and persistent- enhancement curve, respectively. Stereotactic biopsy showed normal breast tissue with minor fibrocystic changes and the extensive presence of microcalcifications.</p

The interobserver reliability (κ statistics) and agreement (proportion of agreement) for BI-RADS MRI classifications.

<p>The interobserver reliability (κ statistics) and agreement (proportion of agreement) for BI-RADS MRI classifications.</p

ROC analysis shows an AUC of 0.76 for the model with clinical characteristics and conventional imaging, which is displayed as the green, dashed line in the three graphs (a-c).

<p>The red, solid lines show the AUC's for the models after addition of MRI reading. The model for routine reading has an AUC of 0.81 (a), both models with expert MRI reading have an AUC of 0.87 (b-c).</p

Baseline table presenting clinical patient characteristics and features on mammography and ultrasound for the 207 index lesions.

<p>*independent sample T-test, ∧chi-square test, ^&Fisher's exact test</p>a<p>occult or benign lesion on mammography (BI-RADS 1 or 2), classified as BI-RADS 3, 4 or 5 on ultrasound.</p>b<p>cystic lesions, hypoechoic areas not otherwise specified, and areas of architectural distortion.</p

Sensitivity and specificity for routine and expert reading of 3.0 T breast MRI.

<p>Sensitivity and specificity for routine and expert reading of 3.0 T breast MRI.</p

BI-RADS MRI classifications for routine and expert MRI reading.

<p>BI-RADS MRI classifications for routine and expert MRI reading.</p