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Breast imaging pitffals mri p taourel
1. Pitfalls in breast MRI :
How to deal between
Sensitivity and Specifcity ?
P. Taourel, E. Pages
2. Breast MRI : a weak specificity
• Studies comparing MRI and MG
– Staging of brast cancer : Spe = 70%
close to Spe of MG
– High risk women : Spe = 90 %
• Why this feeling of low specificity
– enhancement ≠ cancer
– Lack of experience
– Difficulty of biopsy
C Kuhl Radiology 2007
3. Breast MRI : is it perfectly sensitive ?
• The sensitivity of an exam depends of the gold standard
> 95 % in most of the studies
≈ 75 % in screening studies
= 85 % in the stidy with gold standard = pathologic analysis
of mastectomy
• MRI Sensitivity > Sensitivity of other imaging modalities
14. To analyze / classification BIRADS
• Mass
– 3D
– Cancer, FA, papilloma, fat necrosis, sclerosing
adenosis, lymph node, some atypical form of benign
lesions
– Key features for Benign:
•
•
•
•
•
•
Smooth outline
Regular form
Homogeneous enhancement (value if big)
Hyper T2
Fat content
Weak enhancement and no wash-out
20. Rim must be analyzed according to the
content and the regular pattern
21. To analyze / BIRADS classification
• Non mass enhancement
– Neither mass nor focus
– Benign mass, young patient, inflammation,
DCIS, ILC
– Key features for enhancement :
• Bilateral and symmetric
• Cysts ++
• Negative findings
22.
23. To analyze / classification BIRADS
• Focus
– < 5 mm
– Very low rate of malignancy
– Key features for benign (no F.U = BIRADS 2)
• Multiple
• No wash-out
• Clinical context
24. F• Lack of enhancement
• Not seen
– Backround enhancement, artefact
– small
– Tricky area
• Misinterpretation
• Mismanagement
25. Causes of False negative
• Retrospective review of 60 pairs of breast
cancer
• 47% of « errors »
– 10% = misdiagnosis
– 25% = misinterpretation
– 12% = mismanagement
Pages Radiology 2012
26. Lack of enhancement
• DCIS
• Small invasive cancer
• Some pathologic pattern:
– Inflammatory cancer
– Invasive lobular carcinoma
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153. F• Lack of enhancement
• Not seen
– Backround enhancement, artefact
– small
– Tricky area
• Misinterpretation
• Mismanagement
212. Be careful with kinetic, particularly in
menopausal patients
2
3
OR not to have
malignant curve
in menopausal 2
patients :
2.94 : initial rise
2.38 : washout 1
I Millet
Radiology dec
2013
Progressive
Plateau
ROI > 3 pixels
Région la plus
suspecte
Lavage
Temps
(min)
213. F• Lack of enhancement
• Not seen
– Backround enhancement, artefact
– small
– Tricky area
• Misinterpretation
• Mismanagement
219. How to avoid F+ and F- ?
1.
2.
3.
4.
To recognize the pseudo-enhancement
To negative normal structure : bilateral foci,
punctuate enhancement, lymph nodes
6 month FU
Interpretation according to clinical context and
personal status
- focus/BIRADS
- enhancement/menopausal status
5.
6.
Be careful with stability (morphology +++)
Be careful with autosatisfaction : FU of benign
results in biopsy performed on 2d look US
